Chapter 1 - Epidemiology, risk factors and pathogenesis
Pancreatic Cancer
Cancer of the pancreas is the 12th most common cancer worldwide and the 7th most common cause of cancer death.
About 460 000 cases and 430 000 deaths were estimated in 2018.
The risk is higher in men than in women and increases with age; it is mainly a disease of high-income countries.
Trends in incidence have remained fairly stable over time.
The early stages do not usually produce symptoms, so the disease is generally advanced when it is diagnosed, which accounts for relatively low survival rates.
Cigarette smoking is the leading modifiable cause of pancreatic cancer. It is estimated to cause 20%-25% of pancreatic cancers.
Body fatness, reflected by greater body mass index, including abdominal obesity and adult weight gain, is a cause of pancreatic cancer.
Other risk factors include chronic pancreatitis and diabetes. Family history and rare genetic syndromes (5%-10% of cases) also carry increased risk.
About 95% of pancreatic cancers occur in the exocrine pancreas, the most common being the infiltrating ductal adenocarcinoma. Other pancreatic neoplasms include neuroendocrine tumours.
Intraductal papillary mucinous neoplasms and mucinous cystic neoplasms are curable precursor lesions that can progress to an incurable invasive carcinoma.
The molecular pathology of pancreatic cancer is dominated by activating mutations in KRAS and inactivating mutations of TP53, CDKN2A and SMAD4.
Revision Questions
- Identify the population groups with higher risk of pancreatic cancer according to age, sex and geography.
- What are the most important modifiable risk factors for pancreatic cancer identified so far?
- Which are the tumour suppressor genes commonly involved in the pathology of pancreatic cancer?
