Pancreatic Cancer

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Pancreatic Cancer

Pancreatic cancers claim the lives of around 30 ,000 people in the United Stated every year . It is ranked as the third most common malignancy occurring in the gastrointestinal tract . The mortality rate is high with only a 5 5-year-survivabitlity rate . This places pancreatic cancer as the fifth leading cause of death related to cancer (Erickson , 2005

Pancreatic cancers were mostly prevalent in men however , the increase in the smoking habits of women has increased their cancer incidences The ratio

of the prevalence among the men and women is 1 .2-1 .5 :1 (Erickson , 2005 , St . Joseph Hospital , 2006

Pancreatic cancers rank the thirteenth in the incidences and eighth as the cause of death due to cancer . The incidence is high among the African Americans , the Korean , Czech , Latvian , and New Zealanders (Erickson , 2005

Locations of Pancreatic Cancer

60 of the carcinomas are located in the head of the pancreas . 15 in the body , 5 in the tail , and 20 appear diffused throughout the gland (Hruben and Wilentz , 2004 ) pancreatic cancers are divided into exocrine and endocrine cancers , depending upon the location from where the carcinoma arises (Erickson , 2005 ) Exocrine cancers arise from the ductal epithelium , acinar cells , the connective and the lymphatic tissue . Metastasis is usually to the lymph nodes , followed by liver . It can also invade the surrounding viscera (Erickson , 2005

The predisposing factors of the cancer are usually a history of chronic pancreatitis and alcohol consumption . It has also been noted that family history also increases the predisposition to pancreatic cancer (Erickson , 2005

Genetic Influence

The genetic alterations that are seen in these cases are the following The K-RAS gene , p16 , SMAD4 and p53 are the most common genes that result in pancreatic cancer . The other less common genes include the AKT2 gene (chromosome 19q , MYB gene (6q , AIBI gene (chromosome 20q , the BRCA (chromosome 13q , the LKB1 /STK11 (chromosome 19p , MKK4 (17p , TGF ?-R1 (9q , TGF ?-R2 (3p ) and RB1 (13q ) gene (Hruben and Wilentz , 2004

Signs and Symptoms

The signs and symptoms of pancreatic cancer are vague , which accounts for the late diagnosis of the cancer . The patients complain of anorexia irritable syndrome , malaise , nausea , fatigue , weight loss , migratory thrombophlebitis or Trosseau sign , and midepigastric pain or back pain Depression is one of the most prominent signs of pancreatic cancer (Dimagno , 2006 , St . Joseph 's Hospital , 2006

When the cancer involves the head of the pancreas , there is usually painless obstructive jaundice . The symptoms are the darkening of the urine and the lightening of the stools . The patients may also complain of pruritis (Erickson , 2005

Upon examination , a positive Courvoisier sign or palpable gall bladder may be found . Weight loss and midepigastric tenderness can also be noted . In delayed cases , the patient may present with ascites , palpable abdominal mass , and a palpable liver due to metastasis , also splenomegaly from portal vein obstruction (Erickson , 2005

Differential Diagnosis

Pancreatic cancer must be distinguished from the following conditions

Abdominal aortic...