Oncology
Pancreatic Cancer
췌장암
Mostly pancreatic ductal adenocarcinoma (PDAC), often advanced at diagnosis
- How common
- Most lethal cancer (5-yr survival 12%)
- Typical age
- Ages 60–80
What is it?
KRAS mutation occurs in nearly all PDAC, with CDKN2A, TP53, SMAD4 loss driving progression.
Commonly affected: Pancreatic head 60%, body 25%, tail 15%; liver, peritoneum
How it develops
- KRAS mutationInitiating event in 95% of PDAC
- PanIN 1-3 progressionCDKN2A loss drives progression to PanIN 3
- Invasive PDACTP53, SMAD4 loss enable invasion
- Local invasion & liver metsPeripancreatic vascular invasion, liver mets
Symptoms
- Painless jaundiceClassic for head cancer (bile duct obstruction)
- Weight loss/cachexiaSevere cachexia common
- Abdominal/back painBody/tail cancers radiate to back
- New-onset diabetesSuspect PDAC if onset >50 yo
- Trousseau signMigratory thrombophlebitis
How it is examined
- Abdominal examCourvoisier sign (palpable nontender gallbladder)
- Lymph node examVirchow, Sister Mary Joseph
- Nutrition/PSECOG, albumin, cachexia
Imaging
AXR has no diagnostic value.
- Nonspecific
Pancreas protocol CT (3-phase) standard; MRI/MRCP, EUS+FNA for diagnosis.
- Pancreatic head mass
- Double duct sign
- Vascular involvement (SMA/SMV)
Non-surgical care
- Resectability assessmentResectable / borderline / locally advanced / metastatic
- Neoadjuvant/adjuvant chemomFOLFIRINOX (good PS) or gemcitabine + nab-paclitaxel
- Advanced 1st-linemFOLFIRINOX or gem/nab-pac; BRCA+: olaparib (POLO)
- Biliary drainage/painERCP stent (jaundice), celiac plexus block (pain)
- Germline testingBRCA1/2, PALB2, ATM (germline), MSI status
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Resectable or post-neoadjuvant borderline (15–20% of all cases)
Procedures that may be discussed
- Whipple (pancreaticoduodenectomy, head)
- Distal pancreatectomy + splenectomy (body/tail)
- Total pancreatectomy (multifocal)
- Neoadjuvant mFOLFIRINOX → resection (borderline)
- Biliary/gastric bypass (palliative)
Outlook
5-yr survival: localized 44%, regional 16%, distant 3%. Post-resection 5-yr 20–25%.