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# Pancreatic Cancer: The Silent Assassin ## Introduction: Lethal Biology Pancreatic ductal adenocarcinoma (PDAC) ranks as the third leading cause of cancer death despite representing only 3% of new diagnoses. This discrepancy stems from aggressive biology: 80% present with unresectable disease, and 5-year survival remains below 10%. The tumor microenvironment creates an immunosuppressive niche that resists conventional therapies. --- ## Causes and Risk Factors: Metabolic Links ### Strong Associations - **Smoking**: 1.5-3× increased risk - **Chronic Pancreatitis**: 15× higher risk - **New-Onset Diabetes**: Manifestation of early disease - **Obesity**: BMI >30 increases risk 20% ### Genetic Syndromes - **Hereditary Pancreatitis**: PRSS1 mutations - **Familial PDAC**: CDKN2A, BRCA2, PALB2 mutations - **Peutz-Jeghers Syndrome**: STK11 mutations --- ## Prevention Strategies: Targeting High-Risk Cohorts ### Surveillance Protocol for High-Risk Individuals ```mermaid graph LR A[High-Risk Criteria] --> B[Baseline MRI/MRCP] B --> C{Abnormal?} C -->|Yes| D[EUS with FNA] C -->|No| E[Annual MRI + CA19-9] D --> F[Management per findings]