Pancreatic cancer (PC) is a very rare cancer, ranked 14th in incidence and 7th in mortality globally. In India, the pancreas ranks 24th with almost 10860 new cases and ranks 18th in death rate.
It is observed that because of the changing lifestyle, PC rates will increase in the near future. Besides this, several other factors and changing lifestyles have affected the occurrence of this disease over the years.
What is pancreatic cancer?
Pancreatic cancer starts in the tissues of the pancreas — an organ in your abdomen that lies behind the lower part of your stomach. Your pancreas releases enzymes that help in digestion . It also the produces hormones that help manage your blood sugar and various other metabolisms in the body.
Various growths can occur in the pancreas, which may include noncancerous and cancerous tumors. However, the most common type of cancer that forms in the pancreas begins in the cells in the lining of ducts that carry digestive enzymes out of the pancreas. This is called adenocarcinoma of pancreas.
Unfortunately, pancreatic cancer is not easily detected in early stages when it’s most curable. This is because it rarely presents any symptoms until it has spread to surrounding tissues.
Types of Pancreatic cancer
Two types of tumors grow in the pancreas: exocrine and endocrine tumors. Majority of all pancreatic tumors are exocrine tumors, and the most common variety of exocrine pancreatic cancer is termed adenocarcinoma.
Therefore, pancreatic adenocarcinoma is what people mean when they are talking about pancreatic cancer. As this kind of cancer begins in the ducts of the pancreas, it is also known as ductal adenocarcinoma.
The other uncommon types of the pancreatic tumors are neuroendocrine tumors (NETs), cystic tumours, pancreatoblastoma, SPEN and acinic cell tumours .
Causes of Pancreatic Cancer
Until now, no specific cause of pancreatic cancer has been identified. We still don’t know what is the exact cause of pancreatic cancer is. However, clinical research has been able to identify some risk factors.
Risk factors for pancreatic cancer
- Smoking cigarettes, and other forms of tobacco
- Drinking alcohol
- Diabetes (type 2)
- Exposure to chemicals such as the ones used in dry cleaning
- Chronic pancreatitis (inflammation of the pancreas)
- Hereditary chronic pancreatitis
- Hereditary syndromes with mutations in genes like the BRCA genes that are passed from parent to child
- Age more than 45
- Male gender is more prone than female gender
Your doctor may suspect pancreatic cancer if you have more of these risk factors or recently developed pancreatitis or diabetes.
Signs and symptoms of pancreatic cancer
Signs and symptoms of pancreatic cancer rarely show until the disease has reached the advanced stage. They may include:
- Abdominal pain
- Loss of appetite
- Yellowish discolouration of skin and the whites of your eyes
- Light-colored stools
- Dark-colored urine
- Itchy skin
- Development of diabetes
If your doctor suspects pancreatic cancer, you may have to undergo one or more of the following diagnostic tests:
Imaging tests used to diagnose pancreatic cancer include magnetic resonance imaging (MRI) with MRCP , computerized tomography (CT) scans, and positron emission tomography (PET) scans.
Endoscopic ultrasound (EUS) is a technique that uses an ultrasound device incorporated into an endoscope to get the visual of your pancreas. This device is passed down your oesophagus just like an endoscopy procedure. When the tip reaches the second part of duodenum it obtains pictures of pancreas. The characteristics of the tumor and its relation to surrounding structures can be studies in detail using EUS.
Biopsy is a procedure for removing a small tissue sample to examine under a microscope. The sample is collected by inserting a needle through your skin and into your pancreas (fine-needle aspiration/core needle biopsy). For a curative surgery biopsy is not needed in pancreatic cancer. However if radiation or chemotherapy is being considered as treatment options then biopsy becomes necessary.
Blood test. Blood tests are done for specific proteins (tumor markers) released by pancreatic cancer cells. It may also be useful in knowing how cancer responds to treatment.Ca 19-9 tumor marker is the most commonly studied one for pancreatic cancer.
