Decision making in the treatment of pancreatic cancer : a retrospective analysis

Pancreatic cancer is a major and often frustrating disease in clinical gastroenterology. Diagnosis and treatment are very difficult; 90% of all patients diagnosed with pancreatic cancer die within one year after diagnosis has been made. The incidence of pancreatic cancer has increased steadily in the past 60 years, beconting the fourth leading cause of death in Western Europe and the USA. The aetiology of pancreatic cancer remains unclear. Some studies have found some influence of cigarette smoking; others find coffee consumption as an aetiological factor. Diet, diabetes mellitus, chronic pancreatitis, industrial exposure and alcohol consumption are mentioned as aetiological factors, but no consensus has been reached so far. It is possible that different methods of obtaining data and its subsequent analysis are the main reasons that a definitive aetiological factor has not been found. Further investigations in experimental models and a better understanding of oncogenes might result in improved knowledge of the aetiology of pancreatic cancer. When cancer of the pancreas or periampullary region have been diagnosed, surgical excision continues to be the only possibility for cure. However, the overall resectability rate is low, and long-term survival after intentional curative resection is 0-15 % in cases of cancer of the head of the pancreas and up to 50% in cases of periarnpullary cancer. Although several types of adjuvant treatments have been proposed, none of these have proven to be effective. One of the major problems, however, remains to select those patients who will benefit from radical surgery, and as a consequence, how to palliate patients with irresectable cancer, aiming for maximal quality of life and low morbidity.

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