Pancreatic Cancer

Symptoms: Loss of appetite, unintentional weight loss, abdominal pain, dark urine, itchy skin, nausea and vomiting

Causes and Risk Factors: tobacco use, obesity, diabetes, chronic pancreatitis, diet, chemical exposure, and a family history of the disease

Prevalence: Currently, 4.9 per 100000 of the population worldwide is diagnosed with pancreatic cancer. In India, the total number of individuals suffering from pancreatic cancer is approximately 0.5-2.4 per 100000 of men and 0.2-1.8 of women.

Severity: Mild to Severe.

Gender affected: Both male and female populations above 55 years of age can get affected.

Which doctor to consult: A general physician, oncologist, gastroenterologist.

Overview: 

Pancreatic cancer is a serious disease that begins in the tissues of the pancreas. Deep within the belly, the pancreas is a tiny, spongy, hockey stick-shaped gland that is situated between the stomach and the spine. The pancreas plays a vital role in digestion by producing enzymes that help break down foods and hormones like insulin that control blood sugar levels.

The most common type of pancreatic cancer is pancreatic ductal adenocarcinoma which starts in the exocrine cells responsible for enzyme production. There are also pancreatic neuroendocrine tumors, which are rarer and begin in the endocrine cells that produce hormones.

This disease is most common in elderly population above 55 years of age. Symptoms of pancreatic cancer may not appear until the disease is in advanced stages. When symptoms do present, they include loss of appetite, unintentional weight loss, abdominal pain, dark urine, itchy skin, nausea and vomiting.

Pancreatic cancer is mostly seen in men than in women. Some of the risk factors for developing pancreatic cancer include tobacco use, obesity, diabetes, and a family history of the disease. The treatment of pancreatic cancer varies depending on the stage of cancer and may include surgery, chemotherapy, radiation therapy, or a combination of these.

Types of Pancreatic Cancer:

Pancreatic cancer can be classified into two main types based on the origin of the cancer cells within the pancreas:

Pancreatic Adenocarcinoma: This is the most common type of pancreatic cancer, accounting for about 95% of cases. It originates in the exocrine cells, which are responsible for producing digestive enzymes. These tumors typically start in the ducts of the pancreas.

Pancreatic Neuroendocrine Tumors (PNETs): These are much less common and arise from the endocrine cells of the pancreas, which produce hormones like insulin and glucagon. PNETs can be functional (producing hormones) or non-functional (not producing hormones) and tend to have a better prognosis than adenocarcinomas.

Each type has different characteristics, treatment options, and prognoses. It’s important for diagnosis and treatment planning to accurately determine the type of pancreatic cancer. 

Symptoms:

The symptoms of pancreatic cancer can vary and may not appear until the disease is advanced. Some common symptoms include:

• Abdominal pain that may radiate to the back

• Loss of appetite or unintended weight loss

• Jaundice, which is yellowing of the skin and the whites of the eyes

• Itchy skin, light-colored stools, and dark-colored urine

• Digestive problems, such as abnormal stools, nausea, or vomiting

• Sudden weight loss and very high sugar levels in diabetic patients

If you or someone you know is exhibiting these symptoms, it’s important to seek medical attention immediately. Early detection and treatment are crucial for the best outcomes.

Causes and Risk factors:

Pancreatic cancer is a complex disease, and its exact causes are not fully understood. However, several factors have been identified that may increase the risk of developing pancreatic cancer:

• Genetic mutations: Changes in the DNA of pancreatic cells can lead to uncontrolled cell growth and cancer

• Family history: A family history of pancreatic cancer or genetic syndromes like BRCA2 gene mutation, Lynch syndrome, and familial atypical mole-malignant melanoma (FAMMM) syndrome can increase risk

• Smoking: Cigarette smoking is the most significant risk factor associated with pancreatic cancer

• Obesity: Being overweight or obese can increase the risk

• Chronic pancreatitis: Long-term inflammation of the pancreas is a risk factor

• Diabetes: People with diabetes may have an increased risk

• Diet: A diet high in red and processed meats may increase risk, while a diet rich in fruits and vegetables may decrease risk

• Alcohol consumption: Heavy alcohol use can increase the risk of pancreatic cancer

• Chemical exposure: Exposure to certain chemicals, such as those used in the dry cleaning and metal working industries, may increase risk

• Age: Most people diagnosed with pancreatic cancer are over the age of 45

• Gender and race: Men are more likely to develop pancreatic cancer than women, and it is more common in Black individuals and Jews.

