PANCREATIC CANCER

Pancreatic cancer develops when cells in the pancreas undergo mutations and start growing uncontrollably, forming a tumor. Your pancreas, nestled in your abdomen between your spine and stomach, plays a vital role in regulating blood sugar levels and aiding digestion by producing hormones and enzymes.

Primarily, pancreatic cancers originate in the ducts of the pancreas, particularly in the main pancreatic duct, which links it to the common bile duct. Detecting early-stage pancreatic tumors poses a challenge as they often go undetected on imaging tests. Consequently, many diagnoses occur after the cancer has spread, complicating treatment further, as pancreatic cancer tends to resist many standard cancer drugs.

Researchers are actively exploring avenues for early detection, employing genetic testing and novel imaging techniques. However, there’s still much to uncover about this elusive disease.

Types

Pancreatic tumors are broadly categorized into two types:

1. Exocrine tumors: These account for over 90% of all pancreatic tumors, with adenocarcinoma being the most prevalent subtype, originating in the organ’s lining cells.
2. Neuroendocrine tumors (NETs): Less common, comprising less than 10% of pancreatic tumors, NETs are also known as islet cell carcinoma.

Causes

The exact cause of this cancer type remains unclear, though experts have identified several risk factors associated with its development.

Risk Factors

Several factors increase the risk of developing this cancer. These include:

1. Smoking: Tobacco use, including smoking cigarettes, cigars, and other forms of tobacco, is a significant risk factor for pancreatic cancer.
2. Obesity: Carrying excess weight, particularly around the waist, increases the risk of developing pancreatic cancer.
3. Diabetes: Individuals with Type 2 diabetes, especially if it appears suddenly, may be at a higher risk of pancreatic cancer.
4. Exposure to certain chemicals: Contact with specific chemicals like pesticides and petrochemicals may elevate the risk of pancreatic cancer.
5. Chronic pancreatitis: Persistent inflammation of the pancreas, known as chronic pancreatitis, can increase the likelihood of developing pancreatic cancer.
6. Hereditary factors: Certain genetic mutations passed from biological parents to children, such as those in the BRCA1 or BRCA2 genes, can contribute to an increased risk of pancreatic cancer.

Prevalence

Pancreatic cancer contributes to about 3% of all cancer cases in the United States, ranking as the 10th most common cancer among men and individuals assigned male at birth, and the 8th most common among women and individuals assigned female at birth. However, its incidence is increasing, with projections suggesting it could become the second leading cause of cancer-related deaths in the United States by 2030.

Symptoms

Unfortunately, pancreatic cancer often remains silent in its early stages, with symptoms only appearing once the tumor begins affecting nearby organs in the digestive system.

Common symptoms of pancreatic cancer include:

1. Jaundice, is characterized by yellowing of the skin.
2. Dark urine.
3. Light-colored stool.
4. Upper abdominal pain.
5. Middle back pain.
6. Fatigue.
7. Itchy skin.
8. Nausea and vomiting.
9. Gas or bloating.
10. Loss of appetite.
11. Blood clots.
12. Weight loss.
13. Onset of diabetes, especially if it’s new.
    Your healthcare provider may suspect pancreatic cancer if you’ve recently been diagnosed with diabetes or pancreatitis, a painful condition caused by inflammation of the pancreas.

Symptoms of pancreatic neuroendocrine cancer may differ from those of typical pancreatic cancer. They might include diarrhea and anemia, although symptoms can vary among individuals.

Complications

Complications of pancreatic cancer arise as the disease progresses. It commonly spreads to nearby blood vessels, lymph nodes, and eventually to distant organs such as the liver, peritoneum (the abdominal cavity lining), and lungs. Most cases of pancreatic cancer are diagnosed after the cancer has already spread beyond the pancreas.

