Pancreatic cancer natural history, complications and prognosis: Difference between revisions

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==Overview==
==Overview==
Depending on the extent of the tumor at the time of diagnosis, the prognosis is generally regarded as poor, with complete [[remission (medicine)|remission]] extremely rare.<ref name=Ghaneh>{{cite journal |author=Ghaneh P, Costello E, Neoptolemos JP |title=Biology and management of pancreatic cancer |journal=Gut |volume=56 |issue=8 |pages=1134-52 |year=2007 |pmid=17625148 |doi=10.1136/gut.2006.103333}}</ref>
Depending on the extent of the tumor at the time of diagnosis, the prognosis is generally regarded as poor, with complete [[remission (medicine)|remission]] extremely rare.<ref name="Ghaneh">{{cite journal |author=Ghaneh P, Costello E, Neoptolemos JP |title=Biology and management of pancreatic cancer |journal=Gut |volume=56 |issue=8 |pages=1134-52 |year=2007 |pmid=17625148 |doi=10.1136/gut.2006.103333}}</ref>




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===Complications===
===Complications===
*Common complications of [disease name] include:
*Common complications of pancreatic cancer may arise as a result of the disease or therapy:
**[Complication 1]
*Malabsorption:
**[Complication 2]
**[[Pancreatic insufficiency|Exocrine pancreatic insufficiency]] due to [[pancreatic duct]] [[obstruction]] by the [[tumor]] may lead to [[malabsorption]]. [[Malabsorption]] in patients presents with [[anorexia]], [[weight loss]], and [[diarrhea]].
**[Complication 3]
* Pain:  
**Patients with advanced pancreatic cancer may develop intractable pain requiring narcotic analgesics and surgical intervention such as neurolysis of celic ganglia.
====Jaundice:====
*[[Jaundice|Obstructive jaundice]] can present with features of [[cholangitis]]:
**[[Fever]] and [[Rigor|chills]]
**[[Nausea and vomiting|Nausea]], [[Nausea and vomiting|vomiting]]
**[[Acholic stools|Clay-colored stools]]
**Dark [[urine]]
**Yellowish discoloration of skin
**[[Itch|Pruritus]]
**[[Abdominal pain|Right upper quadrant pain]]
**[[Anorexia]]
*Patients may require  [[Endoscopy|Endoscopic]] [[decompression]] with [[stent]] placement in patients due to biliary obstruction.
====Duodenal obstruction====
*Patients may develop duodenal obstruction as a result of complications of surgery.
*Duodenal obstruction may be treated with [[Endoscopy|endoscopic]] [[Stent|stenting]] or [[gastrojejunostomy]].
===Prognosis===
===Prognosis===
*The primary factors that influence prognosis are:
*The primary factors that influence prognosis are:
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:*Whether the tumor has spread to lymph nodes or elsewhere
:*Whether the tumor has spread to lymph nodes or elsewhere


<br/>
<br />
*'''Staging and TNM (tumour, lymph node, metastasis) classification related to incidence, treatment, and prognosis:''' <ref name="pmid22592847">{{cite journal| author=Bond-Smith G, Banga N, Hammond TM, Imber CJ| title=Pancreatic adenocarcinoma. | journal=BMJ | year= 2012 | volume= 344 | issue=  | pages= e2476 | pmid=22592847 | doi=10.1136/bmj.e2476 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22592847  }} </ref>
*'''Staging and TNM (tumour, lymph node, metastasis) classification related to incidence, treatment, and prognosis:''' <ref name="pmid22592847">{{cite journal| author=Bond-Smith G, Banga N, Hammond TM, Imber CJ| title=Pancreatic adenocarcinoma. | journal=BMJ | year= 2012 | volume= 344 | issue=  | pages= e2476 | pmid=22592847 | doi=10.1136/bmj.e2476 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22592847  }} </ref>


