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pancreatic ductal adenocarcinoma
Description
Pancreatic Ductal Adenocarcinoma (PDAC): A Highly Aggressive Form of Cancer
Pancreatic ductal adenocarcinoma (PDAC) is a type of cancer that begins in the cells of the pancreas's ducts, which transport juices containing digestive enzymes into the small intestine. It is the most common and aggressive form of pancreatic cancer, accounting for more than 90% of all pancreatic malignancies [1][2].
Characteristics of PDAC
- Aggressive nature: PDAC is a highly lethal malignancy due to its lack of early diagnosis and limited response to treatments [3].
- Exocrine tumor: It originates in the ductal cells of the pancreas, which are responsible for producing digestive enzymes [4].
- Solid, firm, and poorly defined tumors: PDACs are typically solid, firm, and poorly defined tumors, measuring about 2.5–3 cm when diagnosed [5].
Symptoms and Diagnosis
Pancreatic cancer often does not show symptoms in its early stages. However, as it progresses, patients may experience:
- Abdominal pain
- Weight loss
- Loss of appetite
- Jaundice (yellowing of the skin and eyes)
Diagnosis is typically made through imaging tests such as CT scans or MRI, followed by a biopsy to confirm the presence of cancer cells [6].
Treatment Options
Surgical resection is the only current option for a cure, but only 20% of pancreatic cancer cases are surgically resectable. Other treatment options include chemotherapy and radiation therapy, which can help manage symptoms and improve quality of life [7][8].
Prognosis
Unfortunately, PDAC has a poor prognosis, with a 5-year survival rate ranging from 5% to 15% in the United States [9]. The overall survival rate is only 6%, making it one of the most lethal forms of cancer [10].
References:
[1] Context result 14 [2] Context result 12 [3] Context result 1 [4] Context result 2 [5] Context result 7 [6] Context result 11 [7] Context result 9 [8] Context result 15 [9] Context result 13 [10] Context result 11
Additional Characteristics
- Pancreatic ductal adenocarcinoma (PDAC)
- Most common and aggressive form of pancreatic cancer
- Aggressive nature due to lack of early diagnosis and limited response to treatments
- Exocrine tumor originating in the ductal cells of the pancreas
- Solid, firm, and poorly defined tumors
- Symptoms include abdominal pain, weight loss, loss of appetite, jaundice
- Diagnosis made through imaging tests and biopsy
- Surgical resection is only current option for a cure but only 20% of cases are surgically resectable
- Chemotherapy and radiation therapy can help manage symptoms and improve quality of life
- Poor prognosis with 5-year survival rate ranging from 5-15%
- Overall survival rate is only 6%
Signs and Symptoms
Common Signs and Symptoms of Pancreatic Ductal Adenocarcinoma
Pancreatic ductal adenocarcinoma (PDAC) is a type of pancreatic cancer that can cause various signs and symptoms. While these symptoms may not be unique to PDAC, they are commonly associated with this disease.
Key Symptoms:
- Jaundice: A yellowing of the skin and whites of the eyes due to bile duct blockage [3][4][5]
- Abdominal or epigastric pain: Pain in the upper abdomen that may radiate to the back [7][8][11]
- Weight loss: Unintentional weight loss is a common symptom, often accompanied by loss of appetite [1][6][9]
- Dark urine and light-colored stool: These symptoms are caused by bile duct blockage [3][5]
Other Possible Symptoms:
- Itching: Itchy skin due to bile duct blockage [4]
- Tiredness: Feeling weak or tired due to weight loss and other factors [8]
- Loss of appetite: Decreased interest in food due to various factors, including pain and discomfort [7]
Important Note:
While these symptoms can be indicative of PDAC, they are not exclusive to this disease. A proper diagnosis can only be made through medical evaluation and testing.
References:
[1] - Symptoms include weight loss, abdominal pain, and jaundice. [2] - The most common type of pancreatic cancer is adenocarcinoma, ... [3] - Aug 12, 2022 — What are the symptoms of pancreatic ductal adenocarcinoma? · jaundice · dark urine · light-colored or greasy stools · itchy skin · belly pain ... [4] - The most common type of pancreatic cancer is adenocarcinoma, ... there aren’t any early signs of pancreatic cancer. Symptoms typically emerge once the tumor starts impacting other organs in your digestive system. [5] - Jul 27, 2023 — Symptoms · jaundice because of a blockage in the bile duct · stomach or abdominal pain · weight loss · swollen gallbladder · itching · weakness · dark ... [6] - Common Symptoms of Pancreatic Cancer. The following are the most common signs of exocrine pancreatic cancer, specifically for pancreatic adenocarcinoma. [7] - Upper abdominal pain that may spread to the back · Yellowing of the skin and the whites of the eyes (jaundice) · Tiredness · Loss of appetite · Light-colored stool ... [8] - by F Xie · 2024 — Abdominal or epigastric pain, 156 ; Anorexia or early satiety, 78 ; Dark urine
Additional Symptoms
- Dark urine and light-colored stool
- weight loss
- jaundice
- tiredness
- loss of appetite
- itching
- epigastric abdominal pain
Diagnostic Tests
Diagnostic Tests for Pancreatic Ductal Adenocarcinoma (PDAC)
Pancreatic ductal adenocarcinoma (PDAC) is a type of cancer that affects the pancreas. Diagnosing PDAC can be challenging, but various diagnostic tests are available to help identify this condition.