Diagnosis

Detecting pancreatic cancer in its early stages poses a challenge due to the pancreas’s location and the difficulty of detecting tumors through routine exams and imaging tests. However, if pancreatic cancer is suspected, healthcare providers typically recommend a series of tests to aid in diagnosis:

1. CT scan (computed tomography): This imaging test uses X-rays to create detailed cross-sectional images of the inside of your body, including the pancreas and surrounding organs.
2. MRI (magnetic resonance imaging): MRI uses powerful magnets and radio waves to produce detailed images of the pancreas and other abdominal structures.
3. Endoscopic ultrasound (EUS): This procedure involves inserting a thin, flexible tube with an ultrasound probe attached through the mouth into the stomach and duodenum to obtain high-resolution images of the pancreas and nearby structures.
4. Laparoscopy: This minimally invasive surgical procedure involves inserting a thin, lighted tube with a camera (laparoscope) through small incisions in the abdomen to visualize and examine the pancreas and other organs directly.
5. Endoscopic retrograde cholangiopancreatography (ERCP): ERCP combines endoscopy and X-rays to examine and treat problems in the bile ducts, pancreatic duct, and gallbladder.
6. Percutaneous transhepatic cholangiography (PTC): PTC is a procedure that involves injecting contrast dye into the liver through a needle inserted through the skin to visualize the liver and bile ducts using X-ray imaging.
7. Biopsy: In some cases, a tissue sample may be collected from the pancreas using a needle or during surgery to examine under a microscope for signs of cancer or other abnormalities.
8. Blood tests: Pancreatic cancer can cause elevated levels of certain substances, such as carbohydrate antigen (CA) 19-9, which may be detected through blood tests. Elevated levels of CA 19-9 can indicate the presence of pancreatic cancer cells.
9. Genetic testing: Following a pancreatic cancer diagnosis, genetic testing may be recommended to identify any hereditary factors contributing to the disease. Mutations in genes such as BRCA1 and BRCA2, typically associated with breast cancer, can also increase the risk of pancreatic cancer. First-degree relatives of individuals with pancreatic cancer may consider genetic testing to assess their own risk.

Treatments

Pancreatic cancer has a low survival rate overall, but early detection and treatment can lead to complete remission. The most effective way to cure pancreatic cancer is through total surgical removal of the cancerous tissue.

Treatment approaches for pancreatic cancer depend on several factors, including the tumor’s location, stage, your overall health, and whether the cancer has spread beyond the pancreas. Here are some common treatment options:

Surgery:

Surgeons primarily aim to cure pancreatic cancer through surgery, but they typically only recommend it when they believe they can remove all the cancerous tissue. However, Incomplete removal can significantly reduce the effectiveness of surgery. Ideally, for a successful surgery, cancer should be localized within the pancreas. However, even in such cases, complete cancer removal may not always be achievable. Surgeons choose the surgical technique based on the tumor’s location and size:

• Whipple procedure (pancreaticoduodenectomy): Doctors recommend this procedure for tumors located in the head of the pancreas, near the small intestine. The Whipple procedure involves removing the head of the pancreas, the duodenum (first part of the small intestine), the gallbladder, a portion of the bile duct, and nearby lymph nodes. Surgeons reconnect the remaining bile duct and pancreas to the small intestine, restoring digestive function.
• Distal pancreatectomy: Surgeons may perform a distal pancreatectomy when a tumor is located in the tail of the pancreas. During this procedure, the surgeon removes the tail of the pancreas and part of the pancreas body. In most cases, removal of the spleen also occurs. Since the spleen aids in fighting infections, doctors may recommend certain vaccinations before undergoing this surgery.
• Total pancreatectomy: In cases where cancer has spread throughout the entire pancreas but resection is still feasible, doctors may consider a total pancreatectomy. This extensive surgery involves removing the entire pancreas, along with the gallbladder, spleen, and part of the stomach and small intestine.

Chemotherapy:

This treatment uses drugs to kill cancer cells. Doctors often use it as a standalone treatment, especially for advanced pancreatic cancer. In some cases, they may give it before surgery to shrink the tumor or after surgery to eliminate any remaining cancer cells.

Radiation therapy:

Radiation therapy employs high-energy X-rays to destroy cancer cells. This treatment is a common choice for pancreatic cancer. Providers often combine radiation therapy with chemotherapy, a treatment approach known as chemoradiation. Doctors may recommend this combination therapy before or after surgery, or as part of the primary cancer treatment. Radiation therapy can also help alleviate symptoms in individuals with advanced pancreatic cancer who are not candidates for surgery.

Targeted therapy:

Targeted therapy uses drugs specifically targeting proteins involved in cancer cell growth and spread. Doctors may combine these drugs with other treatments like radiation therapy. Common targeted therapy drugs for pancreatic cancer include Erlotinib, Olaparib, Larotrectinib, and Entrectinib.

