**2. Epidemiology of the adenocarcinoma of the pancreas**

As mentioned earlier, pancreatic adenocarcinoma is one of the malignancies with worse prognosis among all solid tumors, with a small number of patients who will achieve cure after an optimal treatment, only if they have access to a good quality of cancer therapies based on specialized oncological surgeons who usually perform pancreas cancer surgery. In the United States, pancreatic cancer is the second most common malignant tumor of the gastrointestinal tract and the fourth malignancy related to cancer death in adults [1], with an estimated incidence of 48,960 new cases by 2015 and 40,560 deaths during the same year. Reported incidence and mortality are slightly higher in men than in women [2]. According to the reports of "Surveillance, Epidemiology and End Results Program" (SEER), the incidence of pancreatic adenocarcinoma is greater in males than in females (male-to-female ratio 1.3:1) and in Afro American population than in white population (14.8 per 100,000 in Afro American males compared with 8.8 per 100,000 in the general population) [3]. Worldwide, pancreatic cancer is the eighth leading cause of death related to cancer in men (138,100 deaths per year) and the ninth cause of death related to cancer among female population (per year) [4].

In some developing Latin American countries, for reasons associated with industrialization and with the increasing life expectancy, pancreatic cancer and biliary tract malignancies are becoming more frequent diseases in adult population regardless of the educational and socioeconomical level. As an example, in Chile, one of the most developed countries in South America, with an estimated population of almost 17 million inhabitants, the reported annual mortality rate for pancreatic adenocarcinoma was 5.8 for 100,000 in men and 5.6 for 100,000 in women by 2012. Curiously, due to problems with the cancer registries in Chile as in other countries of the region, the reported mortality may be higher than the reported incidence for this malignancy during the same period [5]. Despite the lack of better cancer registries, it is well known that the incidence and mortality rates are similar among patients with pancreatic cancer, and both curves get closer in low- and middle-income countries; nevertheless, in developed countries, the chance of surviving a pancreatic cancer is still low and the incidence rate is just a little higher than the mortality rate.

Assuming a correct diagnosis and a complete staging, there are different rates of mortality among pancreatic cancer patients according to the extension and probability of resection of the whole tumor. The 5-year survival for all the patients is 7.2%. The highest survival is found in 27.1% with very localized disease, but this rate dramatically decreases up to 10.7% for regional disease, and for metastatic disease, the 5-year survival is almost anecdotic with less than 2.5% of survival patients in that space of time [3].
