Overview of Pancreatic Adenocarcinoma

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Pancreatic adenocarcinoma remains one of the most lethal cancers in the United States, with approximately 68,000 new cases expected in 2025 and ranking among the top 3 causes of cancer-related deaths. This case presentation by Farshid Dayyani, MD, from the University of California, Irvine, features a 58-year-old man with classic symptoms, including 10-lb weight loss, abdominal pain, and decreased appetite. The patient’s medical history included well-controlled atrial fibrillation, hypertension, and type 2 diabetes, with no family history of malignancies.

Diagnostic workup revealed a 6 × 4–cm pancreatic head mass abutting the inferior stomach margin, confirmed as adenocarcinoma through biopsy. Genetic testing showed KRAS wild-type tumor with no germline BRCA mutations. Laboratory findings included significantly elevated CA 19-9 levels at 2300 IU/mL, elevated bilirubin at 3.6 mg/dL, and moderately elevated liver (alanine aminotransferase, 98 U/L; aspartate aminotransferase, 88 U/L; alkaline phosphatase, 400 U/L), indicating biliary obstruction.

The prognosis for pancreatic adenocarcinoma remains poor, with an overall 5-year survival rate of only 13.3% for all stages combined. For advanced disease specifically, survival rates drop below 5%. Most patients present with unresectable disease due to the lack of effective screening methods. Treatment approaches for locally advanced pancreatic cancer mirror those used for metastatic disease, focusing on systemic chemotherapy with potential radiation consolidation for select patients who demonstrate response.