It’s important to note that having one or more of these risk factors does not mean that a person will definitely develop pancreatic cancer. Conversely, some people with pancreatic cancer may not have any known risk factors.

Complications:

Pancreatic cancer can lead to a number of complications, both from the disease itself and as a result of the treatments. Here are some of the complications associated with pancreatic cancer:

• Bowel obstruction: The tumor may grow large enough to block part of the digestive tract, causing nausea, vomiting, and severe abdominal pain
• Jaundice: If the tumor blocks the bile duct, it can cause jaundice, leading to yellowing of the skin and eyes, dark urine, and light-colored stools
• Pancreatitis: Inflammation of the pancreas can occur, which can be painful and may require hospitalization.
• Weight loss and malnutrition: Due to digestive problems, patients may lose weight and struggle to absorb nutrients properly
• Diabetes: Pancreatic cancer can affect the production of insulin, leading to new-onset diabetes or the worsening of existing diabetes
• Liver metastasis: The cancer may spread to the liver, causing hepatomegaly (enlarged liver), ascites (fluid in the abdomen), and liver failure
• Ascites: Fluid buildup in the abdomen can occur when cancer cells spread to the lining of the abdominal cavity
• Blood clots: Pancreatic cancer increases the risk of blood clots in the veins, particularly in the legs (deep vein thrombosis) which can be life-threatening if they travel to the lungs (pulmonary embolism)
• Cachexia: A syndrome characterized by severe body weight, muscle, and fat loss and cannot be fully reversed with nutritional supplements.

These complications can significantly impact the quality of life and may require various treatments to manage. Patients and their caregivers need to be aware of these potential issues and work closely with their healthcare team to address them as they arise.

Prevention:

Preventing pancreatic cancer involves managing certain risk factors, although there is no guaranteed way to prevent it. Here are some measures that may help lower the risk:

• Avoid smoking: Smoking is a significant risk factor.
• Maintain a healthy diet: Include plenty of fruits, vegetables, and whole grains, and limit red and processed meats, sugary drinks, and highly processed foods.
• Regular exercise: Staying active can help maintain a healthy weight, which might lower the risk.
• Healthy weight: Being overweight or obese is associated with an increased risk of pancreatic cancer.
• Limit alcohol intake: Heavy alcohol use can lead to chronic pancreatitis, a known risk factor for pancreatic cancer.
• Reduce exposure to chemicals: Avoid workplace exposure to carcinogens.

It’s also important to be aware of the symptoms and seek medical attention if you experience any, as early detection can be crucial.

When to visit a doctor:

It’s important to consult a doctor or oncologist or gastroenterologist if you experience symptoms that could be indicative of stomach cancer, especially if they persist or worsen. Here are some signs that should prompt a visit to a healthcare professional:

• Abdominal pain that radiates to your back
• Loss of appetite or unintended weight loss
• Jaundice, which is yellowing of the skin and the whites of your eyes
• Light-colored stools and dark urine
• Itchy skin
• New diagnosis of diabetes or existing diabetes that’s becoming difficult to control
• Digestive problems, including abnormal stools, nausea, or vomiting

Early stages of pancreatic cancer may not show symptoms, but as the disease progresses, these symptoms can appear. If you or someone you know is exhibiting these symptoms, it’s crucial to seek medical attention immediately

Diagnosis:

Diagnosing pancreatic cancer typically involves a combination of methods to confirm the presence of cancer cells and to determine the extent or stage of the cancer. Here’s a detailed overview of the diagnostic process:

Imaging Tests

Imaging tests create pictures of the inside of the body, allowing doctors to see if there’s a tumor in the pancreas:

• CT scan: Provides detailed images of the pancreas to diagnose pancreatic cancer.

• MRI: Offers detailed images of the pancreas, liver, and gallbladder.

• Endoscopic ultrasound (EUS): Uses sound waves to create improved images of the pancreas by inserting a scope through the abdomen.

