pancreatic cancer : Types, causes and symptoms

Pancreatic Cancer : Causes, Symptoms And Treatment

(Last Updated On: February 10, 2018)

What is Pancreatic Cancer ?

Pancreatic cancer is a disease in which harmful (cancerous) cells grow in the tissues of the pancreas.

The pancreas is a gland located behind the stomach and in front of the spine, Pancreatic cancer is one of deadliest cancer in the world.

The pancreas creates digestive juices and hormones that control blood glucose.

Cells known as exocrine pancreas cells produce the digestive juices, while cells known as endocrine pancreas cells produce the hormones. the majority of pancreatic cancers occur in the exocrine cells.

Function Of Pancreas

The pancreas is an organ in the abdomen that sits in front of the spine above the extent of the belly button. It performs 2 main functions:

First, it makes insulin, a hormone that regulates blood sugar levels (an endocrine function); and
second, it makes and secretes into the intestine digestive enzymes that help break down dietary proteins, fats, and carbohydrates (an exocrine function).

The enzymes help digestion by chopping proteins, fats, and carbohydrates into smaller parts so that they’ll be more easily absorbed by the body and used as building blocks for tissues and for energy.

Enzymes leave the pancreas via a system of tubes known as “ducts” that connect the pancreas to the intestines where the enzymes combine with ingested food.

The pancreas sits deep in the abdomen and is in close proximity to several vital structures like the small intestine (the duodenum) and also the bile ducts, as well as important blood vessels and nerves.

Types Of Pancreatic Cancer

There are 2 types of pancreatic cancer, that of the exocrine gland and that of the endocrine gland. about 95 % of pancreatic cancers begin in the exocrine (enzyme-producing) cells of the pancreas.

Exocrine tumors: Most tumors affecting the exocrine gland are referred to as adenocarcinomas. this type of cancer forms in the pancreas ducts. Treatment for these tumors relies on the stage of growth.

Endocrine tumors: These tumors are less common and are most frequently benign. though rare, cancer stemming from a pancreatic endocrine tumor (PET) affects the hormone-producing cells. These tumors are also referred to as islet cell tumors or neuroendocrine tumors.

Symptoms Of Pancreatic Cancer

Pancreatic cancer usually does not show any signs and symptoms in its early stage.
Symptoms of pancreatic cancer in advanced stage include:

Pain in the upper abdomen that radiates to your back

Loss of appetite or unintended weight loss

Depression

New-onset diabetes

Blood clots

Fatigue

Yellowing of your skin and the whites of your eyes (jaundice)

Causes And Prevention Of Pancreatic Cancer

About 53,670 People are diagnosed with pancreatic cancer in united states. most of the people who develop pancreatic cancer do so without any predisposing risk factors.

However, perhaps the biggest risk factor is increasing age; being over the age of 60 puts an individual at larger risk.

Rarely, there are familial or hereditary genetic syndromes arising from genetic mutations that run in families and put people at higher risk, like BRCA-2 and, to a lesser extent, BRCA-1 gene mutations.

Familial syndromes are uncommon, however, it’s necessary to let a doctor know if anyone else in the family has been diagnosed with cancer, particularly pancreatic cancer.

Additionally, certain behaviors or conditions are thought to slightly increase a person’s risk of developing pancreatic cancer.

for example, African-Americans is also at bigger risk as many people with close family members who are previously diagnosed with pancreatic cancer.

Here is some factors which increase risk of Pancreatic cancer are :

♦ Smoking

♦ Chronic pancreatitis (inflammation of the pancreas)

♦ Inherited conditions (including hereditary pancreatitis)

♦ Familial pancreatic cancer syndromes

♦ Long-standing diabetes

♦ Obesity

Prevention

You may reduce your risk of pancreatic cancer if you:

Stop smoking : If you smoke, try to stop. discuss with your doctor about methods to help you stop, together with support teams, medications and nicotine replacement therapy. If you do not smoke, do not begin. Smoking Also Cause Lung Cancer

Maintain a healthy weight : If you are at a healthy weight, work to maintain it. If you need to lose weight, aim for a slow, steady weight loss — 1 to 2 pounds (0.5 to 1 kilogram) per week.

Mix daily exercise with a diet rich in vegetables, fruit and whole grains with smaller portions to help you lose weight.

Select a healthy diet : A diet full of colorful fruits and vegetables and whole grains could help reduce your risk of cancer.

Consider meeting with a genetic counselor if you have a family history of pancreatic cancer.

He or she will review your family health history with you and confirm whether you would possibly benefit from a genetic test to understand your risk of pancreatic cancer or other cancers.

 Diagnosis

Pancreatic cancer may go undetected till it’s advanced. By the time symptoms occur, diagnosing pancreatic cancer is sometimes comparatively easy. sadly, a cure is never possible at that time.

Diagnosing pancreatic cancer usually happens once somebody comes to the doctor after experiencing weeks or months of symptoms.

