New Strategies, Guidelines, and Therapeutic Advances for the Comprehensive Continuum of Metastatic Pancreatic Cancers: Focus on Chemotherapeutic and Surgical Approaches to Pancreatic Adenocarcinoma and Pancreatic Neuroendocrine Tumors

摘要

Pancreatic cancer is a relatively rare but highly lethal malignancy. Although pancreatic cancer accounts for only 3% of all cancer diagnoses in the United States, it is the fourth deadliest cancer for both men and women, behind only lung cancer, colorectal cancer, prostate cancer, and breast cancer. In contrast to other cancer types, in which relative survival has improved dramatically in recent decades, the prognosis for patients with pancreatic cancer remains poor, with a 5-year survival rate of 8%. This rate drops to 2.7% for the 52% of patients with metastatic disease at diagnosis. Epidemiology of Pancreatic Cancer The incidence of pancreatic cancer varies geographically, with the highest rates reported in more-developed areas and lower rates in less-developed areas. Pancreatic cancer is primarily a disease of older adults, with a median age at diagnosis of 70 years. As the population ages, the incidence of pancreatic cancer is expected to increase. By 2030, pancreatic cancer is predicted to become the second-leading cause of cancer death, surpassing breast, prostate, and colorectal cancers (Figure I). Rates of pancreatic cancer are higher in men than women (14.2 vs 11.1 per 100,000 persons) and in African Americans vs whites among both men (17.0 vs 14.2 per 100,000 persons) and women (14.3 vs 11.1 per 100,000 persons).2 Among lifestyle factors, tobacco smoking is associated with a significant increase in the risk of pancreatic cancer.