{|
{|
! rowspan="1" colspan="5" style="background:#4479BA; color: #FFFFFF;" align="center" + | '''Staging and TNM Classification related to Incidence, Treatment, and Prognosis'''
! colspan="5" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" + | '''Staging and TNM Classification related to Incidence, Treatment, and Prognosis'''
|+  
|+  
| rowspan="1" colspan="1" style="background:#4479BA; color: #FFFFFF;" + | '''Stage'''
| colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" + | '''Stage'''
| rowspan="1" colspan="1" style="background:#4479BA; color: #FFFFFF;" + | '''TNM Classification'''
| colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" + | '''TNM Classification'''
| rowspan="1" colspan="1" style="background:#4479BA; color: #FFFFFF;" + | '''Clinical Classification'''
| colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" + | '''Clinical Classification'''
| rowspan="1" colspan="1" style="background:#4479BA; color: #FFFFFF;" + | '''Incidence at diagnosis (%)'''
| colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" + | '''Incidence at diagnosis (%)'''
| rowspan="1" colspan="1" style="background:#4479BA; color: #FFFFFF;" + | '''5-year survival rate (%)'''
| colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" + | '''5-year survival rate (%)'''
|-
|-
| style="background:#DCDCDC; + | '''0'''
| style="background:#DCDCDC; + " | '''0'''
| style="background:#F5F5F5; + | '''Tis, N0, M0'''
| style="background:#F5F5F5; + " | '''Tis, N0, M0'''
| style="background:#F5F5F5; + | Resectable
| style="background:#F5F5F5; + " | Resectable
| style="background:#F5F5F5; + | 7.5
| style="background:#F5F5F5; + " | 7.5
| style="background:#F5F5F5; + | 15.2
| style="background:#F5F5F5; + " | 15.2
|-
|-
| style="background:#DCDCDC; + | '''IA'''
| style="background:#DCDCDC; + " | '''IA'''
| style="background:#F5F5F5; + | '''T1, N0, M0'''
| style="background:#F5F5F5; + " | '''T1, N0, M0'''
| style="background:#F5F5F5; + | —
| style="background:#F5F5F5; + " | —
| style="background:#F5F5F5; + | —
| style="background:#F5F5F5; + " | —
| style="background:#F5F5F5; + | —
| style="background:#F5F5F5; + " | —
|-
|-
| style="background:#DCDCDC; + | '''IB'''
| style="background:#DCDCDC; + " | '''IB'''
| style="background:#F5F5F5; + | '''T2, N0, M0'''
| style="background:#F5F5F5; + " | '''T2, N0, M0'''
| style="background:#F5F5F5; + | —
| style="background:#F5F5F5; + " | —
| style="background:#F5F5F5; + | —
| style="background:#F5F5F5; + " | —
| style="background:#F5F5F5; + | —
| style="background:#F5F5F5; + " | —
|-
|-
| style="background:#DCDCDC; + | '''IIA'''
| style="background:#DCDCDC; + " | '''IIA'''
| style="background:#F5F5F5; + | '''T3, N0, M0'''
| style="background:#F5F5F5; + " | '''T3, N0, M0'''
| style="background:#F5F5F5; + | —
| style="background:#F5F5F5; + " | —
| style="background:#F5F5F5; + | —
| style="background:#F5F5F5; + " | —
| style="background:#F5F5F5; + | —
| style="background:#F5F5F5; + " | —
|-
|-
| style="background:#DCDCDC; + | '''IIB'''
| style="background:#DCDCDC; + " | '''IIB'''
| style="background:#F5F5F5; + | '''T1-3, N1, M0'''
| style="background:#F5F5F5; + " | '''T1-3, N1, M0'''
| style="background:#F5F5F5; + | Locally advanced
| style="background:#F5F5F5; + " | Locally advanced
| style="background:#F5F5F5; + | 29.3
| style="background:#F5F5F5; + " | 29.3
| style="background:#F5F5F5; + | 6.3
| style="background:#F5F5F5; + " | 6.3
|-
|-
| style="background:#DCDCDC; + | '''III'''
| style="background:#DCDCDC; + " | '''III'''
| style="background:#F5F5F5; + | '''T4, any N, M0'''
| style="background:#F5F5F5; + " | '''T4, any N, M0'''
| style="background:#F5F5F5; + | —
| style="background:#F5F5F5; + " | —
| style="background:#F5F5F5; + | —
| style="background:#F5F5F5; + " | —
| style="background:#F5F5F5; + | —
| style="background:#F5F5F5; + " | —
|-
|-
| style="background:#DCDCDC; + | '''IV'''
| style="background:#DCDCDC; + " | '''IV'''
| style="background:#F5F5F5; + | '''Any T, any N, M1'''
| style="background:#F5F5F5; + " | '''Any T, any N, M1'''
| style="background:#F5F5F5; + | Metastatic
| style="background:#F5F5F5; + " | Metastatic
| style="background:#F5F5F5; + | 47.2
| style="background:#F5F5F5; + " | 47.2
| style="background:#F5F5F5; + | 1.6
| style="background:#F5F5F5; + " | 1.6
|-
|-
|}
|}


===5-Year Survival===
===5-Year Survival===
*For patients with localized disease and small cancers (<2 cm) with no lymph node metastases and no extension beyond the capsule of the pancreas, complete surgical resection is associated with an actuarial 5-year survival rate of 18% to 24%.
*For patients with localized disease and small cancers (<2 cm) with no lymph node metastases and no extension beyond the capsule of the pancreas, complete surgical resection is associated with a 5-year survival rate of 18% to 24%.