Pancreatic cancer symptoms commonly include abdominal pain, weight loss, itching, or jaundice (yellow skin).

A doctor then embarks on a search for the cause, using the tools of the trade:

By taking a medical history : a doctor learns the story of the health problem, like the time of onset, nature, and location of pain, smoking history, and other medical problems.

during a physical exam : a doctor might feel a mass in the abdomen and see swollen lymph nodes in the neck, jaundiced skin, or weight loss.

lab tests : might show proof that bile flow is being blocked or other abnormalities.

Based on an individual’s exam, lab tests, and description of symptoms, a doctor often orders an imaging test:

computed tomography (CT scan): A scanner takes multiple X-ray photos, and a computer reconstructs them into detailed pictures of the inside of the abdomen. A CT scan helps doctors build a pancreatic cancer diagnosis.

magnetic resonance imaging (MRI): using magnetic waves, a scanner creates detailed pictures of the abdomen, in particular, the area around the pancreas, liver, and gallbladder.

Ultrasound: Harmless sound waves reflected off organs in the belly produce pictures, potentially helping doctors build a pancreatic cancer diagnosis.

positron emission tomography (PET scan): radioactive glucose injected into the veins is absorbed by cancer cells. PET scans might help confirm the degree of pancreatic cancer spread.

If imaging studies find a mass in the pancreas, a pancreatic cancer diagnosis is likely, however not definite. only a biopsy — taking actual tissue from the mass — will diagnose pancreatic cancer. Biopsies are often performed in many ways:

percutaneous needle biopsy: under imaging guidance, a radiologist inserts a needle into the mass, capturing some tissue. This procedure is also referred to as a fine needle aspiration (FNA).

endoscopic retrograde cholangiopancreatography (ERCP): a flexible tube with a camera and other tools on its end (endoscope) is placed through the mouth to the small intestine, close to the pancreas. ERCP will collect pictures from the area, as well as take a small biopsy with a brush.

endoscopic ultrasound: similar to ERCP, an endoscope is placed close to the pancreas. an ultrasound probe on the endoscope determines the mass and a needle on the endoscope remove some tissue from the mass.

laparoscopy is a surgery that uses many small incisions. using laparoscopy, a surgeon will obtain tissue for biopsy, as well as see inside the abdomen to detect if pancreatic cancer has spread. However, laparoscopy has higher risks than other biopsy approaches.

If pancreatic cancer appears very likely, and the tumor seems removable by surgery, doctors may suggest surgery without a biopsy.

Stages Of Pancreatic Cancer

Once cancer is diagnosed, it’s “staged.” pancreatic cancer is broken into four stages with stage 1 being the earliest stage (stage 0 isn’t counted) and stage IV being the most advanced (metastatic disease).

The following are the stages of pancreatic cancer according to the National Cancer Institute:

Stage 0: Cancer is found only in the lining of the pancreatic ducts.

Stage zero is also referred to as carcinoma in situ.

Stage I: Cancer has formed and is in the pancreas only.

Stage IA: The tumor is 2 centimeters or smaller.
Stage IB: The tumor is larger than 2 centimeters.

Stage II: Cancer could have spread or advanced to close tissue and organs and lymph nodes close to the pancreas.

Stage IIA: Cancer has spread to close tissue and organs, however, has not spread to close lymph nodes.
Stage IIB: Cancer has spread to close lymph nodes and should have spread to other close tissue and organs.

Stage III: Cancer has spread or progressed to the major blood vessels close to the pancreas and should have spread to close lymph nodes.

Stage IV: Cancer may be of any size and has spread to distant organs, like the liver, lung, and peritoneal cavity.

It also could have spread to organs and tissues close to the pancreas or to lymph nodes. This stage has also been termed end-stage pancreatic cancer.

Unlike many cancers, but, patients with pancreatic cancer are commonly categorized into 3 groups, those with local disease, those with locally advanced, unresectable disease, and people with metastatic disease. Initial therapy usually differs for patients in these 3 groups.

Patients with stage I associate degreed stage II cancers square measure thought to possess native or “resectable” cancer (cancer that may be fully removed with an operation).

Patients with stage III cancers have “locally advanced, unresectable” unwellness.

During this state of affairs, the chance for the cure has been lost however native treatments like radiation stay choices.

In patients with stage IV carcinoma, therapy is most typically counseled as a method of dominant the symptoms associated with cancer and increasing life.

Below, we’ll review common treatments for the 3 teams of duct gland cancers (resectable, domestically advanced unresectable, and pathological process duct gland cancer).

Treatment

Determining cancer’s stage is commonly tough. Imaging tests like CT scans and ultrasound offer some information, however knowing exactly how far pancreatic cancer has spread usually needs surgery.

