November is Pancreatic Cancer Awareness Month. Pancreatic cancer is the third leading cause of cancer-related death in the United States and the seventh leading cause of cancer related death worldwide. Over 43,000 individuals in the United States die from pancreatic cancer each year.  Pancreatic cancer holds the worst prognosis of any malignancy, with a five-year survival rate of only 8.2%, highlighting the importance of treatment advances.

The overall lifetime risk of developing pancreatic cancer is about 1.6%. The risk of developing pancreatic cancer increases with advancing age, with the median age at diagnosis being 70.  Males - particularly African-American males - are at a higher risk for developing pancreatic cancer.  The greatest modifiable risk factor for developing pancreatic cancer is cigarette smoking.  Hereditary factors and identification of specific germ-line mutations may confer up to a 16% increased risk for pancreatic cancer.

Patients typically present with abdominal pain in the mid-epigastric area.  Patients may also exhibit steatorrhea, jaundice, a palpable gallbladder, splenomegaly, pruritus, or migratory superficial thrombophlebitis. Diagnosis is performed by imaging studies such as CT in combination with histologic tissue diagnosis. There are different methods and approaches to staging, and these may vary by institution and specialist. The American Joint Commission on cancer staging guidelines for pancreatic cancer can be found here.

The patients with the most favorable prognosis are those with surgically resectable disease upon presentation. However, this represents only 10-20% of patients with newly diagnosed pancreatic cancer. Those that have resectable disease have about a 20% chance of survival at five-years.  Those without resectable disease may consider radiation therapy +/- adjuvant chemotherapy in consultation with their oncologist, as the outcomes are varied and the treatment options are very patient specific.

National organizations, such as the Pancreatic Cancer Action Network, are helping to raise public awareness about this disease. There are similar organizations worldwide to support pancreatic cancer and to help raise awareness.  Efforts include fundraising, providing support to patients, families, and decreasing modifiable risk factors. 

Read more about pancreatic cancer:

Harrison's Principles of Internal Medicine, 20e: Chapter 79: Pancreatic Cancer

The MD Anderson Manual of Medical Oncology, 3e: Chapter 21: Pancreatic Cancer

Pancreatic Cancer Action Network