Epidemiologic studies of pancreatic cancer have shown little or no association with consumption of alcohol or caffeine, but implicate certain occupational exposures, cigarette smoking, and chronic pancreatitis as potential risk factors. Recent genetic studies have shown that specific cellular oncogenes such as K-ras can result in expression of altered protein products capable of transforming cells into a malignant phenotype. New or recently applied diagnostic modalities such as endoscopic ultrasonography, spiral computed tomography, and laparoscopy have improved staging efficiency, thus identifying patients most likely to benefit from surgery. Surgery continues to be the only chance for a cure, but high locoregional recurrence rates and relatively poor long-term survival rates emphasize the need for aggressive multimodality protocols integrating both radiation and chemotherapy.
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