[Frontiers in Bioscience 2, d271-282, June 1, 1997]
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THE ROLE OF LANGERHANS ISLETS IN PANCREATIC DUCTAL ADENOCARCINOMA
Parviz M. Pour

The UNMC/Eppley Cancer Center, University of Nebraska Medical Center, Omaha, NE

Received 5/6/97 Accepted 6/2/97

2. INTRODUCTION

Pancreatic cancer, which has a high incidence worldwide, is a disease with poor prognosis since it evades early detection. In the United States, the disease presently accounts for 3% of all cancers responsible for 5% of all cancer deaths (1). It is the fourth most common cause of cancer death in men (exceeded only by lung, colorectal and prostatic cancers) and the fifth cause of cancer death in women (exceeded by breast, colorectal,lung and ovarian­uterine cancers). It is estimated that, in 1997, about 27,000 new cases of pancreatic cancer will be diagnosed in the United States, and 25,900 people will die of this disease (1).


Pancreatic cancer has a very poor prognosis. The overall five­year survival rate is less than 1% (2). The principal reason for this prognosis is the inability to diagnose the disease at an early, localized, and curable stage. Approximately 85­90% of all pancreatic tumors have extended beyond the pancreas or have metastasized at the time of exploratory surgery (3). Unfortunately, the etiological factor(s) of pancreatic cancer is not known and therefore prevention of this silent killer is not yet possible. Epidemiologic and experimental studies have suggested a link between pancreatic cancer and smoking (4-6), diabetes (7-10) or a high fat diet (11-17). However, it is not clear how these factors influence pancreatic cancer.

Although it is generally believed that cancers of exocrine pancreas in humans originate from ductal cells, their derivation from acinar cells has also been considered(18). Experimental results in different species point to the differences in the cell of origin of tumors induced in pancreas (19-23). Although rats primarily develop acinar cell tumors (21-22), ductal and ductular cells are believed to be the progenitor cells of pancreatic cancer in hamsters.

In this review, the potential sites of origin of pancreatic adenocarcinomas are discussed.