Pancreatic cancer begins in the tissues of your pancreas — an organ in your abdomen that lies horizontally behind the lower part of your stomach. Your pancreas secretes enzymes that aid digestion and hormones that help regulate the metabolism of sugars.
Pancreatic cancer often has a poor prognosis,because most often they are diagnosed at an advanced stage. If detected early, surgery can be curative in few cases depending on your final biopsy report.
Signs and symptoms of pancreatic cancer often don’t occur until the disease is advanced. When signs and symptoms do appear, they may include:
- Upper abdominal pain that may radiate to your back
- Yellowing of your skin and the whites of your eyes (jaundice)
- Loss of appetite
- Weight loss
- Blood clots
It’s not clear what causes pancreatic cancer.
UNDERSTANDING YOUR PANCREAS
Your pancreas is about 6 inches (about 15 centimeters) long and looks something like a pear lying on its side. The pancreas secretes hormones, including insulin, to help your body process sugar in the foods you eat. And it produces digestive juices to help your body digest food.
HOW PANCREATIC CANCER FORMS
Pancreatic cancer occurs when cells in your pancreas develop mutations in their DNA. These mutations cause cells to grow uncontrollably and to continue living after normal cells would die. These accumulating cells can form a tumor.
Most pancreatic cancer begins in the cells that line the ducts of the pancreas. This type of cancer is called pancreatic adenocarcinoma or pancreatic exocrine cancer.
Rarely, cancer can form in the hormone-producing cells of the pancreas. This type of cancer is called islet cell cancer or pancreatic endocrine cancer.
Factors that may increase your risk of pancreatic cancer include:
- Excess body weight
- Chronic inflammation of the pancreas (pancreatitis)
- Personal or family history of pancreatic cancer
As pancreatic cancer progresses, it can cause complications such as:
- Pancreatic cancer that blocks the liver’s bile duct can cause jaundice. Signs include yellow skin and eyes, dark-colored urine, and pale-colored stools.
- A growing tumor may press on nerves in your abdomen, causing pain that can become severe. Pain medications can help you feel more comfortable. Radiation therapy may help stop tumor growth temporarily to give you some relief.
In severe cases, your doctor may recommend a procedure to inject alcohol into the nerves that control pain in your abdomen (celiac plexus block). This procedure stops the nerves from sending pain signals to your brain.
- Bowel obstruction. Pancreatic cancer that grows into or presses on the small intestine (duodenum) can block the flow of digested food from your stomach into your intestines.
- Weight loss. A number of factors may cause weight loss in people with pancreatic cancer.
Pancreatic enzyme supplements may be recommended to aid in digestion. Try to maintain your weight by adding extra calories where you can and making mealtime as pleasant and relaxed as possible.
TESTS AND DIAGNOSIS
DIAGNOSING PANCREATIC CANCER
If your doctor suspects pancreatic cancer, you may have one or more of the following tests to diagnose the cancer:
- Triple phase CT Scan abdomen
- Endo Ultrasound (EUS)
- Side Viewing Endoscopy
- Biopsy- though not mandatory if thinking of surgery, but in advanced cases not ameanable to curative resection,biopsy is required.
- Tumour marker study – CA 19 – 9
STAGES OF PANCREATIC CANCER
Using information from staging tests, your doctor assigns your pancreatic cancer a stage. The stages of pancreatic cancer are:
- Stage I. Cancer is confined to the pancreas.
- Stage II. Cancer has spread beyond the pancreas to nearby tissues and organs and may have spread to the lymph nodes.
- Stage III. Cancer has spread beyond the pancreas to the major blood vessels around the pancreas and may have spread to the lymph nodes.
- Stage IV. Cancer has spread to distant sites beyond the pancreas, such as the liver, lungs and the lining that surrounds your abdominal organs (peritoneum).
TREATMENTS AND DRUGS
Treatment for pancreatic cancer depends on the stage and location of the cancer as well as on your age, overall health and personal preferences.
The first goal of pancreatic cancer treatment is to eliminate the cancer, when possible. When that isn’t an option, the focus may be on preventing the pancreatic cancer from growing or causing more harm.
When pancreatic cancer is advanced and treatments aren’t likely to offer a benefit, your doctor will help to relieve symptoms and make you as comfortable as possible.
Surgery may be an option if your pancreatic cancer is confined to the pancreas. Operations used in people with pancreatic cancer include:
- Surgery for tumors in the pancreatic head. If your pancreatic cancer is located in the head of the pancreas, you may consider an operation called a Whipple procedure (pancreatoduodenectomy).
The Whipple procedure involves removing the head of your pancreas, as well as a portion of your small intestine (duodenum), your gallbladder and part of your bile duct. Part of your stomach may be removed as well. Your surgeon reconnects the remaining parts of your pancreas, stomach and intestines to allow you to digest food.
Whipple surgery carries a risk of infection and bleeding. After the surgery, some people experience nausea and vomiting that can occur if the stomach has difficulty emptying (delayed gastric emptying).
Expect a long recovery after a Whipple procedure. You’ll spend several days in the hospital and then recover for several weeks at home.
- Surgery for tumors in the pancreatic tail and body. Surgery to remove the tail of the pancreas or the tail and a small portion of the body is called distal pancreatectomy. Your surgeon may also remove your spleen. Surgery carries a risk of bleeding and infection.
Research shows pancreatic cancer surgery tends to cause fewer complications when done by experienced surgeons. Don’t hesitate to ask about your surgeon’s experience with pancreatic cancer surgery. If you have any doubts, get a second opinion.
Radiation therapy uses high-energy beams, such as X-rays, to destroy cancer cells. You may receive radiation treatments before or after cancer surgery, often in combination with chemotherapy. Or, your doctor may recommend a combination of radiation and chemotherapy treatments when your cancer can’t be treated surgically.
Radiation therapy usually comes from a machine that moves around you, directing radiation to specific points on your body (external beam radiation). In specialized medical centers, radiation therapy may be delivered during surgery (intraoperative radiation).
Chemotherapy uses drugs to help kill cancer cells. Chemotherapy can be injected into a vein or taken orally. You may receive only one chemotherapy drug, or you may receive a combination of chemotherapy drugs.
Chemotherapy can also be combined with radiation therapy (chemoradiation). Chemoradiation is typically used to treat cancer that has spread beyond the pancreas, but only to nearby organs and not to distant regions of the body. This combination may also be used after surgery to reduce the risk that pancreatic cancer may recur.
In people with advanced pancreatic cancer, chemotherapy may be used alone or it may be combined with targeted drug therapy.