Copyright ©The Author(s) 2018.
World J Gastroenterol. Nov 21, 2018; 24(43): 4846-4861
Published online Nov 21, 2018. doi: 10.3748/wjg.v24.i43.4846
Table 1 Summary of modifiable risk factors associated with pancreatic cancer
FactorDirection of associationStrength of associationType of studies conductedRelated notable findingsRef.
SmokingPositiveStrong association; 74% increased risk in current smokers; 20% increased risk in former smokersCase-control, cohort, nested case-control studiesDose responsive; risk remains 10-20 yr following smoking cessation[18-20]
AlcoholMixed between no association and positiveVarious; 15%-43% increased risk in meta-analysisMeta-analysis of cohort studiesDose responsive; sex dependent; Increased risk in spirit drinkers; link with chronic pancreatitis which is a risk factor for pancreatic cancer[9,21-24]
ObesityPositive10% increased risk for every 5 BMI unitsCohort studiesLink with Type 2 diabetes which is associated with increased risk of pancreatic cancer[25]
Dietary factorsVariableNon-significant positive association for red meat; 17% increased risk associated with 50 g/d of processed meat consumption compared to 20 g/dCohort studiesOverall consensus cannot be made and further research is required[25]
Helicobacter pyloriPositive45% increased riskMeta-analysis of case-control studiesSignificant publication bias and small numbers included therefore further studies are required[26]
Table 2 Range of increased relative risk of pancreatic cancer associated with specific syndromes as summarised by Chen et al[30] and Del Chiaro et al[31]
GeneSyndromeIncrease relative risk vs general population
Chen et al[30]Del Chiaro et al[31]
BRCA2Hereditary breast and ovarian cancer2.2-5.9
STK11Peutz-Jeghers syndrome76.2-139.0132.0
PRSS1Hereditary pancreatitis53-8750-70
CDKN2AFamilial atypical multiple mole melanoma14.8-80.034-39
MMRHereditary nonpolyposis colorectal cancer0.0-10.74.7
Table 3 Summary of impact of dietary factors, nutrition and physical activity on pancreatic cancer risk
Diet, nutrition, physical activity and pancreatic cancer
Decreases riskIncreases risk
Strong evidenceConvincingBody fatness
ProbableAdult attained height
Limited evidenceLimited - suggestiveRed meat, Processed meat; alcoholic drinks (heavier drinking); foods and beverages containing fructose; foods containing saturated fatty acids
Limited - no conclusionPhysical activity; fruits; vegetables; folate; fish; eggs; tea; soft drinks; coffee; carbohydrates; sucrose; glycaemic index; glycaemic load; total fat; monounsaturated fat; polyunsaturated fats; dietary cholesterol; vitamin C; and multivitamin/mineral supplements
Strong evidenceSubstantial effect on risk unlikely
Table 4 Summary of the different subtypes of pancreatic ductal adenocarcinoma[52]
Morphological VariantCharacteristics
Adenosquamous carcinomaSignificant components of ductal/glandular and squamous differentiation (at least 30%). Considered to have a worse prognosis than pancreatic adenocarcinoma.
Colloid/mucinous carcinomaProduction of copious amounts of extracellular stromal mucin. Most arise in association with intraductal papillary mucinous neoplasms; thought to have more favourable prognosis than pancreatic adenocarcinoma
Undifferentiated/anaplastic carcinomaMinimal or no differentiation; highly atypical cells which may appear spindle shaped or sarcomatoid, often admixed with osteoclast-like giant cells. One of the most aggressive forms of pancreatic cancer with extremely poor survival rates
Signet ring cell carcinomaDiscohesive, singly invasive cells with intracytoplasmic mucin that may displace the nucleus. Similar tumours throughout the gastrointestinal tract. Very rare form of pancreatic cancer with prognosis similar to that of pancreatic adenocarcinoma
Medullary carcinomaSyncytial arrangement of pleomorphic epithelial cells with associated intratumoral lymphoid infiltrate. Prognosis is slightly better than pancreatic adenocarcinoma
Hepatoid carcinomaMorphological similarity to hepatocellular carcinoma. May produce bile. Very rare tumour with a poor prognosis similar to that of pancreatic adenocarcinoma