Management of pancreatic cancer

Abstract

Most patients with adenocarcinoma of the exocrine pancreas have incurable disease at the time of diagnosis. Only 30% of the patients will undergo resection for a potentially curable tumor and only one third of these tumors is found to be localized [1–4]. Thus, about 10% of patients with pancreatic cancer will have hope of cure by surgery. Although the incidence of pancreatic cancer is increasing and a relation with certain life styles such as smoking is shown [5–7] no population group at risk from the disease has been delineated sofar. Therefore, there is little hope that screening procedures will lead to earlier diagnosis and treatment. Resection for pancreatic cancer is a formidable procedure with an operative mortality of around 20% [8, 9], although figures of well below 10% have been reported more recently [10, 11]. Five year survival after resection is not much more than 5% [9, 12–14] and not better than survival after palliative procedures, according to some authors [15, 16]. Therefore many doctors have a nihilistic therapeutic attitude toward pancreatic cancer. For them extensive diagnostic and staging procedures are superfluous since palliative treatment should be initiated for all patients. Although palliation is all that can be achieved for most patients, many physicians pursue curative treatment for a small minority.