Pancreatic cancer or adenocarcinoma is a type of cancer that occurs when mutations in DNA can cause uncontrolled growth of pancreatic cells and greater mortality than normal cells. The pancreas is a gland located behind the stomach and in front of the spine. Pancreatic cancer is usually detected at a much later stage and cannot be removed by surgery. Giovanni Battista Morgagni is the first to provide the description of pancreatic cancer in 1761. (ref2). The survival of pancreatic cancer patients even today is very low as it has a much lesser effect than conventional treatments such as chemotherapy with gemcitabine. Pancreatic cancer is a major unresolved disease, and approximately 56,770 adults are diagnosed and 30,000 die each year in the United States (ref1). There is a 3% chance of getting this disease compared to other types of cancer. (ref3) Many ongoing researchers are conducting many clinical trials to study different types of immunotherapy to find a treatment for the disease, genetically modified T cells have also been studied to treat the disease. (ref4) However, the aggressive nature of the disease remains poorly understood. Say no to plagiarism. Get a tailor-made essay on "Why Violent Video Games Shouldn't Be Banned"? Get an original essay Giovanni was not fortunate enough to have access to the microscope, which makes his diagnosis questionable, his publication “de Sedibus Et Causis Morborum Per Anatomen Indagatis Libri” Quinque” gave the first description of pancreatic cancer. However, when the microscope became more accessible in 1858, Jacob Mendez Da Costa described the first microscopic observation of adenocarcinoma. The first surgery in an attempt to remove the pancreatic tumor was attempted by William Stewart Halsted but was unsuccessful. However, Walther Carl Eduard Kausch was the first to perform a successful pancreaticoduodenectomy. Pancreatic cancer is now a safe procedure performed in many hospitals that have a low mortality rate of less than 3%. Pancreatic tumors usually show signs and symptoms in the advanced stages and not in the early stages which makes them even more fatal. Some of the symptoms of pancreatic cancer are jaundice when the head of the pancreas is small, steatorrhea, pain in the abdomen and upper back, loss of appetite, gas, indigestion and many more. The disease is usually diagnosed when brought to a doctor's attention due to symptoms. The doctor usually conducts a health examination, which includes problems such as obesity, tobacco smoking, diabetes. Many studies have been conducted to verify the environmental influence on the presence of pancreatic cancer. A large-scale case study showed an interaction between heavy smokers and the Arg399Gln polymorphism of the DNA repair gene called XRCC1. The same study showed the relationship between the GSTT1 null genotype and smoking in pancreatic cancer. (ref1-17). This shows us that the increased risk of pancreatic cancer depends on detoxification from the carcinogen and the DNA repair capacity of individuals. The K-ras mutation is even 3% higher among alcoholics than non-drinkers. K-ras mutation is the highest among all human cancers, research shows that K-ras mutation can be influenced by environmental factors. On the contrary, more research and knowledge is needed to vouch for this claim. (ref1-24) The doctor also examines the family history which includes history of pancreatic cancer, breast or ovarian cancer, Peutz-jeghers syndrome, lynching syndrome in the family. Numerous other tests such as complete blood count, blood chemistry tests, tumor marker tests,CT scans, ultra scans, MRI, ERCP, PET scan can be conducted to detect the presence of cancer cells. CT scans are the most recommended diagnostic procedure compared to ERCP due to the appearance of the biliary tree. A plastic stent implanted by an experienced gastroenterologist is recommended when the patient has a localized tumor. In advanced cases, an expandable stent is preferable. A CT-guided fine needle aspiration is then conducted to diagnose the tissue. Tumor curability is identified using dynamic thin-cut multiphase helical CT of the abdomen and pelvis. The presence of a hotspot in the K-ras gene is observed in more than 85% of patients with pancreatic cancer. Early diagnosis of the K-ras mutation can be detected by examining the patient's feces or pancreatic juice. (ref1-29) Furthermore, the tumor suppressor gene p16 and TP53 are inactivated in almost 95% of cases. (ref1-31). Growth factors and receptors such as epidermal growth factor, interleukin6, interleukin1, transforming growth factor are overexpressed by pancreatic cancer and make the cancer easily metastasize. (ref1-49). The article also shows that endothelial growth factors are present around tumors that result from various alterations in transcriptional activities. Transcription can be disturbed through two mechanisms, one due to mutations in oncogenes which are usually genetic. This may be the cause in the early stages but in the more advanced stages it is linked to stress factors such as hypoxia, acidosis and free radicals. These factors lead to metastasis and cause the death of the patient. There are several ways through which the disease can be managed, pancreatic cancer can be divided into two types: one is