Neoplasms of the Exocrine Pancreas

Abstract

Overview Pancreatic cancer is largely preventable with healthier lifestyle choices perhaps to include a predominantly plant‐based diet. Currently, about 10% of patients have germline mutations putting them at increased risk for pancreatic cancer. Population‐wide reductions in smoking, obesity, and diabetes will probably increase the proportion of patients with genetically driven disease, expanding the options for precision medicine. Pancreatic cancer is notorious for local invasion and metastatic dissemination and treatment paradigms must account for both. Surgical resection of localized disease provides the only meaningful chance for cure, with improvements in survival seen using both adjuvant and neoadjuvant approaches. Cytotoxic therapy is the mainstay of treatment for locally advanced and metastatic disease. The role of radiation is in evolution. Small subsets of patients are benefiting from precision medicine using targeted treatments and immunotherapy.