Pancreatic ductal adenocarcinoma is the tenth most common cancer and the fourth leading cause of cancer death in the United States. In 2008, an estimated 37,680 new cases were diagnosed, with 34,290 deaths from the disease. The peak incidence occurs in the sixth and seventh decades of life, and men and women are equally affected by this disease, which has an overall 5 year survival rate of 4%. Smoking and obesity are clear risk factors for the development of pancreatic ductal adenocarcinoma; industrial asbestos exposure, experimental radon exposure, alcohol abuse, and diabetes appear to be less clearly associated. Approximately 5% to 10% of patients are believed to have a familial form of pancreatic cancer most commonly associated with mutations in BRCA-2 (familial breast cancer), PRSS1 (hereditary pancreatitis), p16 (familial atypical multiple mole or melanoma), or HNPCC (hereditary nonpolyposis colorectal cancer).
Surgical resection via pancreaticoduodenectomy (PD) is the only potentially curative therapy; such resection improves the overall 5 year survival rate to 15% to 25%. Because of the presence of locally advanced disease, distant metastases, or significant medical comorbidities, only a minority (20% to 30%) of patients at the time of diagnosis are candidates for surgical resection, the lowest percentage among all of the periampullary malignancies.
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