the localized tumor which can be removed surgically, the advanced tumor (when the mesenteric portal venous is involved) which is irrecoverable and it is also called metastatic. Curable pancreatic cancer is completely curable and has a survival rate of 20%, meaning patients can live up to 5 years, approximately 15-16% of patients have curable pancreatic cancer (ref1-69). The size and condition of the tumor can be predicted by examining the status of the lymph nodes and the status of the surgical margins. Several treatments such as chemoradiotherapy with fluorouracil, chemotherapy, the ESPAC-1 trial, and a combination of these are also recommended and being researched. The ESPAC-1 study was not fully accepted as doctors had the flexibility to also use additional treatments. The ESPAC-3 trial in which patients were given fluorouracil-based chemoradiotherapy and gemcitabine postoperatively is underway and it is hoped that this will help to understand the practice of pancreatic oncology. Locally advanced or non-resolving tumors have tumors that have moved into vascular structures such as the celic axis, mesenteric artery, or portal mesenteric vein. Tumors involved with bulky peripancreatic lymphadenopathy are also not curable. But this does not include metastatic tumors that occur in more distant locations such as the liver, chest, or peritoneum. The Gastrointestinal Tumor Study Group conducted three studies that showed that patients who received both fluorouracil and radiation had doubled survival rates. (ref1-79). However, this is not a long-term solution as within a few months patients have developed other metastatic diseases. Further research may shed light on finding a cure, but for now the survival rate of patients is generally poor. Metastatic pancreatic cancer is nearly incurable and is treated with gemcitabine. The adultsaffected by metastatic pancreatic cancer experience a lot of pain, gastric outlet obstruction, thromboembolic events. Tumor burden and performance status at presentation of gemcitabine influence survival rate. The survival rate of patients treated with gemcitabine is higher than those treated with flurouracil. When gemcitabine is incorporated into the DNA chain it leads to premature chain termination; this property of the chemical is used to treat disease. However, gemcitabine as a second-line treatment has a lower mortality rate but represents the current standard care for metastatic pancreatic cancer. Pancreatic cancer cells are differentiated in two ways that are classified based on the growth of the cancer cells, low-grade and high-grade. Low grade includes well-differentiated cells that resemble normal cells and grow at a slower rate and are less likely to be malignant. However, high grades are undifferentiated and are more likely to spread. The grade of the cells is important for planning treatment and predicting future prognosis. The TNM staging system classifies pancreatic cancer into five stages. Stage 0 may also be called in situ since the cells are usually found only on the lining of the pancreas. The next stage, Stage 1, is divided into 1a and 1b, 1a is a stage with a tumor 2 cm or smaller and 1b is a stage with a tumor larger than 2 cm but less than 4 cm. Stage 2 includes tumors larger than 2 cm in 2a and 2b includes tumors of any size and have spread to nearby lymph nodes (usually only 1-3 places). (ref5). Stage 3 is when the cancer has spread to more than 4 places near the lymph nodes. It also includes tumors that have grown outside the pancreas near blood vessels. Stage 4 is when the cancer has spread to other parts of the body and is called metastatic cancer. Adults who suffered from pancreatic cancer between October 1999 and August 2006 were evaluated, and the data was managed by the surgical oncology department. Patients who also had neoplasms, non-pancreatic tumors of the periampullary region and cystadenocarcinomas were excluded from the study. The Eastern Cooperative Oncology Group scale was used to record the performance status of patients whose detailed blood chemistry, medical history, and abdominal CT scans were evaluated for planned pancreatectomy. Patients' age was recorded at the start of the first evaluation and the presence of serum CA 19-9 was recorded for referral, but this serum was not obtained in young patients. After the initial evaluation of patients, only patients with borderline curable pancreatic cancer were included in the evaluation and were classified into three groups, Group A included patients with short, segmented superior mesenteric vein occlusion. Have one or more tumor stumps of the SMA (less than 180˚ of the circumference of the vessel). Group B included has suggestive spread of tumor but not metastasis. This group includes diseases that may be of concern for possible extrapancreatic metastatic disease. They exclude patients with N1 disease who underwent endoscopic ultrasound-guided fine-needle aspiration or laporatomy, and finally Group C includes patients who were initially treated with chemoradiotherapy, chemotherapy, or both. Patients who completed both of these preoperative treatments without disease progression were included for surgery. Group C patients were managed by a special multidisciplinary team including physicians, pancreatic dieticians,