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About EPI in Pancreatic Cancer

What You Should Know: Exocrine Pancreatic Insufficiency (EPI) in Pancreatic Cancer

Pancreatic Cancer Overview

Pancreatic cancer is the
3rd leading
Cause of cancer-related
death in the United States1
Majority of pancreatic tumors are exocrine, most of which are adenocarcinomas2
Estimated incidence in the US: 62,200 cases3

Represents 3.2% of all new cancer cases3

Incidence: 13.3 and 11.1 per 100,000 males and females, respectively3

Etiologies of EPI in Pancreatic Cancer

Obstruction of pancreatic duct by tumors5
Pancreatic atrophy or fibrosis secondary to tumor(s)6
Complications of pancreatic resection6,7
  • Reduction of glandular tissue
  • Fibrosis in the remaining pancreatic remnant
  • Alteration of pancreatic anatomy
  • Extensive denervation following lymph node dissection

Incidence of EPI in Pancreatic Cancer

50-90% of patients with unresectable pancreatic cancer develop EPI8
In patients with resectable pancreatic cancer,
EPI occurs in 46-68% of patients prior to surgery,9-11
increasing to 55-89%of patients after surgery9,10,12,13


1. American Cancer Society. Cancer Facts & Figures 2022. https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-figures-2022.html. Accessed January 23, 2023. 2. Pancreatic Cancer Action Network. Types of pancreatic cancer. https://pancan.org/facing-pancreatic-cancer/about-pancreatic-cancer/types-of-pancreatic-cancer/. Published September 29, 2021. Accessed January 23, 2023. 3. SEER Cancer Stat Facts: Pancreatic Cancer. National Cancer Institute. Bethesda, MD, https://seer.cancer.gov/statfacts/html/pancreas.html. Accessed January 23, 2023. 4. Rahib L, Smith BD, Aizenberg R, Rosenzweig AB, Fleshman JM, Matrisian LM. Cancer Res. 2014;74(11):2913-21. 5. Vujasinovic M et al. Nutrients. 2017;9(3).pii:E183. 6. Ghaneh P, Neoptolemos J P. Ann N Y Acad Sci. 1999;880:308-318. 7. Bartel MJ, Asbun H, Stauffer J, Raimondo M. Dig Liver Dis. 2015;47(12):1013-1020. 8. Perbtani Y, Forsmark CE. F1000Res. 2019;8:F1000 Faculty Rev-1991. 9. Sikkens EC et al. Br J Sure. 2014;101(2):109-113. 10. Belyaev O, Herzog T, Chromik AM, Meurer K, Uhl W. Langenbecks Arch Surgery. 2013;398(4):547-555. 11. Matsumoto J, Traverso LW. J Gastrointest Surg. 2006;10(9);1225-1229. 12. Halloran CM et al. Pancreatology. 2011;11(6):535-545. 13. Roeyen G, Jansen M, Ruyssinck L, et al. HPB (Oxford). 2016;18(12):1017-1022.

Expert opinion on practical diagnosis and management of EPI.

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