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Risk factors for pancreatic cancer in patients with chronic pancreatitis
Gopalakrishna Rajesh, Banavara Narasimhamurthy Girish, Suprabha Panicker, Rama P. Venu, Vallath Balakrishnan  
Department of Gastroenterology, Amrita Institute of Medical Sciences, AIMS Ponekkara P.O.
Cochin - 682 041, Kerala, India.

Corresponding Author
G. Rajesh


Background: Chronic pancreatitis (CP) especially tropical pancreatitis has been reported to be a pre-malignant condition. Recent reports indicate change in profile of CP in India with identification of novel risk factors; and delayed presentation as well as delayed onset of exocrine and endocrine insufficiency. The prevalence and characteristics of pancreatic cancer in the present setting is unknown.
Methods: We studied the prevalence and profile of pancreatic cancer among CP patients and associated risk factors.
Results: Among 1157 patients with CP enrolled and followed up prospectively in our Pancreas clinic, there were 70 (42 males, 28 females) patients who developed pancreatic cancer. Sixty (85.7%) had idiopathic/tropical chronic pancreatitis (ICP/TCP) while 10(14.3%) had alcoholic chronic pancreatitis (ACP) as underlying etiology. The mean duration to detection of cancer after diagnosis of CP was 27.4 months in ACP as compared to 36.8 months in TCP patients (p=0.134). There were only 8 patients who developed pancreatic cancer before 40 years age. Fourteen (20%) were smokers while 56 (80%) were diabetic. The tumor was located most commonly in head of pancreas in both ACP and TCP patients; however location in body and tail was less common in ACP patients. 
Conclusion: The prevalence of pancreatic cancer among CP was found to be 6.05% and it was far more common in ICP/TCP as compared to ACP. Onset of pancreatic cancer in young patients with CP appears to be uncommon in ICP/TCP in the present series. Diabetes mellitus and smoking were risk factors associated with pancreatic cancer.