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Pancreatic Cancer

The pancreas is a 6-inch-long gland and lies between the stomach and the spine. The pancreas makes juices that help digest food and produce hormones like glucagon and insulin that help in controlling blood sugar levels.

Generally, healthy cells grow and expire in moderate numbers. However, during cancer, there is an increased amount of abnormal production of cells, and these cells gradually take over the healthy cells.

 

What are the symptoms of pancreatic cancer?

Pancreatic cancer may not show early signs and symptoms. Check with your doctor in case you experience any of the symptoms:

  • Skin and whites of the eyes become yellow (Jaundice).
  • Pale stools.
  • Dark-colored urine.
  • Pain experienced in the upper or middle abdomen and back.
  • Unintended weight loss.
  • Loss of appetite.
  • Lethargy.

 

 

 

What causes pancreatic cancer, and who is at risk?

The exact cause of pancreatic cancer is unknown. However, certain risk factors will increase the chances of pancreatic cancer.

  • Smoking.
  • Being highly overweight.
  • Personal history of chronic pancreatitis or diabetes.
  • Family history of pancreatic cancer or pancreatitis.
  • Certain hereditary conditions like :
  • Multiple endocrine neoplasia type 1 (MEN1) syndrome.
  • Peutz-Jeghers syndrome.
  • Hereditary breast and ovarian cancer syndrome.
  • Familial atypical multiple mole melanoma (FAMMM) syndrome.
  • Ataxia-telangiectasia.
  • Hereditary nonpolyposis colon cancer (HNPCC; Lynch syndrome).
  • Von Hippel-Lindau syndrome.

 

 

How is pancreatic cancer diagnosed?

Pancreatic cancers are challenging to diagnose in the early stages.  When you visit the doctor with symptoms, he will examine you to identify the problem.

Physical examination: The doctor will take your health history, including eating habits, past illness, etc. He will do a physical check-up and look for signs of the disease, such as lumps or anything unusual.

 

Based on the observations from the physical examination, he will suggest some tests that will help confirm the diagnosis.

Biopsy: In this procedure, a sample tissue is taken from the tumor site and sent to the laboratory to look for any cancer cells. There are various ways to do a biopsy like core biopsy, fine needle aspiration (FNA), etc.

Blood chemistry studies: The doctor may recommend a blood test to measure the amounts of certain substances, such as bilirubin, released into the blood by organs and tissues in the body.  Any abnormality can be a sign of disease.

Tumor marker test: In this procedure, a urine sample, blood, or tissue is taken to measure the amounts of certain substances, such as CA19-9 and carcinoembryonic antigen (CEA), made by tissues, organs, or tumor cells in the body. Certain substances are linked to specific cancer types when found in high levels in the body, and they are called tumor markers.

Abdominal ultrasound: This procedure, with the help of sound waves, creates a picture of the internal organs in the abdomen to look for any signs of the spread of cancer.

Endoscopic ultrasound (EUS): In this procedure, an endoscope is inserted into the body, through the mouth or rectum. A probe located at the end of the endoscope is used to bounce high-energy sound waves off tissues and internal organs and make echoes. This procedure is also called endosonography.

Endoscopic retrograde cholangiopancreatography (ERCP): This procedure is used to x-ray the ducts (tubes), which take bile from the liver to the gallbladder and then to the small intestine. Pancreatic cancer sometimes leads to narrowing of these ducts and block or slow bile flow, causing jaundice. This procedure helps in finding the abnormality.

Laparoscopy: It is a surgical procedure to look inside the organs to check for signs of disease. Minor cuts are made in the stomach wall, and a thin, lighted tube (laparoscope) is inserted into one of the incisions. This procedure helps see any abnormality, and sometimes some tissue samples are also taken from the pancreas to check for cancer.

 

What are the next steps after confirmation of cancer?

After confirmation of cancer, your doctor may ask you to go for additional tests to determine the spread of the tumor to the lymph nodes or other areas of your body. These tests also help in determining the grade of cancer. These tests may include:

 

CT scan: This test uses a special dye medium that helps with a clear image of the body parts from different angles. It can help in seeing detailed images of soft tissue and blood vessels. CT scan is used to measure the tumor size and helps look for the spread of the tumor to different body organs.

Magnetic resonance imaging (MRI): An MRI uses magnetic fields to produce detailed body images. It helps in measuring the size of the tumor and also to look for the spread of cancer.

