Year 2011 / Volume 103 / Number 1
Editorial
Pancreatic cancer. A multidisciplinary approach

pp. 1-4

A. López Martín y L. F. Carballo Álvarez

Abstract
Pancreatic cancer (PC) still is a significant, unresolved health issue with highly similar incidence and mortality rates. It is the most lethal form of digestive cancer with a 5-year survival rate of 5%. The most common demographic risk factor is ad- vanced age, particularly 70-80 years, as well as being a male and belonging to popu- lations of Jewish origin or black ethnicity. Among environmental, non-hereditary factors tobacco smoking and a hyperproteic diet with extreme fat contents stand out. Obesity with a body mass index (BMI) = 30 increases the risk of PC by 72 %(1). The multivariate analysis of this study shows that moderate physical activity signi- ficantly reduces the risk of PC. Diabetes mellitus (DM) and chronic pancreatitis (CP) are both interrelated, and risk is independent from DM duration and higher in insulin-dependent individuals. Various factors are interrelated: tobacco with he- reditary CP, where PC develops 20 years earlier. The incidence of PC is clearly hig- her in patients with CP and amounts to 1.4%-2.7%; cumulative risk at 10 and 20 years is 1.8 and 4%, respectively. The problem here is the challenging diagnosis of PC in these patients. Hereditary factors include hereditary CP, familial atypical mul- tiple mole melanoma syndrome, Peutz-Jeghers syndrome, hereditary breast cancer, and germ-line mutation of p16.
The following considerations may be derived from studies intended to assess the various disorders associated with PC development: an increased prevalence of PC may be seen in patients with pancreas divisum with an odds ratio of 2.4 (2); there is a potential association of infection with some Helicobacter species (H-specific 6S rDNA) (3); a possible association with hepatitis B virus infection during the replica- tive phase has been reported (4); active alcoholism and smoking speed up the process and cancer develops at an earlier age (5); PC in young patients is associated to a higher frequency of prior acute pancreatitis episodes (6).
PC symptoms relate to anatomic site; thus, tumors in the head of the pancreas usually result in bile obstruction signs including jaundice. Those in the body and tail, and usually tumors in the uncinate process may induce pain in the upper half of the abdomen, back pain, early satiety, weight loss, asthenia, anorexia, and symp- toms associated with gastric voiding difficulties. Similarly, diabetes onset may be the first clinical feature developing in around 10% of patients. Many of these non- specific symptoms may mimic other primary tumors (such as ampullomas, bladder cancer, and cholangiocarcinomas), metastatic tumors (mainly renal), or benign con- ditions (chronic pancreatitis, peptic ulcer disease, etc.).
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