PANCREATIC-CARCINOMA IN PERSPECTIVE - A CONTINUING CHALLENGE

There are approximately 27,000 new cases of carcinoma of the pancreas each year and most afflicted patients will die of the disease. Althoug h smoking is a common denominator, chronic pancreatitis is considered an important precursor lesion in a smaller number of cancers. Pancreat ic cancer is primarily a disease of the pancreatic ducts. The molecula r events are under intense study, but c-K-ras mutation is involved in approximately 80% of the cases and p53 to a slightly lesser degree (60 -80%). Early manifestations are usually occult, but jaundice is a comm on manifestation in patients with cancers of the pancreatic head. Thin -slice computed tomography, portography, and endoscopic retrograde cho langiopancreatography are currently the most sensitive detection techn iques. The developing use of endoscopic ultrasound and laparoscopy app ear to enhance detection and are under evaluation. In many patients wi th advanced disease, endoscopic bypass may eliminate the need for unne cessary surgery, although gastrointestinal bypass is still required in some patients (10-15%). Curative resection is possible in selected pa tients (perhaps 10-15%), with expectation of extended survival ranging from 6->20% in some series. The survival differences may be related t o stage, patient selection, and the expertise of the operative team. P reoperative chemotherapy/radiation is under study and may improve outc ome. Clinical trial participation is essential for improvement in trea tment outcomes. (C) 1996 American Cancer Society.