Introduction

Cancer of the pancreas (PANCREATIC CANCER) occurs when abnormal cells in the pancreas begin division and growth in an unregulated manner forming a tumor (cancerous growth).

The pancreas is a glandular organ about 6 inches long found in the abdominal cavity. It has three parts, male the head, body and tail. The head is the wider end, the body is the middle part while the narrow end forms the tail. It performs important functions in the body such as:

•  Controlling blood sugar through making and releasing of insulin and glucagon hormones.
•  Digestive roles. It releases digestive enzymes.

The pancreas is located (hidden) behind other organs like the stomach, small intestine, liver, gallbladder, spleen and bile duct.

 

 Key Facts & Statistics

What are the key facts and statistics about pancreatic cancer?

• Pancreatic cancer accounts for about 3% of all cancer cases in the US.
• It is the 10^th most common type of cancer in men.
• It is the 8^th most common type of cancer in women.
• In the United Kingdom, almost 11,000 people are diagnosed with pancreatic cancer every year. This makes it the 10^th most common cancer in the UK.
• Almost 95% of pancreatic cancers begin in exocrine cells.
• In the US, 11 out of 100 people are usually still alive 5 years after being diagnosed with this cancer. This recovery rate is poor.
• It is speculated that by 2030, this cancer will be the second leading cause of cancer deaths in the US.

 

Causes

What are the causes of pancreatic cancer?

The exact cause(s) of pancreatic cancer is not yet established. However, scientific experts have noted and identified several elements as risk factors.

 

 Risk Factors

What are the risk factors for pancreatic cancer?

• Smoking tobacco products. These include cigars, cigarettes and other kinds of tobacco.
• Obesity. Having excess body weight that is unhealthy for an individual can increase the chance of developing pancreatic cancer.
• Fruitarian diet. A medical paper was published in 2010 looking at the effects of fructose (a sugar naturally occurring in fruits), specifically how it relates to pancreatic cancer. Researchers from UCLA found that pancreatic cells utilize fructose to activate a key cellular pathway that drives cell division causing cancer cells to grow and spread more rapidly. Therefore, a high fructose diet may cause pancreatic cancer and accelerate its growth.
• Diabetes (type 2).
• Chemical exposure to pesticides.
• Chronic pancreatitis. It refers to permanent inflammation of the pancreas. It can be inherited when specific genetic alterations are passed down from a parent to offspring.
• Hereditary conditions;

1. Such as multiple endocrine neoplasia type 1 (MEN1) syndrome, hereditary nonpolyposis colon cancer, hereditary breast and ovarian cancer syndrome and familial atypical multiple mole melanoma (FAMMM) syndrome.
2. With mutations in genes such as BRCA1 and BRCA 2 genes.

 

Stages

What are the stages of pancreatic cancer?

• Pancreatic cancer is classified into 5 main stages. These are: stages 0, I, II, III and IV.

1. Stage 0 (carcinoma in situ).
2. Stage I pancreatic cancer.
3. Stage II pancreatic cancer.
4. Stage III pancreatic cancer.
5. Stage IV pancreatic cancer.

 

• Various systems for staging are used in describing the extent of cancers. TNM staging is used for staging pancreatic cancer.  It  uses three parameters, which are:

1.  Tumour size (T)
2.  Regional nodal metastasis (N)
3.  Distant metastasis (M)

Further discussion about these 5 stages of pancreatic cancer is described in Pancreatic cancer stages.

 

 Signs & Symptoms

What are the signs and symptoms of pancreatic cancer?

Initially, there are no noticeable signs and symptoms in the early stages. Even as they begin to present, they look similar to those of many other conditions.

•  Jaundice (the skin becomes yellowish and the yes whiten).
•  Dark urine.
•  Loss of appetite.
•  Fatigue.
•  Unexplained loss of weight.
• Upper abdominal and middle back pain.
•  Light-clored stools.
• Itchy skin.
• Nausea and vomiting.
• New-onset diabetes.
• Blood clots.
• Bloating.

