Pancreatic cancer

What is pancreatic cancer?

Pancreatic cancer begins when abnormal cells in the pancreas grow and divide out of control and form a tumor. The pancreas is a gland located deep in the abdomen, between the stomach and the spine. It makes enzymes that help digestion and hormones that control blood-sugar levels. Organs, like the pancreas, are made up of cells. Normally, cells divide to form new cells as the body needs them. When cells get old, they die, and new cells take their place. Sometimes this process breaks. New cells form when the body does not need them, or old cells do not die. The extra cells may form a mass of tissue called a tumor. Some tumors are benign. This means they are abnormal but cannot invade other parts of the body. A malignant tumor is called cancer. The cells grow out of control and can spread to other tissues and organs. Even when the cancer spreads to other areas of the body, it is still called pancreatic cancer if that is where it started. Pancreatic cancer often spreads to the liver, abdominal wall, lungs, bones and/or lymph nodes.

Types of pancreatic cancer

Exocrine cancers are by far the most common type of pancreas cancer. If you are told you have pancreatic cancer, it’s most likely an exocrine pancreatic cancer. Pancreatic adenocarcinoma: About 95% of cancers of the exocrine pancreas are adenocarcinomas. These cancers usually start in the ducts of the pancreas. Less often, they develop from the cells that make the pancreatic enzymes, in which case they are called acinar cell carcinomas. Less common types of exocrine cancer: Other, less common exocrine cancers include adenosquamous carcinomas, squamous cell carcinomas, signet ring cell carcinomas, undifferentiated carcinomas, and undifferentiated carcinomas with giant cells. Ampullary cancer (carcinoma of the ampulla of Vater): This cancer starts in the ampulla of Vater, which is where the bile duct and pancreatic duct come together and empty into the small intestine. Ampullary cancers aren’t technically pancreatic cancers, but they are included here because they are treated much the same. Ampullary cancers often block the bile duct while they’re still small and have not spread far. This blockage causes bile to build up in the body, which leads to yellowing of the skin and eyes (jaundice). Because of this, these cancers are usually found earlier than most pancreatic cancers, and they usually have a better prognosis (outlook).

Benign pancreatic tumors

Some growths in the pancreas are simply benign (not cancer), while others might become cancer over time if left untreated (known as precancers). Because people are getting imaging tests such as CT scans more often than in the past (for a number of reasons), these types of pancreatic growths are now being found more often. Serous cystic neoplasms (SCNs) (also known as serous cystadenomas) are tumors that have sacs (cysts) filled with fluid. SCNs are almost always benign, and most don’t need to be treated unless they grow large or cause symptoms. Mucinous cystic neoplasms (MCNs) (also known as mucinous cystadenomas) are slow-growing tumors that have cysts filled with a jelly-like substance called mucin. These tumors almost always occur in women. While they are not cancer, some of them can progress to cancer over time if not treated, so these tumors are typically removed with surgery. Intraductal papillary mucinous neoplasms (IPMNs) are benign tumors that grow in the pancreatic ducts. Like MCNs, these tumors make mucin, and over time they sometimes become cancer if not treated. Some IPMNs can just be followed closely over time, but some might need to be removed with surgery if they have certain features, such as if they are in the main pancreatic duct. Solid pseudopapillary neoplasms (SPNs) are rare, slow-growing tumors that almost always develop in young women. Even though these tumors tend to grow slowly, they can sometimes spread to other parts of the body, so they are best treated with surgery. The outlook for people with these tumors is usually very good.

Causes of pancreatic cancer

It’s not clear what causes pancreatic cancer. Doctors have identified some factors that may increase the risk of this type of cancer, including smoking and having certain inherited gene mutations.

Understanding your pancreas

Your pancreas is about 6 inches (15 centimeters) long and looks something like a pear lying on its side. It releases (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 and absorb nutrients.

How pancreatic cancer forms?

Pancreatic cancer occurs when cells in your pancreas develop changes (mutations) in their DNA. A cell’s DNA contains the instructions that tell a cell what to do. These mutations tell the cells to grow uncontrollably and to continue living after normal cells would die. These accumulating cells can form a tumor. When left untreated, the pancreatic cancer cells can spread to nearby organs and blood vessels and to distant parts of the body. 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. Less frequently, cancer can form in the hormone-producing cells or the neuroendocrine cells of the pancreas. These types of cancer are called pancreatic neuroendocrine tumors, islet cell tumors or pancreatic endocrine cancer. Changes in your DNA cause cancer. These can be inherited from your parents or can arise over time. The changes that arise over time can happen because you were exposed to something harmful. They can also happen randomly. Pancreatic cancer’s exact causes are not well understood. About 5% to 10% of pancreatic cancers are considered familial or hereditary. Most pancreatic cancer happens randomly or is caused by things such as smoking, obesity and age. You may have an increased risk of developing pancreatic cancer if you have:

• Two or more first-degree relatives who have had pancreatic cancer
• A first-degree relative who developed pancreatic cancer before the age of 50
• An inherited genetic syndrome associated with pancreatic cancer

If you have any of these, the Pancreatic Cancer Action Network strongly recommends consulting with a genetic counselor to determine your risk and eligibility for a screening program. A person may also be more likely to get pancreatic cancer because of:

• Long-standing diabetes
• Chronic and hereditary pancreatitis
• Smoking
• Race (ethnicity): African-American or Ashkenazi Jew
• Age: over the age of 60
• Gender: males slightly more likely
• Diets high in red and processed meats
• Obesity

This does not mean that everyone who has these risk factors will get pancreatic cancer or that everyone who gets pancreatic cancer has one or more of these.

