Pancreatic cancer natural history, complications and prognosis: Difference between revisions

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==Overview==
==Overview==
Depending on the extent of the tumor at the time of diagnosis, the prognosis is generally regarded as poor, with complete [[remission (medicine)|remission]] extremely rare.<ref name="Ghaneh">{{cite journal |author=Ghaneh P, Costello E, Neoptolemos JP |title=Biology and management of pancreatic cancer |journal=Gut |volume=56 |issue=8 |pages=1134-52 |year=2007 |pmid=17625148 |doi=10.1136/gut.2006.103333}}</ref>
The symptoms of pancreatic cancer usually develop in the sixth decade of life, and start with symptoms such as [[jaundice]], light-colored stools, dark urine, pain in the upper or middle [[abdomen]] and back, unexplained [[weight loss]], anorexia and [[fatigue]].Symptoms typically develop about 20-30 years after exposure to risk factors such as smoking and alcohol. Genetic factors such as alterations in tumor suppressor genes, oncogenes and different signaling pathways are responsible. If left untreated, patients with pancreatic cancer may progress to develop exocrine pancreatic insufficiency arising from pancreatic duct obstruction leading to malabsorption, malnutrition and cachexia. Dudodenal obstruction and biliary obstruction may cause symptoms of bowel obstruction and jaundice.Common complications of pancreatic cancer may arise as a result of the disease or therapy (surgical or medical). Depending on the extent of the tumor at the time of diagnosis, the prognosis is generally regarded as poor, with complete [[remission (medicine)|remission]] extremely rare.<ref name="Ghaneh">{{cite journal |author=Ghaneh P, Costello E, Neoptolemos JP |title=Biology and management of pancreatic cancer |journal=Gut |volume=56 |issue=8 |pages=1134-52 |year=2007 |pmid=17625148 |doi=10.1136/gut.2006.103333}}</ref>




==Natural History, Complications and Prognosis==
==Natural History, Complications and Prognosis==
===Natural History===
===Natural History===
*The symptoms of (disease name) usually develop in the first/ second/ third decade of life, and start with symptoms such as ___.  
*The symptoms of pancreatic cancer usually develop in the sixth decade of life, and start with symptoms such as [[jaundice]], light-colored stools, dark urine, pain in the upper or middle [[abdomen]] and back, unexplained [[weight loss]], anorexia and [[fatigue]].  
*The symptoms of (disease name) typically develop ___ years after exposure to ___.  
*The symptoms of pancreatic cancer typically develop about 20-30 years after exposure to risk factors such as smoking and alcohol. Genetic factors such as alterations in tumor suppressor genes, oncogenes and different signaling pathways may also be responsible.  
*If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
*If left untreated, patients with pancreatic cancer may progress to develop exocrine pancreatic insufficiency arising from pancreatic duct obstruction leading to malabsorption, malnutrition and cachexia. Dudodenal obstruction and biliary obstruction may cause symptoms of bowel obstruction and jaundice.


===Complications===
===Complications===
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Shown below is an image depicting the 5-year conditional relative survival (probability of surviving in the next 5-years given the cohort has already survived 0, 1, 3 years) between 1988 and 2010 of pancreatic cancer by stage at diagnosis according to [[SEER]]. These graphs are adapted from [[SEER]]: The Surveillance, Epidemiology, and End Results Program of the National Cancer Institute.<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref>
Shown below is an image depicting the 5-year conditional relative survival (probability of surviving in the next 5-years given the cohort has already survived 0, 1, 3 years) between 1988 and 2010 of pancreatic cancer by stage at diagnosis according to [[SEER]]. These graphs are adapted from [[SEER]]: The Surveillance, Epidemiology, and End Results Program of the National Cancer Institute.<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref>


<figure-inline class="mw-default-size"><figure-inline>[[Image:Survival time of pancreatic cancer by stage.PNG|646x646px]]</figure-inline></figure-inline>
<figure-inline class="mw-default-size"><figure-inline><figure-inline>[[Image:Survival time of pancreatic cancer by stage.PNG|646x646px]]</figure-inline></figure-inline></figure-inline>


==References==
==References==

Revision as of 15:00, 15 November 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Overview

