Pancreatic cancer: Symptoms, diagnosis and treatment

Most pancreatic cancers are exocrine cancers. Pancreatic neuroendocrine tumors (NETs), or islet cell tumors, are less common but have a better prognosis. If you or a loved one has pancreatic cancer. Knowing what to expect can help you and your family cope with the illness. In this article you can learn about the disease, including its risk factors, symptoms, complications, and treatment.

Pancreatic cancer begins in the tissues of the pancreas – an intra-abdominal organ located behind the lower part of the stomach. The pancreas secretes enzymes that aid in digestion and produces hormones that help control blood sugar.

Several types of growth mutations can occur in the pancreas, including both cancerous and noncancerous tumors. The most common cancer of the pancreas originates in the cells that line the ducts that carry digestive enzymes out of the pancreas. It is also known as pancreatic carcinoma.

Pancreatic cancer is a dangerous disease

Pancreatic cancer is a dangerous disease

Pancreatic cancer is rarely found in its early stages because it often causes no symptoms until the disease has spread to other organs.

Treatment options are based on how far the cancer has spread and include: surgery, chemotherapy, radiation therapy, adjuvant therapy, or a combination of treatments.

1. A brief understanding of the pancreas:

The human pancreas is about 15 centimeters long and looks like a pear lying on its side. It releases hormones, including insulin, to help control blood sugar. In addition, it also produces digestive enzymes to help the body digest food and absorb nutrients.

Pancreas pictures

Pancreas pictures

The pancreas is a gland that is both exocrine and endocrine:

The endocrine part of the pancreas: secretes hormones that go directly into the blood through the capillaries in the pancreas.

Exocrine pancreas: Pancreatic juice is drained out by two pancreatic ducts: the main pancreatic duct and the accessory pancreatic duct.

You may want to refer to: Pancreas: Structure and Function

2. How does pancreatic cancer form?

Pancreatic cancer occurs when cells in the pancreas have mutated DNA. The cell’s DNA contains instructions that tell the cell what to do. These mutations cause cells to grow uncontrollably. The more cells that grow, the more they accumulate to form a tumor. When left untreated, cancer cells can spread to nearby organs and blood vessels and spread to distant parts of the body.

Most cases start in the cells lining the ducts of the pancreas. This type of cancer is called pancreatic adenocarcinoma or exocrine pancreatic cancer.

Most pancreatic cancers start in the cells lining the ducts of the pancreas

Most pancreatic cancers start in the cells lining the ducts of the pancreas

Less commonly, cancer can form in hormone-producing cells or neuroendocrine cells. These types of cancer are called neuroendocrine tumors, islet cell tumors, or pancreatic adenocarcinomas.

You may want to refer to: Endocrine pancreatic tumor: Dangerous cancer and things to know

3. What are the possible manifestations of pancreatic cancer?

Signs and symptoms of the disease usually do not occur until the disease has progressed and spread to other organs. Manifestations may include:

3.1 Abdominal pain spreading to the back:

Cancerous masses that start in the body or tail of the pancreas can grow quite large and begin to press on other nearby organs. Painful consequences. Cancer can also spread to the nerves around the pancreas, often causing back pain.

Abdominal pain spreading to the back

Abdominal pain spreading to the back

3.2 Anorexia, unexplained weight loss:

Unintended weight loss is very common in people with pancreatic cancer. These people often have little or no appetite.

3.3 Nausea, vomiting:

If the cancer presses on the end of the stomach, it can make it difficult for food to pass through. Consequences include nausea, vomiting, epigastric pain, and the pain tends to be worse after eating.

3.4 Symptoms of biliary obstruction:

If cancer blocks the bile duct, bile can build up in the gallbladder, making the gallbladder larger. In addition, when the bile duct is blocked, it causes symptoms such as: jaundice, pale stools, dark urine, itchy skin.

3.5 Formation of blood clots:

Sometimes, the first symptom that someone has pancreatic cancer is a blood clot stuck in a large vein, usually in the leg. This condition is called deep vein thrombosis.

