12 Pancreatic Cancer – Clinical Course and Survival Birgir Gudjonsson MACP, FRCP, AGAF The Medical Clinic, Reykjavik, Iceland 1. Introduction The incidence of pancreatic carcinoma varies from 6-20/100.000 in different countries and ethnic groups, but is considered to be on the average 10/100.000 (Gudjonsson 1987) and causes a significant economic burden on health resources (Gudjonsson 1995, Du 2000). Cancer of the pancreas is the 13th in frequency in the USA but fourth most frequent cause of death from cancer (Jemal 2010) fifth most frequent cause of death in Japan and sixth in China. Adenocarcinoma constitutes 90% of pancreatic malignancies. Only 50% of patients in tumor registries had histologic confirmation (Gudjonsson 1987). The cause of pancreatic cancer is unclear but it is more frequent among cigarette smokers. Chronic pancreatitis leads to increased frequency. 2. Genes Mutations in K-ras genes are found in up to 90% of cases of cancer of the pancreas but are not specific and are also found in patients with chronic pancreatitis. The suppressor genes p16 and p53 are inactivated and DPC4 deleted in 50% of cases of pancreatic cancer. (Cowgill 2003). 3. Clinical features The disease is slightly more frequent among males than females. Patients may occasionally be under thirty years of age. Forty percent are between 60-70 years. Thirty percent are between 50-60 years old and twenty percent between 70-80 years old (Gudjonsson 1987). 4. Clinical features Majority of patients complain of weight loss which is on the average 10 kg. Most complain of pain, which may be deep seated, in a third of patients the pain radiates to the back, a fifth experience relief by bending forward, and 10-15% it is worsened with eating. www.intechopen.com