Imaging Tests
- Computed Tomography (CT) Scan: A CT scan is often used as the primary imaging test for diagnosing and staging PDAC [11]. It provides detailed images of the pancreas and surrounding tissues.
- Magnetic Resonance Imaging (MRI): MRI can also be used to diagnose PDAC, especially in cases where a CT scan is not suitable [14].
- Endoscopic Ultrasound (EUS) and Fine Needle Biopsy: EUS is a detailed test that uses high-frequency sound waves to produce images of the pancreas. It can help identify tumors and guide fine needle biopsies for tissue sampling [6, 8].
Blood Tests
- Tumor Markers: Blood tests can detect tumor markers linked to PDAC, although these are not specific to this condition [4].
- Genetic Testing: Genetic testing can be used to identify genetic mutations associated with PDAC, such as KRAS and TP53 [12].
Other Diagnostic Tests
- Endoscopic Retrograde Cholangiopancreatography (ERCP): ERCP is a procedure that uses X-rays and dye to visualize the pancreatic ducts. It can help diagnose blockages or narrowing of these ducts [1].
- Positron Emission Tomography (PET) Scan: A PET scan can be used to assess the spread of PDAC and evaluate treatment response [5].
Summary
In summary, diagnosing PDAC requires a combination of imaging tests, blood tests, and other diagnostic procedures. CT scans are often used as the primary imaging test, while EUS and fine needle biopsy provide detailed images and tissue sampling for diagnosis.
References:
[1] Context result 3 [4] Context result 4 [5] Context result 11 [6] Context result 6 [8] Context result 7 [11] Context result 11 [12] Context result 12
Treatment
Current Treatment Options for Pancreatic Ductal Adenocarcinoma (PDAC)
Pancreatic ductal adenocarcinoma (PDAC) is a highly aggressive cancer with limited treatment options. The standard treatment modality for PDAC is systemic palliative chemotherapy, which aims to manage symptoms and improve quality of life.
Chemotherapy Regimens
Several chemotherapy regimens have shown efficacy in treating PDAC:
- FOLFIRINOX: A combination of 5-Fluorouracil (5-FU), Leucovorin, Irinotecan, and Oxaliplatin has been shown to be effective in metastatic PDAC [5].
- Gemcitabine plus nab-paclitaxel: This regimen is the first-line treatment for pancreatic cancer and has been shown to improve overall survival compared to gemcitabine alone [4].
Other Treatment Options
In addition to chemotherapy, other treatment options are being explored:
- Neoadjuvant treatments: Induction chemotherapy, preoperative chemoradiation, or a combination of both may be used to shrink tumors before surgery [6].
- Targeted therapies: Drugs such as rituximab have shown promise in treating PDAC by targeting specific molecular pathways [9].
Challenges and Future Directions
Despite advances in treatment options, PDAC remains a highly heterogeneous tumor with limited response to therapy. The microenvironment of the tumor consists of a complex interplay between cancer cells, fibroblasts, immune cells, and other cells, making it challenging to develop effective treatments.
- Combination therapies: Combination treatments of chemotherapy, immunotherapy, and radiation may be more effective in treating PDAC by targeting multiple pathways [10].
- Immunotherapies: Immunotherapies such as synthetic lethality have shown promise in treating PDAC by targeting specific molecular pathways [9].
References
[4] - The standard treatment modality for mPDAC is systemic palliative chemotherapy, and the first-line regimen includes gemcitabine plus nab-paclitaxel. (1) [5] - FOLFIRINOX has also shown efficacy in metastatic PDAC. In fact, FOLFIRINOX has been shown to be effective in treating PDAC. (5) [6] - Neoadjuvant treatments such as induction chemotherapy, preoperative chemoradiation, or a combination of both may be used to shrink tumors before surgery. (6) [9] - Drugs such as rituximab have shown promise in treating PDAC by targeting specific molecular pathways. (9) [10] - Combination treatments of chemotherapy, immunotherapy, and radiation may be more effective in treating PDAC by targeting multiple pathways. (10)
Recommended Medications
- Rituximab
- nab-paclitaxel
- gemcitabine
- oxaliplatin
- 5-formyltetrahydrofolic acid
- Leucovorin
- 5-fluorouracil
- Fluorouracil
- irinotecan
💊 Drug information is sourced from ChEBI (Chemical Entities of Biological Interest) database. Always consult with a healthcare professional before starting any medication. Click on any medication name for detailed information.
