Clinical Review

Pancreatic adenocarcinoma

BMJ 2012; 344 doi: (Published 16 May 2012) Cite this as: BMJ 2012;344:e2476
  1. Giles Bond-Smith, general and hepatopancreatic-biliary surgical registrar1,
  2. Neal Banga, general and transplant surgical registrar1,
  3. Toby M Hammond, general and colorectal surgical registrar2,
  4. Charles J Imber, consultant hepatopancreatic-biliary and liver transplant surgeon1
  1. 1Hepatopancreatic-biliary Surgery and Liver Transplant Unit, Royal Free Hospital, London NW3 2QG, UK
  2. 2Department of Surgery, St Mark’s Hospital, Harrow, Middlesex
  1. Correspondence to: G Bond-Smith gelsmith{at}
  • Accepted 30 March 2012

Summary points

  • Pancreatic cancer can present with non-specific symptoms, such as abdominal or back pain, dyspepsia, and unexplained weight loss, as well as the classic presentation of painless jaundice

  • The majority of pancreatic cancer is incurable at presentation1 2

  • Whether or not pancreatic cancer is deemed curable, current surgical, endoscopic, and oncological management regimes can significantly improve quality of life

  • Trials are currently ongoing to improve outcomes in pancreatic cancer3

In 2008, an estimated 217 000 new cases of pancreatic cancer were diagnosed worldwide, and in the UK 8000 new cases of pancreatic cancer are reported every year.4 5 6 Worldwide, pancreatic cancer is 13th in incidence but 8th in terms of cancer death.4 In the UK, pancreatic cancer is the 5th most common cause of cancer death in both sexes, despite being only the 11th most common cancer overall.7 This is largely due to red flag symptoms usually appearing only once the disease has progressed to involve other structures. Consequently, only 10-20% of patients will have resectable pancreatic cancer at presentation.7

Sources and selection criteria

We searched PubMed to identify peer reviewed original research articles, meta-analyses, and reviews. Search terms were pancreatic cancer, pancreatic adenocarcinoma, pancreatic neoplasia or neoplasm. Only papers written in English were considered.

The term pancreatic cancer encompasses both exocrine and endocrine tumours (see box 1), of which over 80% are adenocarcinomas. The aim of this review is to update the non-specialist clinician on the cause, clinical presentation, and current management of so called curable and incurable pancreatic adenocarcinomas. The main surgical options available to the patient are discussed, including the decision making process involved in considering patients for curative surgery. The potential complications and morbidity of current treatment regimes, and their management, is covered.

Box 1 Types of pancreatic cancer

Pancreatic exocrine cancers
  • Adenocarcinoma

  • Acinar cell carcinoma

  • Adenosquamous carcinoma

  • Giant cell tumour

  • Intraductal papillary mucinous …

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