Christine B. Brezden-Masley, MD, PhD, Staff Physician, Department of Medicine, Division of Hematology and Oncology, St. Michael’s Hospital; Assistant Professor, Department of Medicine, University of Toronto, Toronto, ON.
Monika K. Krzyzanowska, MD, MPH, Staff Physician, Department of Medical Oncology & Hematology, Princess Margaret Hospital; Assistant Professor, Department of Medicine, University of Toronto, Toronto, ON.

Pancreatic cancer is the fourth and fifth leading cause of cancer-related death for men and women, respectively (following lung, colon, and prostate cancers in men; lung, breast, colon, and ovarian cancers in women). Patients usually present with advanced disease, making curative attempts difficult. Surgery is the only curative therapy; however, local disease recurrence with or without spread to distant organs occurs in over 80% of patients. Attempts at better therapeutic modalities are necessary in order to improve outcome in this disease. This review will focus on staging, risk factors, and therapies for resectable, locally advanced, and advanced (metastatic) pancreatic cancer. Novel molecular targeted therapies will also be briefly highlighted.
Key words: pancreatic cancer, chemotherapy, radiation therapy, Whipple procedure, staging.

Dr. Carol Townsley, Clinical Research Fellow, Princess Margaret Hospital,
University Health Network, Toronto, ON.
Dr. David Hedley, Staff Medical Oncologist, Princess Margaret Hospital,
University Health Network, Toronto, ON.

Pancreatic cancer is the fourth leading cause of cancer-related death for both men and women in North America (following lung, colon and prostate/breast), and is responsible for 5% of all cancer-related deaths. At two to three percent, pancreatic adenocarcinoma has the worst overall five-year survival rate of any cancer. Due to the extreme difficulty in diagnosing pancreatic cancer when it is still surgically resectable, and because of the lack of effective systemic therapies, incidence rates are, unfortunately, virtually equal to mortality rates. Although the overall survival is quite poor, there is a subgroup of patients with slow growing tumours who may survive for several years with good symptom control.

Epidemiology and Risk Factors
An increased incidence of pancreatic cancer is seen in patients of male gender, advanced age and black race. The risk of developing pancreatic cancer is low in the first three to four decades of life but increases sharply after the age of 50 years, with most patients being between the ages of 60 and 80 at the time of diagnosis. Although exact risk factors for pancreatic cancer are not well defined, there appears to be a clear association with smoking and possibly with chronic pancreatitis.