Pancreatic adenocarcinoma is a type of malignancy affecting the pancreas. It is one of the cancers with the poorest prognosis, due to the fact that it is usually diagnosed at a late stage. The main symptoms include fatigue, weight loss, abdominal pain, and jaundice.
A considerable number of patients diagnosed with pancreatic cancer are simultaneously diagnosed with diabetes mellitus and nearly half of them exhibit decreased glucose tolerance  ; the inverse observation is not valid, however, in the sense that diabetes precedes pancreatic cancer almost always .
PA is a disease that is known to cause no symptomatology until it's advanced stages, which accounts for its high mortality and therapeutic failure. The symptoms it induces are also fairly non-specific and include:
The evolution of imaging modality technology has positively affected the success rates in the diagnosis of pancreatic cancer during the past years. A computerized tomography scan (CT) or a magnetic resonance imaging scan (MRI) can both be used to diagnose pancreatic cancer and stage the disease, which is a useful tool for the surgeon to develop a proper therapeutic strategy. Other modalities that can be employed include the multi-detector computed tomography (MDCT) and the endoscopic ultrasound (EUS). The latter also allows for tissue sampling, which provides the material for a histological analysis, the gold standard for a definitive diagnosis. A positron emission tomography (PET) scan can also provide useful information under some circumstances .
Depending on the cancerous progression, different therapeutic interventions can be performed. Accurate staging is required prior to the initiation of any therapeutic regime.
In general, patients with a tumor that is believed to be operable may proceed to a pancreatectomy with or without prior chemotherapy. The administration of chemotherapy is greatly affected by the accuracy of the staging process prior to surgery  . Studies have shown that the best prognosis is reserved for those patients who receive neoadjuvant chemotherapy, followed by excision of the malignant tumor . Chemotherapy also contributes to better surgical results if the patient will also need vein resection .
On the other hand, progressed disease is always initially treated with the administration of chemotherapy. Patients who are diagnosed with the metastatic disease are faced with an extremely poor prognosis, as the average survival rate ranges between 3 to 6 months. However, tumors that have locally expanded can be downstaged with the administration of chemotherapy to a size that is deemed operable; the prognosis for these patients does not differ from that of the patients who were initially considered good candidates for excision without neoadjuvant chemotherapy . The agents commonly used are Fluorouracil or Gemcitabine.
Pancreatic adenocarcinoma is usually diagnosed at an advanced stage, since in the early stages of the disease, no symptoms are usually produced. Following a pancreaticoduodenectomy, the associated mortality rate is low, approximately 2%, and greatly depends on the experience of the surgeon and the facilities it is carried out in  . Even after a successful pancreaticoduodenectomy, complications are frequently reported, including wound infection, delayed gastric emptying, fistulas, cardiac pathologies, abscesses and cholangitis .
In general, a surgical intervention aimed at the excision of the pancreatic tumor is followed by a 5-year survival rate of maximum 25%. Prognosis is adversely affected by excessive tumor expansion, poor differentiation and infiltrated lymph nodes. Mutations of the SMAD4 gene are also linked to a higher risk of metastatic disease, even after surgical excision .
Pancreatic adenocarcinoma is characterized by an etiological analysis that has yet to be clearly defined. A certain genetic background has been proposed, given that a 10% of the patients affected by it also have a family history of pancreatic malignancy  . Genes such as BRCA2, STK11, PALB2, and p16/CDKN2 have been identified as playing a role in the pathophysiology of this malignancy, as well as other low-penetrance genes     . Other risk factors that have been associated with pancreatic cancer are obesity, alcohol abuse, smoking, family history of this type of cancer and diabetes mellitus.
PA is in the top five malignancies that are accompanied by the highest mortality rates in the USA . A family history of pancreatic cancer does indeed increase the risk of malignancy in a first-degree relative of the affected person. In addition to familial cases of pancreatic cancer, first-degree relatives of patients who have been diagnosed with sporadic cancer surprisingly also have increased chances of suffering from the same disease .
Familial pancreatic cancer exhibits a poor prognosis, as it tends to lead to metastatic or synchronous malignancies in other organs and also evince a greater number of pre-neoplastic lesions  .
The pancreas is an organ situated in the upper left part of the abdomen, in the region posterior to the stomach. The duality of its function makes it a structure indispensable to the body in order to perform vital functions. It acts an exocrine gland, producing enzymes that facilitate digestion, and an endocrine gland, which partakes in the production of hormones like insulin.
The majority of pancreatic malignancies are generated at the exocrine region of the organ and nearly all of them are identified as pancreatic adenocarcinomas, a type of pancreatic cancer that is known to progress rapidly. The primary issue is that pancreatic cancer causes no symptomatology until the tumor has reached considerable dimensions and the disease is many times too advanced for any treatment option to prove successful .