If the cancer is localized, surgery forms the main part of treatment. There are three main surgical procedures sued for removing pancreatic cancer:
1. Whipple procedure
In a Whipple procedure, a surgeon removes the head , neck and uncinate process of pancreas, along with regional lymph nodes. Due to close proximity and shared blood supply whole of duodenum, lower part of stomach, distal common bile duct, first few centimeters of small intestine ( jejunum) are also removed. A modification this surgery is called PPPD – Pylorus Preserving Pancreatico Duodenectomy. In this surgery no part of stomach is resected.
2. Distal pancreatectomy
In distal pancreatectomy, the surgeon removes body and tail of pancreas with or without the spleen.
3. Total pancreatectomy
In this procedure, the surgeon removes the entire pancreas and spleen.
Therefore, diabetes may develop after this surgery as the body no longer produces insulin cells.
Most pancreatic adenocarcinomas require chemotherapy even after successful surgery. This is to prevent recurrence and prolong survival. Chemotherapy is also used in inoperable and stage 4 cancer.
Radiation therapy focuses high energy beams on the tumour. In some cases of pancreatic cancer radiation is used before surgery to shrink the tumour. It is also used after surgery in case of unsatisfactory margins. In addition, it can help relieve symptoms in the advanced stages by reducing blockage.
Although pancreatic cancer is rare, it can be extremely dangerous. It is detected in later stages as it doesn’t show any symptoms in the early stages. It is better to seek medical help as soon as you develop any symptoms of the disease.
FAQs Related To Pancreatic Cancer
Who is most likely to get pancreatic cancer?
A person is more likely to develop pancreatic cancer if they fall into the following category of risk factors.
- Age. The risk of pancreatic cancer rises with age. The chances of developing pancreatic cancer are more after the age of 45.
- Gender. Men are more susceptible to pancreatic cancer than women.
- Smoking. People who smoke and drink regularly are more likely to develop pancreatic cancer.
- Obesity and diet, and alcohol. Regularly eating foods high in fat can become a major cause of pancreatic cancer. Studies have shown that obese people are more likely to die from pancreatic cancer.
- Diabetes. Diabetes increases the overall risk of developing pancreatic cancer. In addition, suddenly developing diabetes can be a symptom of pancreatic cancer.
- Family history. Family history and genetic conditions increase the risk of developing cancer.
What is the relationship between pancreatitis and pancreatic cancer?
Pancreatitis is a condition caused by the inflammation of the pancreas, the gland that makes digestive juices and digestive hormones in the body. Long-standing pancreatitis can stimulate the growth of abnormal cells in the pancreas, forming cancer.
Will chemotherapy help pancreatic cancer?
Chemotherapy drugs used in treating pancreatic cancer:
- Gemcitabine (Gemzar)
- 5-fluorouracil (5-FU)
- Irinotecan (Camptosar)
- Oxaliplatin (Eloxatin)
- Albumin-bound paclitaxel (Abraxane)
- Capecitabine (Xeloda)
Is pancreatitis always an emergency?
Mild pancreatitis is usually treated with simple, supportive care and may need short-term hospitalization.
Although severe pancreatitis can produce life-threatening complications, like the failure of the heart, lungs, and kidneys hence, it requires more continuous monitoring and supportive care in an intensive care unit where vital signs are monitored continuously.
How long will I be in the hospital?
Your hospital stay will depend on the stage of pancreatic cancer and the treatment option chosen. It will also be based on your overall health, how your body responds to the treatment, and how soon you recover.
It may take from a few days to couple of weeks or even more.
If surgery is not a possibility, what are my treatment options?
Surgery becomes difficult in cases where cancer has spread extensively or is present at a very complex location. In such cases, other treatment options are preferred like:
- Radiation therapy: High-speed energy focused on cancer cells to kill them.
- Chemotherapy: This utilizes drugs to destroy cancer cells.
- Immunotherapy: This encourages and helps your body fight cancer.
- Targeted therapy: Directed at certain proteins or genes that cause cancer to grow. Genetic testing can be used to determine if targeted therapy is right or not.
- Clinical trials: There are several ongoing clinical trials of newer agents and therapies that treat pancreatic cancer. You may participate in one after consulting your doctor.
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Pancreatic cancer is the development of cancer cells in the ducts of the pancreas. People are often worried about the treatment of it. To know if pancreatic cancer is curable or not
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