Pancreatic Cancer
Overview
The pancreas is a secretory organ of the digestive system, and it lies horizontally in the upper-mid quadrant of the abdomen at the lower level of the stomach, just behind the duodenum. The pancreas secretes the enzymes that help digestion and the hormones that help regulate blood glucose.
The pancreatic juice that has an important role, especially in the digestive system, is drained to the duodenum. The pancreatic juice produces lipase, amylase, and trypsin, which are required to digest protein, fats, and carbohydrates.
Pancreatic cancer starts in pancreatic cells and tissues. In anatomic terms, the pancreatic gland has three divisions: head, body, and tail. Pancreas cancer most frequently develops in the head and, again, in most cases, starts in secretory cells of the pancreas.
As is the case for all cancers, early diagnosis of pancreatic cancer may increase the success rate of treatment.
Risk Factors
Most cases are men and diagnosed at age >40 years, and smoking is the principal risk factor, especially in long-standing diabetes mellitus. Other factors that increase the risk of pancreatic cancer are as follows:
• Chronic inflammation of the pancreas (pancreatitis)
• Diabetes mellitus,
• Genetic predisposition,
• Family history of pancreatic cancer and colon cancer,
• Smoking
• Obesity,
• Advanced age,
• Eating foods with high fat content
Types:
The cancer can start in the head, the body, or the tail of the pancreas. Cancers usually develop in the head of the pancreas.
Exocrine cancers: Exocrine cancers are the most common type of pancreatic cancer. Adenocarcinoma is the term used to refer to this type of cancers that develop in the pancreatic canal at the exocrine part of the gland.
Endocrine pancreatic tumors: These tumors, also called neuroendocrine tumors, originate from islet cells, and their treatment varies from exocrine tumors.
Pancreatic Lymphoma: It is a rare type of cancer in the pancreas.
Symptoms: Pancreatic cancer often causes no symptoms until the advanced stage or the symptoms can easily be confused with signs and symptoms of other diseases. Since it progresses insidiously, they are usually skipped in the early stages. Possible symptoms of pancreatic cancer are as follows:
• Lack of appetite
• Unintended weight loss
• Pain in the upper abdomen, sometimes referring to the back
• Sudden-onset diabetes mellitus
• Digestive symptoms, such as bloating, indigestion and lack of appetit
• Nausea
• Depression
• Fatigue, poor exercise performance
• Jaundice
• Pale-colored stool – similar to put
Prevention: As is the case for all other cancers, prevention of pancreatic cancer also aims to eliminate or minimize manageable risks. Healthy eating, a diet rich in fruits and vegetables, regular exercise, and avoiding stressful life are important factors to prevent disease development. Smoking is a risk factor that is proven to play a role in pancreatic cancer. Another critical issue that should not be ignored is whether to quit smoking or not to smoke if already not smoking. Suppose the family history is significant for pancreatic cancer and colon cancer. In that case, it is necessary to visit a doctor to be informed about the necessity of screening and genetic testing.
Diagnosis: After the disease is diagnosed, some tests are performed to determine the best treatment modality before a treatment is instituted. Some particular methods are available that are used to analyze pancreatic cancer and to choose the body parts the cancer has spread after the cancer is diagnosed. These are ultrasound, CT, MRI, PET, endoscopic ultrasound, biopsy, and blood tests.
Treatment: All data about the patient and tumor are collected, and the most appropriate treatment approach is determined. When possible treatment options are reviewed, weighing potential benefits against possible adverse effects and risks is necessary.
Correct identification of type, stage, and grade plays a significant role in determining the best treatment for pancreatic cancer.
Cancer stages are usually symbolized by the Roman numbers I to IV. Stage IV is the most advanced stage of cancer. Each patient's treatment is planned by considering stage, age, general health status, and personal preferences.
The first step in the treatment of pancreatic cancer is to remove the tumor located in the pancreas. If this is not possible, the second objective should be hindering the growth of the tumor to avoid further damage and enhance the quality of life.
Treatment options for pancreatic cancer include radiotherapy, chemotherapy, and surgery. In some cases, these methods are used in combination or sequentially. Your doctor will decide the best treatment for you by considering the type, grade, stage of your tumor, general health status, and age.
Chemotherapy
Chemotherapy uses drugs to treat the cancer. The active substances of medicines kill the cancerous cells. Chemotherapeutic agents can be given into a vein or be taken by mouth. In the case of intravenous administration, a thin tube, called a catheter, is inserted into a great vein, and the chemotherapeutic agent is administered through this catheter throughout the treatment period.
One or more than one chemotherapeutic agents can be administered depending on the type of cancer and response to treatment. Active chemotherapy maintained for a particular time is followed by an "off" period. After the "off" period expires, the therapy resumes. Each sequential active and "off" period is called a cycle.
Side effects of the chemotherapy are a function of the chemotherapeutic agent and the dose. The most common side effects of chemotherapeutics include fatigue, nausea, vomiting, mouth sores, hair loss, and inflammation of the digestive system. Your doctor will also treat side effects caused by chemotherapy. If these side effects are severe enough to threaten your health, your doctor may advise you to suspend the treatment or to switch you to another chemotherapeutic agent.
Radiotherapy
Radiation therapy aims to kill cancer cells by using high-powered energy beams. If the radiation source is out of the body and the beams are directed at the cancer, this treatment is called external radiotherapy. On the other hand, if the radioactive agent is placed at the locus of the tumor through a needle or a catheter, the method is called internal radiotherapy (brachytherapy).
Although radiation therapy can be the first-line treatment, it is usually used to kill cells that cannot be removed operatively. In the first-line treatment, radiotherapy is mainly combined with chemotherapy, and this modality is also called chemoradiotherapy. It is essential in relieving or eliminating pain, shortness of breath, and chronic cough in advanced-stage cancers.
Radiotherapy has a vast spectrum of side effects depending on the body part irradiated. Your doctor will explain the risks that apply to you.
Surgery: In pancreatic cancer surgery, the part of the pancreas where the tumor is located) can be removed (head, body, and tail), or the pancreas can be removed.
Whipple operation is the principal approach in the surgical treatment of pancreatic cancer. While the surgical technique is relatively more straightforward for tumors located in the tail and the body of the pancreas, the tumors located in the head of the pancreas require a complex treatment; the pancreatic head is removed along with the gallbladder, common bile duct, duodenum and surrounding lymph nodes.
Asking your questions about the treatment of pancreatic cancer, your life after treatment, rehabilitation, pain management, clinical studies, and all the questions in your mind about pancreatic cancer to your doctor will help you participate in your treatment and alleviate your concerns.