PA is a type of tumor that evolves from primary lesions which may occur at various occasions during the condition's development. Some of these pre-cancerous lesions are:
Genetic factors play an important role in the evolution of pancreatic number since a series of events has been found to lead to the final malignancy status. Initially, mutations occur in the K-RAS gene of the epithelial cells in the pancreas, this results in an increased cellular reproduction, with equally increased cellular survival and invasion potential. Later on, the p16 tumor suppressor gene is inhibited, leading to a cellular architectural loss. The deactivation of p53 tumor suppressor gene, which ensues in 70% of the cases, influences apoptosis and DNA repairment procedures and both processes are hindered. The final deviation from the normal genetic pattern includes the deactivation of the SMAD4 gene, which is detected in half of the patients affected by PA. 
The consumption of foods with low-calorie count has been proven to augment the risks of developing pancreatic cancer. Therefore, every individual is advised to maintain healthy eating habits and follow a diet that contains fruit, vegetables, wholegrain products, and nuts. Consumption of these products leads to lower inflammation signalling and hinders the occurrence of vascular disorders, thus reducing the risks of pancreatic malignancy.
Pancreatic cancer usually affects the exocrine region of the organ, namely the one responsible for the production of digestive enzymes. The most common type is pancreatic adenocarcinoma (PA), a subtype that rapidly progresses. Pancreatic tumors develop on the ground of other, precursor lesions, the most common being PanINs, which stands for pancreatic intraepithelial neoplasm .
Various risk factors have been proposed to contribute to the pathogenesis of pancreatic adenocarcinoma, such as obesity, alcohol abuse, smoking, and diabetes. Even though the exact causes and pathophysiological mechanisms that underlie the disease have not yet been accurately identified, various genetic mutations occur gradually during the course of the disease evolution; each contributes to a specific type of function disruption that ultimately leads to a cancerous tumor . More specifically:
Pancreatic adenocarcinoma is asymptomatic until a progressed stage has been reached; this accounts for the delayed diagnosis and the high mortality rates that accompany the disease, even after proper treatment has been administered. The symptoms that originate from pancreatic cancer are non-typical - fatigue, weight loss, anorexia, jaundice, abdominal pain, and osphyalgia.
PA is diagnosed with imaging modalities, such as an endoscopic ultrasound, a magnetic resonance imaging scan or a computerized tomography scan of the abdomen. Depending on the location and expansion of each tumor, patients may undergo surgical resection, chemotherapy, radiation therapy or a combination of the aforementioned options.
The pancreas is an organ that is situated in the back portion of the abdomen, behind the stomach. It is responsible both for the production of enzymes that, alongside bile, help to digest food. The pancreas is a unique organ whose function cannot be substituted.
Pancreatic cancer is a frequently diagnosed type of cancer. It is one of the top 5 causes of death due to cancer in the United States and every year, it is believed that it leads approximately 250,000 patients to death. This type of malignancy is followed by such mortality rates because the initial stages of the disease lead to no symptoms. Therefore, patients only present for a medical evaluation when the disease has progressed too far; intervention is, therefore, limited and therapeutic success rates are generally low.
Pancreatic cancer usually affects the part of the pancreas that produces digestive enzymes and most cases involve a pancreatic adenocarcinoma (PA). Although its is unknown how the disease is caused or triggered, a genetic predisposition has been established. It is known that first-degree relatives of patients affected by pancreatic cancer and have a family history of the condition have a higher risk of developing the malignancy themselves when compared to the general population. Other risk factors include excessive alcohol consumption and high-calorie intake, obesity, and diabetes. Genetic mutations that occur gradually during the development of the disease have been identified but they are not the actual causes of cancer. Each genetic mutation contributes to a certain abnormality that facilitates the evolution of cancer. Pancreatic malignant tumors develop on the grounds of other, pre-existing tumors.
A patient affected by pancreatic cancer may report non-specific symptoms such as weight loss, anorexia, malnutrition, pain in the right upper side of the abdomen, back pain and jaundice. The disease is diagnosed by a radiologic depiction of the tumors, which can be achieved with an abdominal CT or MRI scan, or an endoscopic ultrasound. When performing the latter, the physician is able to take some samples which can be biopsied, so that a definitive diagnosis can be achieved. The treatment depends on how progressed the disease is. Metastasis implies that the patient cannot be operated on; such people are expected to survive for 3 to 6 more months. On the other hand, patients who can be surgically treated have a better prognosis. Surgery involves a resection of the tumor, with or without a resection of a part of the duodenum. Chemotherapy and radiation therapy are also beneficial under some circumstances.