Pancreatic carcinoma

Pancreatic carcinoma is a malignant tumour arising from the exocrine part of the pancreas, most often it is a solid adenocarcinoma, less often cystic tumours (< 5%). The origin of the malignant elements is mainly from the epithelium of the pancreatic ducts, approximately one percent are from acini cells. Macroscopically, it is a resistant nodule of a yellowish colour with central necrosis or vascularisation.

In addition to its increasing incidence in the population, which has not yet been satisfactorily explained, it has a high mortality rate, even in cases of early detection of malignancy. It affects men slightly more often than women. In recent years, it has been ranked fourth in terms of mortality (after lung cancer, colorectal cancer and breast cancer). Only 4% of patients live to five years after diagnosis, and the majority do not live beyond one year. Nowadays, the disease is often diagnosed at an advanced stage. Clinically, it is often asymptomatic for a long time or the symptoms are so subtle that they do not attract the attention of the patient or the treating physician. The tumour markers commonly used in the diagnosis does not have significant diagnostic value as they are not specific for pancreatic cancer.

Age
It represents the strongest risk factor. Under the age of 30, the disease is rare, after this age the incidence rises sharply and the peak is reached in seventh and eighth decades.

Smoking
A significant risk factor for the development of the disease, it is associated with a two- to threefold increase in the risk of malignancy. The mechanism is based on the action of tobacco N-nitrosamines directly on target cells or by their secretion into bile with possible reflux into the pancreatic ducts. Passive smoking has not been confirmed as a risk factor.

Alcohol
Alcohol is currently confirmed only as an indirect risk factor for developing cancer. It is possible through its ability to induce chronic pancreatitis, which is a recognised as an endogenous risk factor.

Dietary factors
High intake of meat, cholesterol and fried foods are risk factors as well. On the other hand, vegetables, fruits, fibre, vitamin C and other antioxidants prevent the development of cancer.