Epidemiology

According to the World Cancer Research Fund Cancer Statistics Worldwide (2016), pancreatic
cancer is the twelfth most common malignancy and the seventh leading cause of cancer mortality, with
more than 330,000 deaths in 2012.

In 2008, the global disease burden attributable to this cancer has been estimated at around 126
per 100,000 age- and disability-adjusted life years (DALY) with a substantial number of years of life lost
(Soerjomataram, I. et al, 2012). In a study made by Wong et al. (2017), there is an increased male
predominance of the pancreatic cancer.

The remote location of the pancreas; the lack of appropriate screening tests or diagnostic
markers; the aggressiveness of pancreatic adenocarcinoma; its poor response to chemotherapy or
radiotherapy; and the difficulties to establish a tissue diagnosis led to the low success rates of its
treatment. Owing to its extremely aggressive nature and poor survival rate, it remains an important public
health issue worldwide (Maisonneuve and Lowenfels, 2010).

Most pancreatic cancers were diagnosed in northern and more developed countries (Ferlay, et
al., 2013). The vast majority of pancreatic cancers are adenocarcinoma, with slower-growing endocrine
tumors accounting for other pancreatic cancer subtypes (Yadav, D. & Lowenfels, 2013). The recognized
risk factors for pancreatic cancer include cigarette smoking and use of smokeless tobacco. (Bofetta, et al.,
2008) Some possible risk factors include those that are related to lifestyle diseases such as diabetes
mellitus. (Singh et al., 2013)

Clinical Features

To date, lack of symptoms is the main cause of pancreatic cancer late diagnosis and therapy. The
appearance of clinical presentations usually indicates an advanced stage and the most frequent
presentations are progressive weight loss, anorexia, abdominal pain, and jaundice. These symptoms of
pancreatic cancer are nonspecific and varied in different parts of the pancreas.

The tumor in the head of the pancreas (75%) produces symptoms such as weight loss, painless
jaundice, nausea, and vomiting. The mass of pancreatic head causes blockage of the common bile duct,
which results in jaundice, dark urine, light stool color, and itching. (Zhang, et al., 2016)

Weight loss may be related to malabsorption of nutrients due to pancreatic cancer. Nausea,
vomiting, and poor appetite, due to cancer-related gastric outlet (duodenum) obstruction, may also
contribute to weight loss. If cancer is located at the body/tail of the pancreas, patients usually present
with abdominal pain that radiates to the sides or the back (Soerjomataram, et al., 2012).

Previous reports showed that inflammatory and immune cells were associated with both the pain
intensity and the extent of perineural invasion and this is also involved in pain generation. Due to
pancreatic cancer producing blood clotting chemicals, thrombus forms automatically in the portal blood
vessels, the deep veins of the extremities (Ilic and Ilic, 2016).
References:

Boffetta, P., Hecht, S., Gray, N., Gupta, P. & Straif, K. (2008). Smokeless tobacco and cancer. Lancet Oncol.
9, 667675, doi:10.1016/S1470- 2045(08)70173-6.

Ferlay, J. et al. (2013). GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide. IARC Cancer
Base No. 11. Lyon, France: International Agency for Research on Cancer.

Ilic, Milena and Ilic, Irena. (2016). Epidemiology of pancreatic cancer. World J Gastroenterol 2016
November 28; 22(44): 9694-9705. ISSN 1007-9327. Baishideng Publishing Group Inc.

Maisonneuve, P. & Lowenfels, A. B. (2010). Epidemiology of Pancreatic Cancer: An Update. Dig. Dis. 28,
645656, doi:10.1159/000320068.

Singh, S., Hassan, M., McWilliams R., Chari, S. (2013). Anti-diabetic medications and risk of pancreatic
cancer in patients with diabetes mellitus: a systematic review and meta-analysis. Am. J. Gastroenterol.
108, 510519, doi:10.1038/ajg.2013.7.

Soerjomataram, I. et al. (2012). Global burden of cancer in 2008: a systematic analysis of disability-
adjusted life-years in 12 world regions. Lancet 380, 18401850, doi:10.1016/S0140-6736(12)60919-2.

Wong, C.S., Jiang, J., Liang, M., Yeung M., Sung, J. (2017). Global temporal patterns of pancreatic cancer
and association with socioeconomic development. Scientific reports 7: 3165 | DOI:10.1038/s41598-017-
02997-2

World Cancer Research Fund Cancer Statistics (2016). Retrieved from,

http://www.wcrf.org/cancer_statistics/world_cancer_statistics.php

Yadav, D. & Lowenfels, A. B. (2013). The Epidemiology of Pancreatitis and Pancreatic Cancer.
Gastroenterology 144, 12521261, doi:10.1053/j.gastro.2013.01.068.

Zhang, Q., Zeng, L., Chen, Y., Qian, C., Chen, S., Li, J., and Huang, K. (2016). Pancreatic Cancer Epidemiology,
Detection, and Management. Gastroenterology Research and Practice. Hindawi Publishing Corporation.
http://dx.doi.org/10.1155/2016/8962321.