The symptoms of pancreatic cancer usually develop in the sixth decade of life, and start with symptoms such as jaundice, light-colored stools, dark urine, pain in the upper or middle abdomen and back, unexplained weight loss, anorexia and fatigue.Symptoms typically develop about 20-30 years after exposure to risk factors such as smoking and alcohol. Genetic factors such as alterations in tumor suppressor genes, oncogenes and different signaling pathways are responsible. If left untreated, patients with pancreatic cancer may progress to develop exocrine pancreatic insufficiency arising from pancreatic duct obstruction leading to malabsorption, malnutrition and cachexia. Dudodenal obstruction and biliary obstruction may cause symptoms of bowel obstruction and jaundice.Common complications of pancreatic cancer may arise as a result of the disease or therapy (surgical or medical). Depending on the extent of the tumor at the time of diagnosis, the prognosis is generally regarded as poor, with complete remission extremely rare.[1]


Natural History, Complications and Prognosis

Natural History

  • The symptoms of pancreatic cancer usually develop in the sixth decade of life, and start with symptoms such as jaundice, light-colored stools, dark urine, pain in the upper or middle abdomen and back, unexplained weight loss, anorexia and fatigue.
  • The symptoms of pancreatic cancer typically develop about 20-30 years after exposure to risk factors such as smoking and alcohol. Genetic factors such as alterations in tumor suppressor genes, oncogenes and different signaling pathways may also be responsible.
  • If left untreated, patients with pancreatic cancer may progress to develop exocrine pancreatic insufficiency arising from pancreatic duct obstruction leading to malabsorption, malnutrition and cachexia. Dudodenal obstruction and biliary obstruction may cause symptoms of bowel obstruction and jaundice.

Complications

  • Common complications of pancreatic cancer may arise as a result of the disease or therapy:

Malabsorption:

Jaundice:

Duodenal obstruction

Prognosis

  • The primary factors that influence prognosis are:
  • Whether the tumor is localized and can be completely resected
  • Whether the tumor has spread to lymph nodes or elsewhere


  • Staging and TNM (tumour, lymph node, metastasis) classification related to incidence, treatment, and prognosis: [2]
Staging and TNM Classification related to Incidence, Treatment, and Prognosis
Stage TNM Classification Clinical Classification Incidence at diagnosis (%) 5-year survival rate (%)
0 Tis, N0, M0 Resectable 7.5 15.2
IA T1, N0, M0
IB T2, N0, M0
IIA T3, N0, M0
IIB T1-3, N1, M0 Locally advanced 29.3 6.3
III T4, any N, M0
IV Any T, any N, M1 Metastatic 47.2 1.6

5-Year Survival

  • For patients with localized disease and small cancers (<2 cm) with no lymph node metastases and no extension beyond the capsule of the pancreas, complete surgical resection is associated with a 5-year survival rate of 18% to 24%.
  • Between 2007 and 2010, the 5-year relative survival of patients with pancreatic cancer was 7.2%.[3]
  • When stratified by age, the 5-year relative survival of patients with pancreatic cancer was 10% and 4.6% for patients <65 and ≥ 65 years of age respectively.[3]
  • The survival of patients with pancreatic cancer varies with the stage of the disease. Shown below is a table depicting the 5-year relative survival by the stage of pancreatic cancer:[3]
Stage 5-year relative survival (%), (2004-2010)
All stages 6.7%
Localized 25.8%
Regional 9.9%
Distant 2.3%
Unstaged 4.4%

Shown below is an image depicting the 5-year conditional relative survival (probability of surviving in the next 5-years given the cohort has already survived 0, 1, 3 years) between 1988 and 2010 of pancreatic cancer by stage at diagnosis according to SEER. These graphs are adapted from SEER: The Surveillance, Epidemiology, and End Results Program of the National Cancer Institute.[3]

<figure-inline class="mw-default-size"><figure-inline><figure-inline></figure-inline></figure-inline></figure-inline>

References

  1. Ghaneh P, Costello E, Neoptolemos JP (2007). "Biology and management of pancreatic cancer". Gut. 56 (8): 1134–52. doi:10.1136/gut.2006.103333. PMID 17625148.
  2. Bond-Smith G, Banga N, Hammond TM, Imber CJ (2012). "Pancreatic adenocarcinoma". BMJ. 344: e2476. doi:10.1136/bmj.e2476. PMID 22592847.
  3. 3.0 3.1 3.2 3.3 Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.



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