Treatment of Pancreatic Carcinoma: Therapeutic Nihilism?

Abstract

The incidence of pancreatic carcinoma is rising in Western countries and it now ranks fourth in causes of cancer deaths. The disease is highly lethal and the vast majority of patients die within 1 year of diagnosis. Overall survival at 3 years is practically zero [1]. The diagnosis of adenocarcinoma of the pancreas is most often made when the disease is already far advanced. It tends to spread rapidly intra-ab-dominally and can be called the silent killer of the upper abdomen as opposed to ovarian carcinoma, the silent killer of the lower abdomen. Theoretically, surgery offers the best hope for cure, but only a very small minority of patients are resectable for cure, and the survival of these patients after 3 years drops to about 15%. Nevertheless, this survival is better than that with any other method of treatment. It is clear that all patients must be carefully evaluated as candidates for curative surgery. Although only a small minority of the patients will be resectable for cure, these patients are the only ones with a potential for long-term survival. During the past 10 years new diagnostic facilities such as echography, computerized tomography (CT) and endoscopic retrograde studies (ERCP) have been developed, but to date this enhanced ability to detect earlier disease has not changed the dismal outlook. The outcome for a patient for whom no therapeutic attempts are made is death within a very short time. To accept this outcome does not follow the best concepts of medicine. Palliation and improvement of survival for patients with advanced disease with other treatment modalities (i.e., irradiation, chemotherapy) must be continuously pursued.