Pancreatic Carcinoma: Still a Gloomy Reality

Abstract

Introduction: Pancreatic carcinoma is the fourth leading cause ofcancer deaths. In most patients diagnosis is late and, consequently, it has a poor prognosis. This study aimed to identify the risk factors, signs and symptoms and to evaluate diagnostic and staging modalities, treatment and survival of these patients. Methods: This is a 5-year retrospective study of patients diagnosed with pancreatic cancer at our referral centre between 2011 and 2015. Results: Pancreatic carcinoma was diagnosed in 368 patients, 215 of which were male (58%). The mean age at the time of diagnosis was 66.4 ± 12.9 years; 57% had a normal body mass index (BMI) [20-25kg/m2] and 38% were diabetic. Most patients were not current or former smokers (74%), whereas 13% had excessive alcohol use [>20-40g per day in women; 40-60g per day in men] and 4% had history of chronic pancreatitis. At the time of diagnosis, 325 patients (88%) were symptomatic, being abdominal pain the most common clinical feature (53%). Computerized tomography (CT) was the preferred initial imaging in patients with suspected pancreatic carcinoma (53%), and was the one that more frequently made the definite diagnosis (76%). Staging, mainly using CT, revealed that 36% of tumors were unresectable according to AJCC classification. Therapy with curative intent was performed in 31% of patients. The mean survival time was 13.1±1.6 months. A significant gain in survival was found in those who underwent surgery (21.5 months vs. 8.3 months, p < 0.001) Conclusion:Pancreatic carcinoma typically has a very poor prognosis, commonly with late diagnosis, preventing implementation of therapy with curative intent in most patients. Greater awareness should be devoted to identification of risk factors and clinical features, as well as to the adequate selection of modality for diagnostic and staging, which are of key importance to an earlier detection and more efficient treatment. Being able to undergo surgery is a better prognosis factor.