Epidemiology
Pancreatic cancer is the tenth most common cancer in the UK, with approximately 7600 diagnoses made each year, and the fifth most common cause of cancer death. The average age of diagnosis is between 60 and 65, but 40% present below the age of 75. It is more common in males until age 75, above which incidence in women is higher.
Aetiology
Smoking is the only well-established aetiological factor in pancreatic cancer with a fivefold increase in risk; studies of alcohol and coffee consumption have been contradictory. Some studies have identified diabetes mellitus and chronic pancreatitis as risk factors; however, as both may develop as a consequence of pancreatic cancer the results have been questioned.
Over 90% are adenocarcinoma of ductal origin, 5% are endocrine tumours arising in islet cells and 5% are acinar cell tumours.
Clinical presentation
Two-thirds of pancreatic cancers occur in the head of pancreas, and patients present with epigastric pain, weight loss and jaundice. The remaining third of tumours occur in the body and tail of pancreas and cause pain in the left upper quadrant of the abdomen with constipation due to colonic involvement. The pain increases in severity over time and radiates to the back, coinciding with retroperitoneal invasion. This pain characteristically improves when the patient leans forward. Tumours in the tail and body tend to be larger at the time of diagnosis and therefore have a worse prognosis.
Occasionally tumours are periampullary and cause obstructive jaundice at an early stage. This can result in an earlier diagnosis and therefore these tumours have a better outcome.
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