Pancreatic cancer

The commonest form of pancreatic cancer is pancreatic ductal adenocarcinoma. The long-term outcome of pancreatic cancer is extremely poor, the overall median survival from diagnosis being 3–6 months without treatment, which increases to around 23 months with resectional surgery and adjuvant treatment. Pancreatic cancer is usually diagnosed late and has a biological phenotype characterized by resistance to all cancer treatment modalities and early metastasis. Jaundice is the commonest presenting symptom. Endoscopic stent placement is preferable to transhepatic stenting. The average patency of metal stents in the distal common bile duct is about twice that of plastic stents, the latter lasting about 4 months. Curative surgery is rare. Pancreatoduodenectomy is the most appropriate resectional procedure for tumours of the head of the pancreas. The operation should be confined to specialist centres, to reduce morbidity and mortality and increase resection rates. Adjuvant or neoadjuvant treatment in combination with surgery should be offered in the context of a clinical trial. Efforts should be made to obtain a tissue diagnosis in patients selected for palliation. Duodenal bypass should be used in addition to palliative surgical biliary bypass. If chemotherapy is used for palliation, gemcitabine plus capecitabine may be the treatment of choice.