Chest X-ray: X-ray uses a small amount of radiation to create a picture of the structures inside of the body. It helps the doctors to find out if cancer has spread to the lungs.

Positron emission tomography (PET) or PET-CT scan: A PET scan uses a small amount of radioactive sugar substance, which is injected into the patient's body. This sugar substance is then used by cells, and a scanner then detects this substance to make images of the organs inside of the body.

 

 

What are the stages of pancreatic cancer?

  • Stage 0: Abnormal cells are present in the lining of the pancreas, which may become cancerous and spread into nearby normal tissue.
  • Stage I: Cancer is present in the pancreas only. This stage has been bifurcated into two stages;
  • Stage IA: The tumor size is 2 cm or smaller.
  • Stage IB: The tumor size is greater than 2 cm but not larger than 4cm.
  • Stage II: Tumor is present in the pancreas but may have spread to lymph nodes.
  • Stage IIA: The tumor size is larger than 4 cm.
  • Stage IIB: The tumor can be of any size and has spread to one to three nearby lymph nodes.
  • Stage III: Cancer can be of any size, and cancer has spread to either of the below-mentioned areas:
  • Four or more nearby lymph nodes.
  • The major blood vessels near the pancreas. These include the common hepatic artery, portal vein, celiac axis (trunk), and superior mesenteric artery.
  • Stage IV: The tumor is any size, and cancer has spread to other organs like the lung, liver, or abdomen.

 

 

 

How is pancreatic cancer treated?

Management of pancreatic cancer depends on many factors like the stage of the disease, the patient's age, and his overall health. A combination of treatments like surgery, immunotherapy,  radiation therapy, and chemotherapy is planned for patients which are best suited for them.

  • Surgery: Surgery for pancreatic cancer depends upon the size and the location of the tumor. There are various surgical procedures done depending upon the stage of cancer. Surgery may not be a suitable option for patients with advanced-stage pancreatic cancer.
  • Radiation therapy: Radiation therapy utilises high-energy x-rays or other types of radiation to kill cancer cells. Radiation therapy can be used in a targeted area or whole body; the doctor carefully directs the energy to the affected area that focuses on killing the cancer cells.
  • Chemotherapy: Chemotherapy uses drugs that stop the cancer cells from multiplying, either by killing the cancer cells or by inhibiting them from multiplying. These drugs are administered through the vein or can be given in the form of pills. Capecitabine, Erlotinib, and Gemcitabine are some common food and drug administration (FDA) approved drugs used to treat pancreatic cancers.
  • Targeted therapy: This treatment uses drugs and other substances that identify and attack the cancer cells. As this treatment focuses on cancer cells, it is less harmful in comparison to radiation and chemotherapy. Erlotinib is approved by the FDA for the treatment of patients with advanced pancreatic cancer in combination with the chemotherapy drug Gemcitabine.
  • Immunotherapy: In this procedure, the patient's own immune system is used as a tool to fight against the disease. Substances that boost the immunity of a person are made in the laboratory and then used to enhance the person's immunity to help fight cancer. This treatment is also known as biological therapy or biotherapy. Immune checkpoint inhibitors, which include anti-PD-1 antibodies such as Pembrolizumab, are an option for treating pancreatic cancers.

 

What to expect after pancreatic surgery?

 

After pancreatic surgery, patients have to stay in the hospital on an average of 3-10 days. This is the time where your body is in the recovery phase. You may experience some complications like pain and discomfort around the incision that will be managed by pain medications, and it will gradually heal.

Once discharged from the hospital, the pain will be managed by the oral medications prescribed by your doctor. Full recovery from pancreatic surgery can take two months or longer. After the first 2 months of regular postoperative evaluations with your doctor, the frequency of the follow-up evaluations will be reduced to every 3-6 months. Most patients need a course of chemotherapy after their operation, known as adjuvant chemotherapy.

 

After pancreatic surgery, you may experience difficulty in eating or nausea, vomiting, or heartburn. You need to take small, frequent meals/snacks every three hours. Consult the dietician, and they will give you a proper diet plan. It is essential to remember to drink fluids between meals to stay hydrated.

 

What is the survival rate of pancreatic cancer?

The survival rate of the patient depends on the factors like type and stage of cancer.

  • 5-year survival rate for patients with localized (cancer is limited to the area where it has started) cancer is 39%.
  • 5-year survival rate for patients with regional (cancer has spread to the nearby lymph nodes) cancer is 13%.
  • 5-year survival rate for patients with distant (cancer has moved farther, such as liver, brain, etc.) cancer is 3%.

