Cancer originating in the tissues of the pancreas is known as pancreatic cancer. Pancreas is a horizontally lying organ within the abdomen behind the stomach's lower part. The function of pancreas is to secrete enzymes which help with digestion and also hormones which help in controlling the breakdown of sugars.
The prognosis of pancreatic cancer is usually poor, even in its early stages. Pancreatic cancer metastasizes very rapidly and is rarely caught in its early stages, thus making it the leading cause of death from cancer. Signs and symptoms of pancreatic cancer usually appear when it is at an advanced stage making it impossible to completely remove it surgically.
Stages of Pancreatic Cancer
- Stage I: In this stage, the cancer is limited to the pancreas.
- Stage II: In this stage, the cancer has spread from the pancreas to adjacent organs, tissues and lymph nodes.
- Stage III: In this stage, the cancer has metastasized beyond the pancreas to the vital blood vessels surrounding the pancreas and to the lymph nodes.
- Stage IV: In this stage, the cancer has spread to faraway sites from the pancreas, such as lungs, liver and peritoneum.
Types of Pancreatic Cancer
- Pancreatic cancer which starts in the cells lining the pancreatic ducts is known as pancreatic exocrine cancer or pancreatic adenocarcinoma.
- Pancreatic cancer starting in the cells which produce hormone is known as pancreatic endocrine cancer or islet cell cancer. This type of cancer is very rare.
Causes of Pancreatic Cancer
The cause of pancreatic cancer is not clear. Experts believe that the cancer occurs when there are any mutations in the DNA of the pancreatic cells. These mutations lead to uncontrollable growth and division of the cells which continue to live instead of dying after a specific period like normal cells. The buildup of these cells results in a mass or tumor.
Risk Factors for Pancreatic Cancer
- Individuals who are of African-American race are at a higher risk for developing pancreatic cancer.
- Being overweight.
- Chronic pancreatitis.
- Having diabetes.
- Having a family history of genetic syndromes which increase the risk of cancer such as Lynch syndrome, BRCA2 gene mutation and familial atypical mole-malignant melanoma (FAMMM).
- Family history or personal history of pancreatic cancer.
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Signs and Symptoms of Pancreatic Cancer
The symptoms of pancreatic cancer appear when it has reached an advanced stage, thus making treatment difficult and the prognosis poor.
- Pain in the upper abdomen radiating to the back.
- Jaundice, which is a yellow discoloration of the skin and the whites of the eyes.
- Appetite loss.
- Loss of weight.
- Blood clots.
Investigations for Pancreatic Cancer
- CT (Computerized Tomography) scan, Magnetic Resonance Imaging (MRI) scan and ultrasound help in visualizing the pancreas.
- Endoscopic Ultrasound (EUS) helps in generating pictures of the pancreas. Biopsy can also be obtained during this test and the tissue is sent to the lab for testing for cancer cells.
- Endoscopic Retrograde Cholangiopancreatography (ERCP) involves the use of a dye so the pancreatic bile ducts are highlighted and visualized better. X-rays are also taken and a biopsy can also be done.
- Laparoscopy helps in assessing the spread of the cancer.
- Blood tests are done to check for specific proteins, i.e. tumor markers.
Treatment for Pancreatic Cancer
The treatment for pancreatic cancer is done depending on the stage of the cancer and the location of the cancer along with the patient's age, general health and the patient's treatment preferences.
The aim of the treatment is to eliminate the cancer as much as possible and when it is possible. When removing the cancer is not possible, then doctors focus on preventing the cancer from growing or metastasizing further.
Surgery is done for removing cancer and to help relieve the symptoms and make the patient's life as much comfortable as possible.
Surgery for Pancreatic Cancer
Surgery is done if the cancer is limited to the pancreas. Surgical approaches in pancreatic cancer include:
- Whipple procedure is a surgery done if the tumor is present within the pancreatic head. This procedure is also known as pancreatoduodenectomy. This procedure constitutes removal of the head of the pancreas along with a part of the small intestine or duodenum, and a part of bile duct and gallbladder. Sometimes, a part of the stomach will be removed also. The surgeon will re-attach the remaining parts of the pancreas, intestines and stomach for digestion of food. The risks of Whipple surgery is infection and bleeding. Side effects include: Nausea, vomiting and difficulty in emptying. Recovery time from Whipple surgery is quite lengthy.
- Distal pancreatectomy is the surgery which is done for tumors present in the pancreatic body and tail. The tail of the pancreas and a small part of the body is removed. Sometimes, the spleen may also be removed. There is a risk of bleeding and infection.
Radiation Therapy for Pancreatic Cancer
Radiation therapy is a treatment which involves the use of high-energy beams, like x-rays, to kill the cancer cells. Radiation therapy can be done before or after the cancer surgery and is often done in conjunction with chemotherapy.
Chemotherapy for Pancreatic Cancer
Chemotherapy is a treatment which involves the use of drugs or chemicals to kill the cancer cells. Chemotherapy can be taken orally or injected into a vein. Patient may be given only a single chemotherapy drug or a combination of different chemotherapy drugs.
Chemotherapy can also be used in combination with radiation therapy and this is known as chemoradiation. Chemoradiation is often used for treating cancer which has spread to nearby organs to the pancreas.
Targeted Therapy for Pancreatic Cancer
Targeted therapy is a treatment which involves the use of drugs which attack only specific abnormalities in the cancer cells. Tarceva (erlotinib) is one of the targeted drugs which block the chemicals that are responsible for signaling the cancer cells to grow and divide uncontrollably. Erlotinib is often used in combination with chemotherapy to treat advanced pancreatic cancer.