Pancreatic cancer. The dismal disease.

Pancreatic cancer, the fourth commonest cause of death in the United States, has a very poor prognosis, is increasing in incidence, and, in most cases, is not detected before it has spread beyond the pancreas. Partial, or total, pancreatectomy has increased five-year survival in only a small fraction of cases. New techniques are helpful in earlier diagnosis, but patients have to be selected for examination long before clinical signs or symptoms develop. Elderly patients who use alcohol and tobacco excessively and female diabetics may be at higher risk. Pathologists should examine pancreasduct epithelium at autopsy in patients in the fourth to sixth decades for atypia, papillary hyperplasia, carcinoma in situ, or other possible precursor changes. Diagnostic tumor, or oncofetal antigens, or a biochemical difference in isozyme activities, hopefully, may be developed. Some combinations of surgery, chemotherapy, and radiation therapy may give better prognosis.