Editing Pancreas (section)

===Cancer===
{{Main|Pancreatic cancer}}
[[File:Pancreatic Cancer.jpg|thumb|Pancreatic cancer, shown here, most commonly occurs as an [[adenocarcinoma]] in the head of the pancreas. Because symptoms (such as skin yellowing, pain, or itch) do not occur until later in the disease, it often presents at a later [[Cancer staging|stage]] and has limited treatment options.]]
[[File:Relative incidence of pancreatic neoplasms.png|thumb|350px|Relative incidences of various pancreatic [[neoplasm]]s, with pancreatic cancers in red/pink color.<ref>{{cite journal |last1=Wang |first1=Y |last2=Miller |first2=FH |last3=Chen |first3=ZE |last4=Merrick |first4=L |last5=Mortele |first5=KJ |last6=Hoff |first6=FL | display-authors=etal| title=Diffusion-weighted MR imaging of solid and cystic lesions of the pancreas. | journal=Radiographics | year= 2011 | volume= 31 | issue= 3 | pages= E47-64 | pmid=21721197 | doi=10.1148/rg.313105174 | pmc= }}<br />Diagram by Mikael Häggström, M.D.</ref>]]
[[Pancreatic cancer]]s, particularly the most common type, pancreatic [[adenocarcinoma]], remain very difficult to treat, and are mostly diagnosed only at a stage that is too late for surgery, which is the only curative treatment.  Pancreatic cancer is rare in people younger than 40 and the [[median]] age of [[diagnosis]] is 71.<ref name=NEJM14>{{cite journal | vauthors = Ryan DP, Hong TS, Bardeesy N | title = Pancreatic adenocarcinoma | journal = The New England Journal of Medicine | volume = 371 | issue = 11 | pages = 1039–49 | date = September 2014 | pmid = 25207767 | doi = 10.1056/NEJMra1404198 }}</ref> Risk factors include chronic pancreatitis, older age, smoking, [[obesity]], [[diabetes mellitus|diabetes]], and certain rare genetic conditions including [[multiple endocrine neoplasia type 1]], [[hereditary nonpolyposis colon cancer]] and [[dysplastic nevus syndrome]] among others.{{sfn|Davidson's|2018|p=837-844}}<ref name=PDQ2014>{{cite web|title=Pancreatic Cancer Treatment (PDQ®) Patient Version|url=http://www.cancer.gov/cancertopics/pdq/treatment/pancreatic/Patient/page1/AllPages|website=National Cancer Institute|access-date=8 June 2014|date=2014-04-17}}</ref> About 25% of cases are attributable to [[tobacco smoking]],<ref>{{cite journal | vauthors = Wolfgang CL, Herman JM, Laheru DA, Klein AP, Erdek MA, Fishman EK, Hruban RH | title = Recent progress in pancreatic cancer | journal = CA: A Cancer Journal for Clinicians | volume = 63 | issue = 5 | pages = 318–48 | date = September 2013 | pmid = 23856911 | pmc = 3769458 | doi = 10.3322/caac.21190 }}</ref> while 5–10% of cases are linked to [[heredity|inherited genes]].<ref name="NEJM14" />

Pancreatic adenocarcinoma is the most common form of pancreatic cancer, and is cancer arising from the exocrine digestive part of the pancreas. Most occur in the head of the pancreas.{{sfn|Davidson's|2018|p=837-844}} Symptoms tend to arise late in the course of the cancer, when it causes abdominal pain, weight loss, or yellowing of the skin ([[jaundice]]). Jaundice occurs when the outflow of [[bile]] is blocked by the cancer. Other less common symptoms include nausea, vomiting, pancreatitis, diabetes or recurrent [[venous thrombosis]].{{sfn|Davidson's|2018|p=837-844}} Pancreatic cancer is usually diagnosed by [[medical imaging]] in the form of an [[ultrasound]] or [[CT scan]] with contrast enhancement. An [[endoscopic ultrasound]] may be used if a tumour is being considered for surgical removal, and biopsy guided by [[ERCP]] or ultrasound can be used to confirm an uncertain diagnosis.{{sfn|Davidson's|2018|p=837-844}}

