In a case series of 228 patients, positive peritoneal cytology had a positive predictive value of 94%, specificity of 98%, and sensitivity of 25% for determining unresectability.
No tumor-specific markers exist for pancreatic cancer; markers such as serum cancer antigen (CA) 19-9 have low specificity. Most patients with pancreatic cancer will have an elevated CA 19-9 at diagnosis. Following or during definitive therapy, the increase of CA 19-9 levels may identify patients with progressive tumor growth.[Level of evidence: 3iDiii] The presence of a normal CA 19-9, however, does not preclude recurrence.
Prognosis and Survival
The primary factors that influence prognosis are:
- Whether the tumor is localized and can be completely resected.
- Whether the tumor has spread to lymph nodes or elsewhere.
Exocrine pancreatic cancer is rarely curable and has an overall survival (OS) rate of less than 6%.
The highest cure rate occurs if the tumor is truly localized to the pancreas; however, this stage of disease accounts for less than 20% of cases. For patients with localized disease and small cancers (<2 cm) with no lymph node metastases and no extension beyond the capsule of the pancreas, complete surgical resection is associated with an actuarial 5-year survival rate of 18% to 24%.[Level of evidence: 3iA]
Surgical resection is the mainstay of curative treatment and provides a survival benefit in patients with small, localized pancreatic tumors. Patients with unresectable, metastatic, or recurrent disease are unlikely to benefit from surgical resection.
Pancreatic tumors are resistant to treatment with chemotherapy and radiation.
Patients with any stage of pancreatic cancer can appropriately be considered candidates for clinical trials because of the poor response to chemotherapy, radiation therapy, and surgery as conventionally used.
Palliation of symptoms may be achieved with conventional treatment.
Palliative measures that may improve quality of life while not affecting OS include the following:[12,13]
- Surgical or radiologic biliary decompression.
- Relief of gastric outlet obstruction.
- Pain control.
- Psychological care to address the potentially disabling psychological events associated with the diagnosis and treatment of pancreatic cancer.