Diagnosis and management of pancreatic cancer

Maria Syl D. De La Cruz, Alisa P. Young, Mack Ruffin

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Pancreatic cancer remains the fourth leading cause of cancer-related deaths in the United States. Risk factors include family history, smoking, chronic pancreatitis, obesity, diabetes mellitus, heavy alcohol use, and possible dietary factors. Because more than two-thirds of adenocarcinomas occur in the head of the pancreas, abdominal pain, jaundice, pruritus, dark urine, and acholic stools may be presenting symptoms. In symptomatic patients, the serum tumor marker cancer antigen 19-9 can be used to confirm the diagnosis and to predict prognosis and recurrence after resection. Pancreas protocol computed tomography is considered standard for the diagnosis and staging of pancreatic cancer. Although surgical resection is the only potentially curative treatment for pancreatic ductal adenocarcinomas, less than 20% of surgical candidates survive five years. The decision on resectability requires multidisciplinary consultation. Pancreatic resections should be performed at institutions that complete at least 15 of the surgeries annually. Postoperatively, use of gemcitabine or fluorouracil/leucovorin as adjuvant chemotherapy improves overall survival by several months. However, more than 80% of patients present with disease that is not surgically resectable. For patients with locally advanced or metastatic disease, chemoradiotherapy with gemcitabine or irinotecan provides clinical benefit and modest survival improvement. Palliation should address pain control, biliary and gastric outlet obstruction, malnutrition, thromboembolic disease, and depression.

Original languageEnglish (US)
Pages (from-to)626-632
Number of pages7
JournalAmerican Family Physician
Volume89
Issue number8
StatePublished - Apr 15 2014

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gemcitabine
Pancreatic Neoplasms
irinotecan
Pancreas
Adenocarcinoma
Gastric Outlet Obstruction
Survival
Leucovorin
Differentiation Antigens
Chronic Pancreatitis
Chemoradiotherapy
Neoplasm Antigens
Pruritus
Adjuvant Chemotherapy
Tumor Biomarkers
Jaundice
Malnutrition
Fluorouracil
Abdominal Pain
Neoplasms

All Science Journal Classification (ASJC) codes

  • Family Practice

Cite this

De La Cruz, M. S. D., Young, A. P., & Ruffin, M. (2014). Diagnosis and management of pancreatic cancer. American Family Physician, 89(8), 626-632.
De La Cruz, Maria Syl D. ; Young, Alisa P. ; Ruffin, Mack. / Diagnosis and management of pancreatic cancer. In: American Family Physician. 2014 ; Vol. 89, No. 8. pp. 626-632.
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De La Cruz, MSD, Young, AP & Ruffin, M 2014, 'Diagnosis and management of pancreatic cancer', American Family Physician, vol. 89, no. 8, pp. 626-632.

Diagnosis and management of pancreatic cancer. / De La Cruz, Maria Syl D.; Young, Alisa P.; Ruffin, Mack.

In: American Family Physician, Vol. 89, No. 8, 15.04.2014, p. 626-632.

Research output: Contribution to journalArticle

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De La Cruz MSD, Young AP, Ruffin M. Diagnosis and management of pancreatic cancer. American Family Physician. 2014 Apr 15;89(8):626-632.