* Between 2007 and 2010, the 5-year relative survival of patients with pancreatic cancer was 7.2%.<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref>
* Between 2007 and 2010, the 5-year relative survival of patients with pancreatic cancer was 7.2%.<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref>
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{| style="cellpadding=0; cellspacing= 0; width: 600px;"
{| style="cellpadding=0; cellspacing= 0; width: 600px;"
|-
|-
|style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align=center |'''Stage'''|| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align=center | '''5-year relative survival (%), (2004-2010)'''
| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align="center" |'''Stage'''|| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align="center" | '''5-year relative survival (%), (2004-2010)'''
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''All stages'''|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |6.7%
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''All stages'''|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |6.7%
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''Localized'''|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |25.8%
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Localized'''|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |25.8%
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''Regional'''|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |9.9%
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Regional'''|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |9.9%
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''Distant'''|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |2.3%
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Distant'''|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |2.3%
|-
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''Unstaged'''|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |4.4%
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Unstaged'''|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |4.4%
|}
|}


Shown below is an image depicting the 5-year conditional relative survival (probability of surviving in the next 5-years given the cohort has already survived 0, 1, 3 years) between 1988 and 2010 of pancreatic cancer by stage at diagnosis according to [[SEER]]. These graphs are adapted from [[SEER]]: The Surveillance, Epidemiology, and End Results Program of the National Cancer Institute.<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref>
Shown below is an image depicting the 5-year conditional relative survival (probability of surviving in the next 5-years given the cohort has already survived 0, 1, 3 years) between 1988 and 2010 of pancreatic cancer by stage at diagnosis according to [[SEER]]. These graphs are adapted from [[SEER]]: The Surveillance, Epidemiology, and End Results Program of the National Cancer Institute.<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref>


[[Image:Survival time of pancreatic cancer by stage.PNG]]
<figure-inline class="mw-default-size">[[Image:Survival time of pancreatic cancer by stage.PNG|646x646px]]</figure-inline>


==References==
==References==

Revision as of 14:49, 15 November 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Overview

Depending on the extent of the tumor at the time of diagnosis, the prognosis is generally regarded as poor, with complete remission extremely rare.[1]


Natural History, Complications and Prognosis

Natural History

  • The symptoms of (disease name) usually develop in the first/ second/ third decade of life, and start with symptoms such as ___.
  • The symptoms of (disease name) typically develop ___ years after exposure to ___.
  • If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].

Complications

Jaundice:

Duodenal obstruction

Prognosis

  • The primary factors that influence prognosis are:
  • Whether the tumor is localized and can be completely resected
  • Whether the tumor has spread to lymph nodes or elsewhere


  • Staging and TNM (tumour, lymph node, metastasis) classification related to incidence, treatment, and prognosis: [2]
Staging and TNM Classification related to Incidence, Treatment, and Prognosis
Stage TNM Classification Clinical Classification Incidence at diagnosis (%) 5-year survival rate (%)
0 Tis, N0, M0 Resectable 7.5 15.2
IA T1, N0, M0 — — —
IB T2, N0, M0 — — —
IIA T3, N0, M0 — — —
IIB T1-3, N1, M0 Locally advanced 29.3 6.3
III T4, any N, M0 — — —
IV Any T, any N, M1 Metastatic 47.2 1.6

5-Year Survival

  • For patients with localized disease and small cancers (<2 cm) with no lymph node metastases and no extension beyond the capsule of the pancreas, complete surgical resection is associated with a 5-year survival rate of 18% to 24%.
  • Between 2007 and 2010, the 5-year relative survival of patients with pancreatic cancer was 7.2%.[3]
  • When stratified by age, the 5-year relative survival of patients with pancreatic cancer was 10% and 4.6% for patients <65 and ≥ 65 years of age respectively.[3]
  • The survival of patients with pancreatic cancer varies with the stage of the disease. Shown below is a table depicting the 5-year relative survival by the stage of pancreatic cancer:[3]
Stage 5-year relative survival (%), (2004-2010)
All stages 6.7%
Localized 25.8%
Regional 9.9%
Distant 2.3%
Unstaged 4.4%

Shown below is an image depicting the 5-year conditional relative survival (probability of surviving in the next 5-years given the cohort has already survived 0, 1, 3 years) between 1988 and 2010 of pancreatic cancer by stage at diagnosis according to SEER. These graphs are adapted from SEER: The Surveillance, Epidemiology, and End Results Program of the National Cancer Institute.[3]

<figure-inline class="mw-default-size"></figure-inline>

References

  1. ↑ Ghaneh P, Costello E, Neoptolemos JP (2007). "Biology and management of pancreatic cancer". Gut. 56 (8): 1134–52. doi:10.1136/gut.2006.103333. PMID 17625148.
  2. ↑ Bond-Smith G, Banga N, Hammond TM, Imber CJ (2012). "Pancreatic adenocarcinoma". BMJ. 344: e2476. doi:10.1136/bmj.e2476. PMID 22592847.
  3. ↑ 3.0 3.1 3.2 3.3 Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.



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