The clinical assessment of pancreatic cancer

Despite many scientific advances in the past 50 years, pancreatic cancer remains one of the most deadly cancers in the United States, with a 5-year survival rate of less than 5% [1]. Pancreatic adenocarcinoma is the fourth leading cause of cancer-related death, and is second only to colorectal cancer as a cause of gastrointestinal-related cancer death [2]. The American Cancer Society predicted that 32,180 people in the United States (16,100 men and 16,080 women) would be diagnosed with, and about 31,800 would die of pancreatic cancer in 2005 [1]. The World Health Organization estimated a worldwide incidence of 216,400 cases and 213,500 deaths as a result of pancreatic cancer in 2000 [3]. Multiple factors have contributed to the poor prognosis of patients diagnosed with pancreatic cancer. 1. Due to the nonspecific nature of the symptoms and signs of pancreatic adenocarcinoma, patients are often diagnosed at a relatively advanced stage. 2. Pancreatic cancer tends to disseminate early in its natural history, and commonly during the preclinical phase of the disease [4, 5]. 3. The only definitive therapy is surgical resection since pancreatic adenocarcinoma is resistant to most medical therapy [4]; however, most are deemed unresectable at the time of diagnosis. Between 1985 and 1995, only 9% of more than 100,000 pancreatic cancer patients in the National Cancer Data Base were eligible for surgical resection [6].