Symptoms may include pain, swelling, redness, and warmth in the affected leg. Sometimes a piece of the blood clot can break off and travel to the lungs. The consequences cause pulmonary embolism with manifestations of shortness of breath, chest pain.

3.6 Diabetes:

Rarely diseases cause high blood sugar diabetes because they destroy the cells that make insulin. Diabetes symptoms can include feeling constantly thirsty and hungry, and urinating more than once.

Often, cancer can lead to small changes in blood sugar without causing the symptoms of diabetes. However, these abnormalities can still be detected by blood tests.

If cancer blocks the bile duct

If cancer blocks the bile duct, bile can build up in the gallbladder, making the gallbladder larger. In addition, when the bile duct is blocked, it causes symptoms such as: jaundice, pale stools, dark urine, itchy skin.

4. Causes and factors that increase pancreatic cancer?

Until now, the cause of pancreatic cancer is unknown. Experts have identified several factors that can increase the risk of this type of cancer, including smoking and having certain inherited genetic mutations.

Factors that may increase the risk of pancreatic cancer include:

  • Smoke
  • Diabetes
  • Chronic pancreatitis
  • A family history of inherited syndromes that may increase cancer risk, including: BRCA2 gene mutations, Lynch syndrome, and FAMMM syndrome. has a few atypical moles and a history of melanoma)
  • Family history of pancreatic cancer
  • Fat
  • Older age, as most people are diagnosed after age 65

A large study demonstrated that a combination of smoking, long-term diabetes and a poor diet increases the risk of pancreatic cancer significantly.

5. What are the diagnostic tests for pancreatic cancer?

If your doctor suspects pancreatic cancer, he or she may order some of the following tests:

5.1 Imaging tests:

Imaging tests include chest X-ray, ultrasound, computed tomography (Ctscan), magnetic resonance imaging (MRI), and Positron emission tomography (PET). These imaging tests help:

Look for suspected cancer areas
See how far the cancer has spread
Determine which treatment is appropriate

5.2 Pancreatic cholangiography:

This is an imaging test that looks at the pancreatic ducts and bile ducts to see if they are blocked, narrowed, or dilated. These tests can help determine if a pancreatic tumor is blocking the duct. The test may also be used to help plan surgery. There are many different methods of cholangiography, including: endoscopic retrograde cholangiopancreatography (ERCP), magnetic resonance cholangiopancreatography (MRCP), percutaneous cholangiography (PTC). Each method will have different advantages and disadvantages.

5.3 Biopsy:

A person’s medical history, physical exam, and imaging test results can be highly suggestive of pancreatic cancer. Often, however, the only way to be certain of the diagnosis is to take a sample of pancreatic tissue and have it examined under a microscope. This is called a biopsy test. A biopsy can be done in a variety of ways, including:

Percutaneous biopsy: the doctor inserts a thin needle through the skin and into the pancreas to take a sample of tissue under the head from an ultrasound or CT scan.
Endoscopic biopsy: An endoscope (thin, flexible, with a small video camera attached to the end) down the throat and into the small intestine near the pancreas. Biopsy during surgery

5.4 Blood tests:

Your doctor may test your blood for specific proteins (tumor markers) secreted by cancer cells. A tumor marker test used in pancreatic cancer is called CA19-9. However, this test is not always reliable because some people with cancer do not have elevated CA19-9 levels.

Blood test to help measure CA19-9 levels and other parameters to evaluate liver function

Blood test to help measure CA19-9 levels and other parameters to evaluate liver function

Also blood tests help check liver function. Jaundice (yellowing of the skin and eyes) is often one of the first signs of pancreatic cancer. Doctors often test blood to evaluate liver function in people with jaundice to help determine its cause. Some blood tests can look at levels of different types of bilirubin (a chemical made by the liver) and can help tell if jaundice is caused by liver disease or a blockage of the bile ducts ( due to gallstones, tumors, or other disease).