• Positron emission tomography (PET): Helps determine the degree of cancer spread.

Biopsy

A biopsy involves obtaining a sample of pancreatic tissue to analyze for abnormalities:

• During an EUS, special tools are passed through the endoscope to take a tissue sample from the pancreas.

• A fine-needle aspiration may be performed by inserting a needle through the skin and into the pancreas.

Blood Tests

Blood tests can screen for cancerous markers:

• Tumor markers like CA19-9 may indicate the presence of pancreatic cancer cells. 

• These tests might be repeated during and after treatment to monitor the cancer’s response.

Genetic Testing

Genetic testing looks for inherited DNA changes that increase the risk of cancer:

• It can guide treatment and show whether family members might have an increased risk of pancreatic cancer.

Staging

After confirming a diagnosis, the healthcare team determines the cancer’s stage to understand the prognosis and create a treatment plan. Staging ranges from 0 to 4, with higher numbers indicating more advanced cancer.

• Stage 0: Also referred to as carcinoma in situ, this stage is distinguished by aberrant cells in the pancreatic lining. The cells could develop into cancer and spread to surrounding tissue.

• Stage 1: The pancreas has a tumor (cancerous cells) present. 

• Stage 2: The pancreatic tumor is present and has either spread to the organs, tissues, or lymph nodes in the vicinity. 

• Stage 3: The cancer has spread to the main blood arteries close to the pancreas. It might have also reached adjacent lymph nodes. 

• Stage 4: At this point, the cancer has progressed to nearby tissues or lymph nodes as well as distant organs such as the liver, lungs, or abdominal cavity.

It’s important to note that early-stage pancreatic cancer may not show symptoms, making it challenging to diagnose early. If you have concerns or symptoms related to pancreatic cancer, it’s crucial to consult with a healthcare professional for an accurate diagnosis 

Treatment:

The treatment of pancreatic cancer depends on various factors, including the stage of the cancer, the location of the tumor, the patient’s age, and overall health. Here’s a detailed overview of the treatment options:

Surgery

Surgery is often part of the treatment plan, especially if the cancer is diagnosed at an early stage:

• Tumor excision: Removal of the tumor in the pancreatic head.

• Distal pancreatectomy: Removal of the tumor on the left side (body and tail) of the pancreas.

• Total pancreatectomy: Removal of the entire pancreas; insulin will be administered lifelong after this surgery.

• Lapraroscopy: Through a type of surgery called laparoscopy, a surgeon can access the inside of the pelvis and abdomen without making major skin incisions. The resection for this minimally invasive procedure calls for a laparoscopic distal pancreatectomy. The rate of positive resection margins and results did not differ.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells or control their growth:

• Medications such as 5-Fluorouracil, Capecitabine, Irinotecan, Oxaliplatin are used, either taken orally or through injection.

Radiation Therapy

High-energy beams are used to kill cancerous cells. This therapy may be combined with other treatments for better outcomes.

• External beam radiation therapy: External radiation therapy sources that generate X-rays, gamma rays, electrons, or heavy particles are used in external beam radiation therapy. 

• Brachytherapy: It is a form of internal radiation therapy in which radiation-containing seeds, ribbons, or capsules are inserted either inside the body or in close proximity to the tumors. Internal radiation delivered by laparoscopy or surgery within or near the pancreas is its principal usage.

Targeted Therapy

This is quite effective in treating many types of cancer; however, affrecept, cetuximab, sorafenib, bevacizumab, and axitinib have not worked in treating people with pancreatic cancer as of yet. Pembrolizumab has been approved by the Food and Drug Administration (FDA) as a targeted treatment for pancreatic cancer.

Palliative Care

In advanced stages, the focus may shift to comfort and symptom control:

• This includes managing pain and other symptoms to improve quality of life.

Clinical Trials

Participation in clinical trials can provide access to new treatments:

• Patients can discuss with their healthcare team the possibility of joining clinical trials for new therapies.

It’s important to have a thorough discussion with a healthcare team to understand the best treatment options based on individual circumstances. If you or someone you know is dealing with pancreatic cancer, please consult with a healthcare professional for personalized treatment planning.