Cancer of the pancreas remains a formidable challenge in oncology.
This malignancy ranks as the fourth leading cause of cancer death
in the United States in 2003, with an estimated 30,700 new cases to be
diagnosed and 30,000 deaths. Although gains have been achieved in
the clinical management of these patients, this malignancy is rarely
curable. Long-term survival is limited to patients undergoing resection.
For patients with localized but unresectable malignancy, radiation
therapy combined with fluorouracil, gemcitabine (Gemzar), or
paclitaxel has shown modest improvements in survival and symptom
palliation. However, there has been significant progress in the diagnostic
evaluation of pancreatic cancer patients, which has aided clinicians
in caring for these patients and in selecting therapies. The use of
computed tomography, endoscopic ultrasonography, and laparoscopy
techniques will be discussed. Newer techniques of radiation therapy,
such as intraoperative electron-beam radiation therapy and threedimensional
conformal radiation therapy, with the integration of new
biologically targeted agents may provide new avenues of research and
progress in this disease.