6. How can pancreatic cancer be prevented?

You can reduce your risk of pancreatic cancer by:

  • Quit smoking: If you smoke, try to stop smoking. Talk to your doctor about ways to help you quit smoking, including joining support groups, medications, and nicotine replacement therapy.
  • Maintain a healthy weight: If you are at a healthy weight, try to maintain it. If you need to lose weight, aim for a slow and steady weight loss of 0.5-1kg a week. Combine daily exercise with a diet high in vegetables, fruits, and whole grains with fewer carbs to help you lose weight.
  • Choose a healthy diet: A diet full of colorful fruits and vegetables and whole grains may help reduce cancer risk.
  • Consider seeing a genetic counselor if you have a family history of cancer

7. How is pancreatic cancer treated?

Treatment depends on the stage and location of the cancer as well as the patient’s overall health. For most cases, the first goal of treatment is to remove the cancer when possible.

If surgery cannot be performed, the next step is to support the general condition and improve quality of life.

Treatments include: surgery, radiation, chemotherapy, or a combination of these.

When pancreatic cancer is advanced and these treatments do not provide benefit. The doctor will focus on symptom relief (palliative care) to keep the patient less painful, and more comfortable, for as long as possible.

7.1 Tumor resection:

Surgery for tumors in the head of the pancreas:

If the cancer is in the top of the pancreas, you’ll likely have an operation called a Whipple procedure (pancreatectomy).

The Whipple procedure is a technically difficult surgery to remove the first part of the pancreas, the first part of the small intestine (duodenum), the gallbladder, part of the bile duct, and nearby lymph nodes. In some situations, part of the stomach and colon may also be removed. The surgeon will reattach the remaining parts of the pancreas, stomach, and intestines so that food can be digested.

Whipple procedure: the head of the pancreas, part of the stomach and intestines is removed and then reattached

Whipple procedure: the head of the pancreas, part of the stomach and intestines is removed and then reattached.

Tumor surgery in the body and tail of the pancreas:

Surgery to remove the left side (body and tail) of the pancreas is called a distal pancreatectomy. The surgeon may also need to remove an additional spleen.

Total pancreatectomy:

In some people, the entire pancreas may need to be removed. Humans can live a relatively normal life without a pancreas. However, lifelong insulin and digestive enzymes are required.

Surgery for tumors affecting nearby blood vessels. Many people with advanced pancreatic cancer are not eligible for the Whipple procedure or other pancreatic surgeries if the tumor involves nearby blood vessels. In highly specialized and experienced medical facilities, surgeons can offer pancreatic surgery methods including removal and reconstruction of affected blood vessels.

Each of these surgical methods carries a risk of bleeding and infection. After surgery, some people experience nausea and vomiting if the stomach has been partially removed.

7.2 Chemotherapy:

Chemotherapy uses drugs to help kill cancer cells. These drugs can be injected into a vein or taken by mouth.

Chemotherapy can also be combined with radiation therapy. Chemoradiation is often used to treat cancer that has not spread outside the pancreas to other organs. At large hospitals, this combination can be used before surgery to help shrink tumors. It is sometimes used after surgery to reduce the risk of cancer coming back.

In people with advanced pancreatic cancer and cancer that has spread to other parts of the body. Chemotherapy can be used to control cancer growth, relieve symptoms, and prolong survival.

7.3 Radiation therapy:

Radiation therapy uses high-energy beams, such as X-rays and protons, to kill cancer cells. May be treated with radiation before or after cancer surgery, often in combination with chemotherapy. Or your doctor may recommend a combination of radiation and chemotherapy treatments when the cancer is inoperable.

7.4 Palliative care:

Palliative care is specialized medical care that focuses on reducing pain and symptoms that cause discomfort to the patient. Palliative care is not the same as hospice. It is performed by a team of doctors, nurses, staff and specially trained professionals.

These teams are created to improve the quality of life for people living with cancer.

Palliative care professionals work with the patient, the patient’s family, and the treating physician to provide an additional part of supportive care continuum.

When palliative care is given along with other appropriate treatments – even soon after diagnosis. Most experience people with cancer feeling better physically and psychologically and living longer.

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