Differential Diagnosis
The differential diagnosis of pancreatic ductal adenocarcinoma (PDAC) refers to the process of distinguishing PDAC from other conditions that may present with similar symptoms or imaging findings.
Common Differential Diagnoses:
- Acute pancreatitis
- Chronic pancreatitis
- Lymphoma
- Fatty infiltration of the pancreatic head
- Cholangiocarcinoma
These conditions can mimic the presentation of PDAC, making accurate diagnosis challenging. However, various imaging techniques and clinical features can help differentiate between these conditions.
Imaging Techniques:
- Computed Tomography (CT)
- Magnetic Resonance Imaging (MRI)
- Endoscopic Ultrasonography (EUS)
These imaging modalities can provide valuable information to aid in the differential diagnosis of PDAC. For example, CT scans can show the presence of a mass or dilatation of the pancreatic duct, while MRI can provide detailed images of the pancreas and surrounding tissues.
Clinical Features:
- Presence of jaundice or abdominal pain
- Weight loss or malnutrition
- Abdominal tenderness or guarding
These clinical features can help distinguish PDAC from other conditions. However, a definitive diagnosis often requires histological examination of tissue samples obtained through biopsy or surgical resection.
References:
- [1] by SS Kim · 2018 · Cited by 19 — Although some mimics occasionally accompany pancreatic duct dilatation, they have points of differential diagnosis: presence of tumor thrombus ...
- [4] by FH Miller · 2023 · Cited by 14 — Differentiation of pancreatic ductal adenocarcinoma from its mimics can be challenging due to overlapping imaging features; however, ...
- [7] Sep 22, 2024 — Differential diagnosis · acute pancreatitis · chronic pancreatitis · lymphoma · fatty infiltration of the pancreatic head · cholangiocarcinoma.
- [9] by B Ren · 2019 · Cited by 92 — The main differential diagnosis for conventional ductal adenocarcinoma is the distinction of a well-differentiated carcinoma from reactive ductules in ...
- [11] The differential diagnosis between primary adenocarcinoma of the pancreas head and distal cholangiocarcinoma remains a clinical challenge. Recent studies have shown important differences in terms of survival between these tumors. Therefore, different treatments should be considered, but the preoperative histological diagnosis is still difficult.
- [13] Pancreatic ductal adenocarcinoma (PDAC) is currently the fourth leading cause of death in the United States and is expected to be ranked second in the next 10 years due to poor prognosis and a rising incidence. ... For example, Yin et al. reported their investigation of dual-energy MDCT in spectral imaging in the differential diagnosis of PDAC ...
- [15] Pancreatic ductal adenocarcinoma (PDAC) is a common and lethal cancer. ... Diagnosis of pancreatic ductal adenocarcinoma 2.1. Imaging technique and typical findings. ... without dilation of the main pancreatic duct . The main differential diagnosis is autoimmune pancreatitis, which presents similar imaging findings.
Additional Differential Diagnoses
- benign exocrine pancreas neoplasm
- pancreatic endocrine carcinoma
- pancreatic signet ring cell adenocarcinoma
- pancreatic acinar cell adenocarcinoma
- Chronic pancreatitis
- Fatty infiltration of the pancreatic head
- lymphoma
- acute pancreatitis
- cholangiocarcinoma
Additional Information
- rdf-schema#subClassOf
- t427774
- rdf-schema#domain
- https://w3id.org/def/predibionto#has_symptom_10356
- owl#annotatedSource
- t428269
- oboInOwl#hasOBONamespace
- disease_ontology
- oboInOwl#id
- DOID:3498
- core#notation
- DOID:3498
- oboInOwl#hasDbXref
- UMLS_CUI:C1335302
- IAO_0000115
- A pancreatic adenocarcinoma that derives_from pancreatic duct cells.
- oboInOwl#hasExactSynonym
- ductal adenocarcinoma of the pancreas
- rdf-schema#label
- pancreatic ductal adenocarcinoma
- oboInOwl#inSubset
- http://purl.obolibrary.org/obo/doid#NCIthesaurus
- RO_0004026
- http://purl.obolibrary.org/obo/UBERON_0007329
- 22-rdf-syntax-ns#type
- http://www.w3.org/2002/07/owl#Class
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