 

 

How to keep a check on reoccurrence?

Pancreatic cancer has a high chance of recurrence even after the treatment. It is advisable to be vigilant with the follow-up protocol, and in case of any problem you experience, inform your doctor immediately. Your doctor will do a physical exam and recommend you to go for tests to learn as much as possible about the recurrence. After this testing is done, your doctor may plan the best treatment option available that might include previous treatment as well.

 

Prevention tips

Prevention of pancreatic cancer is not possible. However, by making some lifestyle modifications, you can lower the risk.

Avoid smoking: Smoking is a critical risk factor for pancreatic cancer, and quitting smoking will help in lowering the risk.

Manage weight: Being obese or overweight increases the risk of pancreatic cancer. Indulge in some form of physical activity like exercising, yoga, etc., to keep your body fit.

Diet: People eating a diet high in fruits, vegetables, and whole grains and low in sugar drinks, processed food, and red processed meats probably have a lower risk of pancreatic cancer risk.

Alcohol: High intake of alcohol has been linked to a condition like chronic pancreatitis. It is recommended to quit or limit alcohol consumption.

 

 

 

 

 

 

 

 

Symptoms

Signs and symptoms of pancreatic cancer often don't begin to show until the disease is advanced. They may include:

  • Abdominal pain that moves to your back
  • Loss of appetite or unintended weight loss
  • Yellow skin and white eyes(jaundice)
  • Light-colored stools
  • Dark-colored urine
  • Itchy skin
  • Recent diagnosis of diabetes or pre-existing diabetes that's becoming difficult to control
  • Blood clots
  • Fatigue

Cause of Pancreatic Cancer

Pancreatic Cancer begins when cells in your pancreas develop changes (mutations) in their DNA. When the mutations in DNA grow uncontrollably, this led to the accumulation of cells resulting in a tumor. If left untreated, the pancreatic cancer cells can spread to nearby organs and blood vessels and distant parts of the body.

Risk factors

Aspects that may increase your risk of pancreatic cancer include:

  • Smoking
  • Diabetes
  • Chronic inflammation of the pancreas (pancreatitis)
  • Family history of genetic syndromes can increase cancer risk
  • Family history of pancreatic cancer
  • Obesity
  • Old age ( most people get diagnosed with cancer after age 65)

Diagnosis

You would have to undergo the following test if your doctor suspects Pancreatic Cancer:

  • Imaging tests: The doctor will advise you to go for computerized tomography (CT) scans, ultrasound, magnetic resonance imaging (MRI), and, sometimes, positron emission tomography (PET) scans to visualize your internal organs, including the pancreas. The test will give accurate images of your internal organs.
  • Removing a tissue sample for testing (biopsy): The doctor may perform a biopsy to extract a small sample of tissue for examination under a microscope. The tissue is collected from the pancreas by inserting a needle through your skin and into your pancreas.
  • Blood test: The doctor may recommend a tumor marker test called CA19-9 for pancreatic Cancer. The blood is analyzed for specific proteins (tumor markers) shed by pancreatic cancer cells.

If your doctor confirms a diagnosis of Pancreatic Cancer, then the doctor will try to find how far the extent of the Cancer has reached in your body. This helps in determining treatment to benefit you.

Pancreatic cancer treatment

The treatment for pancreatic cancer depends on the stage of Cancer. There might be some complications during pancreatic cancer treatment, such as weight loss, abdominal pain, bowel obstruction, and liver failure.

Following are the treatment involved:

  • Surgery: If the pancreatic cancer is in the early stages, the surgeon can remove all or some portions of the pancreas to eliminate the original tumor, but it will not dispose of Cancer that has spread to other portions of the body.
  • Chemotherapy: Chemotherapy is used to kill cancer cells and manage the growth of cancer cells. Chemotherapy provides relief to patients who are in late-stage Cancer.
  • Radiation: An intense beam of energy is used to target and eliminate cancerous cells before and after surgery. Radiation therapy is provided alongside chemotherapy. It is operated when cancer spreads outside of the pancreas.
  • Supportive (palliative) care: To provide relief from pain and other symptoms of a critical illness, palliative care is provided. Palliative care can be exercised while undergoing surgery and chemotherapy.

Prevention

You may reduce your risk of pancreatic cancer if you:

  • Stop smoking.
  • Maintain a healthy weight.
  • Choose a nutritious diet.

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