Because of the late development of symptoms, most cancer presents at an advanced [[Cancer staging|stage]].{{sfn|Davidson's|2018|p=837-844}} Only 10 to 15% of tumours are suitable for surgical resection.{{sfn|Davidson's|2018|p=837-844}} {{As of|2018}}, when chemotherapy is given the [[FOLFIRINOX]] regimen containing [[fluorouracil]], [[irinotecan]], [[oxaliplatin]] and [[leucovorin]] has been shown to extend survival beyond traditional [[gemcitabine]] regimens.{{sfn|Davidson's|2018|p=837-844}} For the most part, treatment is [[palliative]], focus on the management of symptoms that develop. This may include management of [[itch]], a [[Bile duct#Drainage|choledochojejunostomy]] or the insertion of stents with [[ERCP]] to facilitate the drainage of bile, and medications to help control pain.{{sfn|Davidson's|2018|p=837-844}} In the United States pancreatic cancer is the fourth most common cause of deaths due to cancer.<ref name="PMC2504856">{{cite journal | vauthors = Hariharan D, Saied A, Kocher HM | title = Analysis of mortality rates for pancreatic cancer across the world | journal = HPB | volume = 10 | issue = 1 | pages = 58–62 | year = 2008 | pmid = 18695761 | pmc = 2504856 | doi = 10.1080/13651820701883148 }}</ref> The disease occurs more often in the developed world, which had 68% of new cases in 2012.<ref name=WCR2014>{{cite book|title=World Cancer Report 2014|date=2014|publisher=World Health Organization|isbn=978-92-832-0429-9|chapter=Chapter 5.7}}</ref> Pancreatic adenocarcinoma typically has poor outcomes with the average percentage alive for at least one and five years after [[diagnosis]] being 25% and 5% respectively.<ref name=WCR2014/><ref name="ACS-CFF-2010">{{cite web| title=American Cancer Society: Cancer Facts & Figures 2010: see page 4 for incidence estimates, and page 19 for survival percentages| url=http://www.cancer.org/acs/groups/content/@nho/documents/document/acspc-024113.pdf| archive-url=https://web.archive.org/web/20150114080100/http://www.cancer.org/acs/groups/content/%40nho/documents/document/acspc-024113.pdf| archive-date=2015-01-14}}</ref> In localized disease where the cancer is small (< 2&nbsp;cm) the number alive at five years is approximately 20%.<ref name=PDQ2014P>{{cite web|title=Pancreatic Cancer Treatment (PDQ®) Health Professional Version|url=http://www.cancer.gov/cancertopics/pdq/treatment/pancreatic/HealthProfessional/page1/AllPages|website=NCI|access-date=8 June 2014|date=2014-02-21}}</ref>

There are several types of pancreatic cancer, involving both the endocrine and exocrine tissue. The many types of [[pancreatic endocrine tumor]]s are all uncommon or rare, and have varied outlooks.  However the [[Incidence (epidemiology)|incidence]] of these cancers has been rising sharply; it is not clear to what extent this reflects increased detection, especially through [[medical imaging]], of tumors that would be very slow to develop. [[Insulinoma]]s (largely benign) and [[gastrinoma]]s are the most common types.<ref>{{cite journal | vauthors = Burns WR, Edil BH | title = Neuroendocrine pancreatic tumors: guidelines for management and update | journal = Current Treatment Options in Oncology | volume = 13 | issue = 1 | pages = 24–34 | date = March 2012 | pmid = 22198808 | doi = 10.1007/s11864-011-0172-2 | s2cid = 7329783 }}</ref>  For those with neuroendocrine cancers the number alive after five years is much better at 65%, varying considerably with type.<ref name=WCR2014/>

A [[solid pseudopapillary tumour]] is a low-grade malignant tumour of the pancreas of [[:wikt:papilla|papillary]] architecture that typically afflicts young women.<ref>{{cite journal | vauthors = Patil TB, Shrikhande SV, Kanhere HA, Saoji RR, Ramadwar MR, Shukla PJ | title = Solid pseudopapillary neoplasm of the pancreas: a single institution experience of 14 cases |doi-access=free | journal = HPB | volume = 8 | issue = 2 | pages = 148–50 | year = 2006 | pmid = 18333264 | pmc = 2131425 | doi = 10.1080/13651820510035721 }}</ref>