Pancreatitis and the Risk of Cancer
Some patients diagnosed with HP or AP have a significantly increased risk of developing pancreatic cancer.
Patients with acute pancreatitis (AP) can present with epigastric abdominal pain radiating through to the back, nausea, and vomiting. The most common causes of AP include alcohol, gallstones, hypertriglyceridemia, hypercalcemia, trauma, autoimmune, infection (eg, mumps), and pancreatic cancer.
Although pancreatic cancer is a rare cause of AP, it should still be kept on the differential diagnosis for some patients.
Tummala et al retrospectively evaluated 332 patients with AP and excluded all of those with etiologies thought to be secondary to alcohol, gallstones, and post-endoscopic retrograde cholangiopancreatography (ERCP), leading to a study group of 218 patients.1 All of these patients underwent endoscopic ultrasound (EUS) with fine needle aspiration (FNA) after resolution of their AP episode.
Thirty-eight (17%) of these patients had pancreatic cancer based on EUS-FNA results. All but 1 of the patients with pancreatic cancer had at least 2 of the following: age over 50 years old, smoking history, weight loss greater than 10 pounds, alkaline phosphatase greater than 165 U/mL or total bilirubin greater than 2 mg/dL, and imaging consistent with a pancreatic mass or distal pancreatic atrophy.
Another study evaluated a relatively large cohort of patients diagnosed with AP at the Veterans Health Administration between 1998 and 2007.2 More than 5700 patients were diagnosed with AP, of whom 710 (12%) were eventually diagnosed with pancreatic cancer. About 10% of the patients who developed pancreatic cancer had an episode of AP within 2 years of the cancer diagnosis.
The risk of cancer was highest within the first year after the AP diagnosis and then significantly decreased; the authors concluded that pancreatic cancer should be considered in patients diagnosed with AP after age 40 and that the cancer diagnosis might be delayed up to 2 years.
Recurrent AP occurs in up to 22% of patients and the overall prevalence of chronic pancreatitis (CP) is approximately 10%.3 Patients with recurrent AP, however, have a 36% chance of developing CP. Once a patient develops CP, a baseline inflammation level is persistent within the pancreas, which can predispose the patient to pancreatic cancer.4