Pancreatic adenocarcinoma, also known as pancreatic ductal adenocarcinoma (PDAC), is the most common and aggressive form of pancreatic cancer, accounting for about 95% of all pancreatic cancer cases. It originates from the ductal cells of the pancreas and is often diagnosed at an advanced stage due to subtle early symptoms.
🧬 Causes & Risk Factors
- Genetic Mutations: Key mutations in genes such as KRAS, TP53, CDKN2A, and SMAD4 are commonly found in PDAC. Notably, the KRAS gene is mutated in nearly 90% of cases, leading to uncontrolled cell proliferation and resistance to apoptosis .(walshmedicalmedia.com)
- Risk Factors:
- Age: Most commonly diagnosed in individuals over 65.
- Smoking: Significantly increases risk.
- Obesity: Associated with a higher risk.
- Family History: Approximately 10% of cases have a hereditary component.
- Chronic Pancreatitis: Long-term inflammation of the pancreas.
- Genetic Syndromes: Conditions like BRCA2 mutations increase risk .(walshmedicalmedia.com)
⚠️ Symptoms
Symptoms often appear late and may include:
- Abdominal pain, particularly in the upper abdomen or back.
- Unexplained weight loss.
- Jaundice (yellowing of the skin and eyes).
- Loss of appetite.
- Nausea and vomiting.
- New-onset diabetes or worsening of existing diabetes.(msdmanuals.com)
🧪 Diagnosis
Early detection is challenging. Diagnostic methods include:
- Imaging:
- CT Scan: Provides detailed images of the pancreas.
- MRI/MRCP: Useful for visualizing pancreatic ducts.
- Endoscopic Ultrasound (EUS): Allows for fine-needle aspiration biopsy .(thelancet.com)
- Biopsy: Essential for confirming diagnosis.
- Genetic Testing: Identifies mutations that may guide treatment.(walshmedicalmedia.com)
🩺 Treatment
Treatment depends on the cancer’s stage and location:(mayoclinic.org)
- Surgical Options:
- Whipple Procedure (Pancreaticoduodenectomy): Removal of the head of the pancreas, duodenum, and other nearby structures.
- Distal Pancreatectomy: Removal of the body and tail of the pancreas.
- Total Pancreatectomy: Complete removal of the pancreas .(pmc.ncbi.nlm.nih.gov, mayoclinic.org)
- Chemotherapy:
- FOLFIRINOX (fluorouracil, leucovorin, irinotecan, oxaliplatin) and Gemcitabine are commonly used regimens .(thelancet.com)
- Radiation Therapy: May be used in combination with chemotherapy, especially for locally advanced cancers.
- Targeted Therapy:
- Zenocutuzumab (Bizengri) is a monoclonal antibody approved for treatment of PDAC with neuregulin 1 gene fusions .(en.wikipedia.org)