Pain management:

Pancreatic cancer can cause significant pain, particularly when it affects nearby nerves. Healthcare providers can assist in managing pain using various methods, such as oral medications, anesthesia, or steroid injections. It’s essential to inform your healthcare provider if you experience severe and persistent pain so they can adjust your treatment plan to alleviate your symptoms.

Home Care Tips

Embracing a holistic approach to pancreatic cancer management extends beyond the confines of medical interventions. Adopting a nutritious diet, rich in fruits, vegetables, and whole grains, lays a sturdy foundation for health and vitality. Engaging in regular physical activity bolsters immune function and mitigates treatment-related side effects. Cultivating a robust support network, comprising family, friends, and support groups, provides invaluable solace and fortitude amidst the rigors of cancer treatment.

Prevention

While it’s not possible to completely prevent this cancer, there are steps you can take to lower your risk:

1. Quit smoking: Smoking is one of the most significant risk factors for this cancer. If you smoke, quitting can greatly reduce your risk.
2. Limit alcohol consumption: Excessive alcohol consumption has been linked to an increased risk of this type of cancer. Limiting your alcohol intake can help lower your risk.
3. Eat a healthy diet: Focus on consuming a balanced diet rich in fresh fruits, vegetables, and whole grains. Limit your intake of red meat, sugary drinks, and processed foods.
4. Reduce exposure to harmful chemicals: Limit your exposure to toxic substances such as asbestos, pesticides, and petrochemicals, as they have been associated with an increased risk of this type of cancer.
5. Maintain a healthy weight: Obesity is a risk factor for pancreatic cancer. Maintaining a healthy weight through regular exercise and a balanced diet can help reduce your risk.

For people with a high genetic risk of pancreatic cancer, doctors recommend proactive monitoring with imaging tests and endoscopic ultrasounds, despite the absence of routine screenings for this cancer. If you have a first-degree family member with this type of cancer, it’s important to discuss your risk with a healthcare provider and consider appropriate screening and genetic tests. Early detection and intervention can improve outcomes for individuals at high risk of pancreatic cancer.

When to See a Doctor

While early-stage of this type of cancer may not present clear-cut symptoms, it’s crucial to seek medical attention promptly if you experience any of the following:

1. Jaundice: Yellowing of the skin and whites of the eyes can occur when pancreatic cancer blocks the bile duct, leading to a buildup of bilirubin in the body.
2. Abdominal or back pain: Persistent or worsening pain in the abdomen or middle back may be a symptom of pancreatic cancer, particularly if it’s not relieved by over-the-counter medications or changes in position.
3. Unexplained weight loss: Significant and unexplained weight loss, especially when not associated with changes in diet or physical activity, can be a warning sign of various underlying health issues, including pancreatic cancer.
4. Sudden onset of diabetes: Developing diabetes unexpectedly, particularly if you have no family history or other risk factors, may be an early symptom of pancreatic cancer. The tumor can affect the pancreas’s ability to produce insulin, leading to elevated blood sugar levels.

Outlook/Prognosis

A diagnosis of pancreatic cancer can be overwhelming, but it’s important to know that each case is unique, and your medical team will work to develop the best treatment plan for you. Your team may include specialists such as gastroenterologists, pathologists, medical oncologists, surgical oncologists, radiation oncologists, and social workers.

The progression of this cancer varies from person to person, but in general, it can take 10 to 20 years for a single cancer cell in the pancreas to develop into a tumor. Ongoing research aims to improve early detection methods to catch pancreatic cancer when it’s more treatable.

The survival rate for pancreatic cancer in the United States is relatively low, with a five-year survival rate of 11%. The five-year survival rate for pancreatic cancer is only 11%, meaning just 11 out of every 100 people diagnosed are expected to survive for five years or more.

It’s important to note that survival rates are estimates and cannot predict individual outcomes. Your response to treatment and overall prognosis will depend on various factors, including the stage of your cancer, your overall health, and how well you respond to treatment. If you have specific questions or concerns about survival rates and what they mean for you, discussing them with your healthcare provider is essential. They can provide personalized information and support to help you navigate your diagnosis and treatment journey.

Sources

• American Cancer Society: “Pancreatic Cancer Overview”
• Mayo Clinic: “Pancreatic Cancer”
• National Cancer Institute: “Pancreatic Cancer Treatment (PDQ)–Patient Version”
• Johns Hopkins Medicine: “Pancreatic Cancer”