Pancreatic cancer starts in the pancreas, an organ located in the abdomen lying horizontally behind the lower part of the stomach. Its work is to secrete enzymes, which aid in the digestion of food. It also produces hormones, which help in the regulation of blood sugar.
Definition & Facts
Most pancreatic cancers are exocrine in nature. They originate in the pancreatic exocrine cells that produce digestive enzymes. Some of the cancers are neuroendocrine which form in islet cells. Endocrine cells produce hormones, which regulate the metabolism of sugar in the body. Exocrine cancers are more common than neuroendocrine tumors.
Poor prognosis is one distinguishing characteristic of pancreatic cancer since it metastasizes or spreads rapidly and thus is hard to detect and begin treating until it may be too late. Fatalities are common with pancreatic cancer. Symptoms signaling its existence may not appear until the cancer has advanced significantly.
Symptoms & Complaints
- Jaundice – yellowing of the eyes and skin
- Loss of appetite
- Weight loss
- Blood clots
- Abdominal pain in the upper part that may spread to the back
- Digestive problems
Medical experts have not yet found the actual cause of most pancreatic cancers but know how it forms. The number one culprit is genetic mutations of DNA inside pancreatic cells. These mutations cause uncontrollable cell multiplications. These abnormal cells grow at an alarming rate while healthy cells die off resulting in cancerous cells referred to as tumors. Other than mutations, other variables may function to predispose individuals to develop the condition. These are risk factors, and they include:
- Inherited genetic mutations like BRCA2 mutations, Lynch syndrome, and familial atypical mole-malignant melanoma
- Family history of pancreatic cancer
- Acute inflammation of the pancreas
- Excess body weight
Diagnosis & Tests
The doctor will ask about past health and medical history, and will also perform a physical examination. He or she will follow that up with further tests to pinpoint the cause and extent of the condition. The tests include:
- Imaging tests, which enable the physician ‘see’ a patient's organs internally which includes CT scans and MRIs
- Endoscopic ultrasound – The doctor uses an ultrasound tool that creates images of the pancreas. The physician passes the device through an endoscope (a thin flexible tube) down the esophagus into the stomach thus getting the pictures.
- Endoscopic retrograde cholangiopancreatography (ERCP)—the doctor uses a special scope to inject a dye that highlights the bile ducts. The endoscope passes through the esophagus, past the stomach and into the upper part of the small intestine. The doctor then passes a catheter through the scope and injects the dye onto the bile ducts. After that, he or she takes X-rays.
- Biopsy – The doctor inserts a needle via the skin into the pancreas (fine-needle aspiration) and then takes a sample of the affected tissue for further laboratory testing. Sometimes, doctors use an endoscopic ultrasound that guides specialized devices to collect samples.
- Laparoscopy – It employs a lighted tube having a video camera at its end. Doctors pass the tube through an incision in the abdomen. The device explores pancreatic tissue and transmits the video images back to the physician so that he or she may see the spread of cancerous cells.
- Blood tests that look for tumor markers (particular proteins)
As soon as doctors establish the existence of cancer, they will conduct tests to determine the extent of the condition (cancer staging) that will lead them to come up with modes of treatment.
- Stage I – Cancer exists in the pancreas only
- Stage II - Cancer has spread to nearby tissues and may appear in lymph nodes
- Stage III - Cancer has spread to some major blood vessels nearby and lymph nodes
- Stage IV - Cancer has spread to far regions like the liver, lungs and the tissue that lines the stomach
Treatment & Therapy
Treatment largely depends on the age, general health of the patient and the severity of the condition. Surgery is most suited when cancer thrives only in the pancreas. There are two procedures involved. One is tumor surgery in the pancreatic head (Whipple procedure). When cancer occurs in the head of the pancreas, then this method is appropriate. A doctor removes the pancreas head, part of the gallbladder and a portion of the small intestine then re-connects the remaining organs through surgery. It is risky since patients may succumb to bleeding and infection.
Another type of surgery is tumor surgery in the pancreatic tail and body: The doctor removes the tail, a small portion of the pancreas’ body and part of the spleen. Patients also run the risk of bleeding and infection.
Radiation therapy may also be used to treat pancreatic cancer with high-energy beams like X-rays, which destroy cancerous cells. For some patients, radiation therapy may accompany chemotherapy, before and after surgery. Chemotherapy employs drugs to kill cancer cells and may be administered through intravenous injections or orally. Doctors may prescribe one chemotherapy drug or a combination of drugs. For cancers that have spread to nearby organs, chemoradiation is preferable, where radiation and chemotherapy are simultaneously used.
Targeted therapy is another approach to treating pancreatic cancer in which particular drugs target specific abnormalities in the cancer cells. A drug like erlotinib targets and blocks chemicals that enable growth of cancerous cells.
Prevention & Prophylaxis