Since surgery has risks, doctors first confirm whether pancreatic cancer seems to be removable by surgery (resectable). pancreatic cancer is then described as follows:

Resectable: On imaging tests, pancreatic cancer not spread (or a minimum of not far), and a surgeon thinks it would all be removable. about 100 percent of pancreatic cancers are considered resectable once first diagnosed.

Unresectable or locally advanced: pancreatic cancer has spread into major blood vessels on imaging tests, that the tumor not carefully be removed by surgery.

Metastatic: pancreatic cancer has clearly spread to different organs, so surgery cannot take away cancer.

If pancreatic cancer is resectable, surgery followed by chemotherapy or radiation or each could extend survival.

People whose pancreatic cancer is considered resectable could undergo one of 3 surgeries:

Whipple procedure (pancreaticoduodenectomy): A surgeon removes the head of the pancreas and sometimes the body of the pancreas, parts of the stomach and small intestine, some lymph nodes, the gallbladder, and also the common bile duct.

The remaining organs are reconnected in a very new way to permit digestion. The Whipple procedure could be a difficult and complicated surgery.

Surgeons and hospitals that do the most operations have the best results.

Most of the time, When a Do sees inside the abdomen, pancreatic cancer that was considered to be resectable turns out to have spread, and therefore be unresectable. The Whipple procedure is not completed in these cases.

Distal pancreatectomy: The tail and/or portion of the body of the pancreas are removed, but not the head. This surgery is rare for pancreatic cancer because most tumors occurring outside the head of the pancreas inside the body or tail are unresectable.

Total pancreatectomy: the entire pancreas and also the spleen is surgically removed. although once considered helpful, this operation is rare today.

Chemotherapy or radiation therapy or both can even be used in combination with surgery for resectable and unresectable pancreatic cancer in order to:

Shrink pancreatic cancer before surgery : increasing the chances of resection (neoadjuvant therapy)
stop or delay pancreatic cancer from returning after surgery (adjuvant therapy)

Chemotherapy includes cancer medicine that travels through the complete body : chemotherapy (“chemo”) kills pancreatic cancer cells in the main tumor as well as those that have spread widely. Chemo medicines that can be used for pancreatic cancer:

  • Gemcitabine
  • 5-fluorouracil (5-FU) or capecitabine

Both 5-FU and gemcitabine are delivered into the veins through regular visits to an oncologist (cancer doctor). an oral drug, capecitabine, could also be substituted for 5-FU, particularly with radiation.

In radiation therapy, a machine beams high-energy X-rays to the pancreas to kill pancreatic cancer cells. radiation therapy is completed throughout a series of daily treatments, sometimes over a period of weeks.

Both radiation therapy and chemotherapy harm some normal cells, together with cancer cells. side effects will include nausea, vomiting, appetite loss, weight loss, and fatigue as well as toxicity to the blood cells.

Symptoms sometimes stop within a few weeks after radiation therapy is complete.

Treating Locally Advanced (Unresectable) pancreatic cancer

In locally advanced pancreatic cancer, surgery cannot remove the complete tumor. Since surgery to remove only a part of pancreatic cancer has been shown to not help, nonsurgical therapies are best.

Treatment consists of chemotherapy with or without radiation therapy. Either 5-FU or gemcitabine will extend life in people with locally advanced pancreatic cancer.

Treating metastatic pancreatic cancer

In metastatic pancreatic cancer, surgery is used just for symptom control, like for pain, jaundice, or gastric outlet obstruction. Radiation is also used for symptom relief, as well.

Chemotherapy can also help to improve patients survival and symptoms. Gemcitabine has been the most Commonly used chemotherapy drug for treating metastatic pancreas cancer.

other drug mixtures include gemcitabine with erlotinib, gemcitabine with capecitabine, gemcitabine with cisplatin, and gemcitabine with nab-paclitaxel.

If you’re in fairly good health you will receive FOLFIRINOX (5-FU/leucovorin/oxaliplatin/irinotecan). other mixtures include gemcitabine alone or with another agent like (nab)-paclitaxel or capecitabine.

Next line drug mixtures to treat pancreatic cancer include oxaliplatin/fluoropyrimidine, or irinotecan liposome (Onivyde) together with fluorouracil plus leucovorin.

Palliative Treatment

As cancer advances, the No. 1 selection of treatment will move from extending life to alleviating symptoms, particularly pain.

Several treatments can help protect against the discomfort from the advanced stage of pancreatic cancer:

♦ Procedures like bile duct stents can relieve jaundice, thus reducing skin sensation and loss of appetite related to bile obstruction.

♦ Opioid analgesics can help relieve pain.

♦ Antidepressants and counseling can help treat depression common in advanced pancreatic cancer.

Clinical Trials

New pancreatic cancer treatments are constantly being tested in clinical trials.

You will be able to find out about clinical trials for the newest treatments for pancreatic cancer on the websites of the American Cancer Society or the National Cancer Institute.

 

Reference :

American Cancer Society

Wikipedia

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