 

Types

What are the most common types of pancreatic cancer?

There are two main forms of pancreatic tumors. These are:

1. Exocrine tumors. More than 90% of pancreatic tumors are exocrine. Pancreatic adenocarcinoma is the most common form of pancreatic cancer.
2. Neuroendocrine tumors. These account for less than 10% of pancreatic tumors. Neuroendocrine tumors are also known as islet cell carcinoma.

 

 Diagnostic Procedures  & Tests

How is pancreatic cancer diagnosed?

Panceatic cancer is difficult to be detected in the initial stages as the pancreas cannot be felt during routine examinations and the tumors are not easily observable on  routine imaging tests.

Diagnostic procedures for pancreatic cancer include:

• Patient history-taking.
• Physical examination of the abdomen including palpating for the spleen.
• Imaging tests :

1.  Computed tomography (CT) scans
2.  Magnetic resonance imaging. It is also called nuclear  magnetic resonance imaging. It uses radio and magnetic waves to create a series of detailed images showing the inside  ares of the body.
3.  Positron emission tomography (PET) scan
4.  Endoscopic ultrasound. It is also called endosonography.

• Blood tests. Pancreas blood tests are used to check for tumor markers (chemical substances that may show the presence of a cancer). Carbohydrate antigen (CA) 19-9 is a type of protein released by pancreatic cancer cells. High levels are indicative of a tumor.
• Staging laparoscopy.  It is used to describe the extent of the cancer (staging) and if it can be removed. It can also be used to pick a tissue biopsy.
• Genetic testing. For persons whose diagnosis is positive, genetic testing can be conducted to check it was hereditary. In some individuals with pancreatic cancer, there may be mutations in BRCA1 and BRCA2 genes. These mutations are not only responsible for breast cancer but also may be indicative of prostate, pancreatic and ovarian cancers.

 

 Treatment and Management

Does pancreatic cancer have a cure?

• Pancreatic cancer has a poor survival rate.
• However, when detected during the early stages and properly treated, complete remission is possible.
• Total pancreatectomy (total removal of the cancer through surgery) is the only way to really cure pancreatitis.

 

How is pancreatic cancer treated?

• Treatment of cancer of the pancreas depends on;

1.  Overall health status.
2.  Exact location of the tumor.
3. The stage of cancer.
4.  Whether it has metastasized to other regions.

 

Treatment strategies are:

• Surgery. 3 types of surgery that can be conducted for pancreatic cancer are:

1.  Pancreaticoduodenectomy.
2.  Distal pancreatectomy.
3. Total pancreatectomy.

• Chemotherapy. Drugs are used to kill cancerous cells. It can be done pre-surgery to shrink the tumor or post-surgery to kill any cancer cells that are still remaining.
• Radiation therapy. It utilizes high-energy X-rays to kill cancer cells. It can be combined with chemotherapy to form chemoradiation.
• Targeted therapy. Drugs for targeted therapy include erlotinib and entrectinib.
• Pain management. This can be achieved through administration of oral pain killers, steroids (parenterally) or anesthesia.

 

Groups used in planning treatment for pancreatic cancer include:

1. Resectable pancreatic cancer
2. Borderline resectable pancreatic cancer
3. Locally advanced pancreatic cancer
4. Metastatic pancreatic cancer
5. Recurrent pancreatic cancer

 

 Complications

What are the complications of pancreatic cancer?

Metastasis. The cancer can spread to surrounding blood vessels and lymph nodes.

It can even go further to the liver and lungs.

Most of the time, pancreatic cancers usually have metastasized by the time they are being diagnosed.

 

Prevention

How do we prevent pancreatic cancer?

Pancreatic cancer is not preventable. However, there are strategies that can be employed to lower risk of developing it. These are:

• Avoiding and/or quitting smoking.
• Limit amount of alcohol consumed.
• Reduce consuming sugary and processed foods.
• Keep weight and body mass index (BMI) within the healthy range.