Risk factors of pancreatic cancer

Factors that may increase your risk of pancreatic cancer include:

• Smoking
• Diabetes
• Chronic inflammation of the pancreas (pancreatitis)
• Family history of genetic syndromes that can increase cancer risk, including a BRCA2 gene mutation, Lynch syndrome and familial atypical mole-malignant melanoma (FAMMM) syndrome
• Family history of pancreatic cancer
• Obesity
• Older age, as most people are diagnosed after age 65

A large study demonstrated that the combination of smoking, long-standing diabetes and a poor diet increases the risk of pancreatic cancer beyond the risk of any one of these factors alone.

Symptoms of pancreatic cancer

Signs and symptoms of pancreatic cancer often don’t occur until the disease is advanced. They may include:

• Abdominal pain that radiates to your back
• Loss of appetite or unintended weight loss
• Yellowing of your skin and the whites of your eyes (jaundice)
• Light-colored stools
• Dark-colored urine
• Itchy skin
• New diagnosis of diabetes or existing diabetes that’s becoming more difficult to control
• Blood clots
• Fatigue

Complications of pancreatic cancer

As pancreatic cancer progresses, it can cause complications such as:

• Weight loss. A number of factors may cause weight loss in people with pancreatic cancer. Weight loss might happen as the cancer consumes the body’s energy. Nausea and vomiting caused by cancer treatments or a tumor pressing on your stomach may make it difficult to eat. Or your body may have difficulty processing nutrients from food because your pancreas isn’t making enough digestive juices.
• Jaundice. 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. Jaundice usually occurs without abdominal pain.Your doctor may recommend that a plastic or metal tube (stent) be placed inside the bile duct to hold it open. This is done with the help of a procedure called endoscopic retrograde cholangiopancreatography (ERCP). During ERCP an endoscope is passed down your throat, through your stomach and into the upper part of your small intestine. A dye is then injected into the pancreatic and bile ducts through a small hollow tube (catheter) that’s passed through the endoscope. Finally, images are taken of the ducts.
• Pain. A growing tumor may press on nerves in your abdomen, causing pain that can become severe. Pain medications can help you feel more comfortable. Treatments, such as radiation and chemotherapy, might help slow tumor growth and provide some pain relief.In severe cases, your doctor might 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 first part of the small intestine (duodenum) can block the flow of digested food from your stomach into your intestines.Your doctor may recommend that a tube (stent) be placed in your small intestine to hold it open. In some situations, it might help to have surgery to place a temporary feeding tube or to attach your stomach to a lower point in your intestines that isn’t blocked by cancer.

Diagnosis of pancreatic cancer

After taking down your health history and performing a physical exam, the doctor may order several tests to determine the cause of your problem or extent of the condition, including:

• CT scan (computed tomography)
• MRI (magnetic resonance imaging)
• Endoscopic ultrasound (EUS)
• Laparoscopy (surgical procedure to look at organs)
• Endoscopic retrograde cholangiopancreatography (ERCP)
• Percutaneous transhepatic cholangiography (PTC; procedure used to X-ray liver and bile ducts)
• Biopsy (removal of tissue to view it under a microscope).

Pancreatic cancer stages

When pancreatic cancer is discovered, doctors will likely perform additional tests to understand if or where the cancer has spread. Imaging tests, such as a PET scan, help doctors identify the presence of cancerous growths. Blood tests may also be used. With these tests, doctors are attempting to establish the cancer’s stage. Staging helps explain how advanced the cancer is. It also helps doctors determine treatment options. Once a diagnosis has been made, your doctor will assign a stage based on the test results:

• stage 1: tumors exist in the pancreas only
• stage 2: tumors have spread to nearby abdominal tissues or lymph nodes
• stage 3: the cancer has spread to major blood vessels and lymph nodes
• stage 4: tumors have spread to other organs, such as the liver

Pancreatic cancer stage 4

Stage 4 pancreatic cancer has spread beyond the original site to distant sites, like other organs, the brain, or bones. Pancreatic cancer is often diagnosed at this late stage because it rarely causes symptoms until it has spread to other sites. Symptoms you might experience at this advanced stage include:

• pain in the upper abdomen
• pain in the back
• fatigue
• jaundice (yellowing of the skin)
• a loss of appetite
• weight loss
• depression

Stage 4 pancreatic cancer cannot be cured, but treatments can relieve symptoms and prevent complications from the cancer. These treatments can include:

• chemotherapy
• palliative pain treatments
• bile duct bypass surgery
• bile duct stent
• gastric bypass surgery

The five-year survival rate for stage 4 pancreatic cancer is 3 percent.

Pancreatic cancer stage 3

Stage 3 pancreatic cancer is a tumor in the pancreas and possibly nearby sites, such as lymph nodes or blood vessels. Pancreatic cancer at this stage has not spread to distant sites. Pancreatic cancer is called a silent cancer because it is often not diagnosed until it has reached an advanced stage. If you have symptoms of stage 3 pancreatic cancer, you may experience:

• pain in the back
• pain or tenderness in the upper abdomen
• a loss of appetite
• weight loss
• fatigue
• depression

Stage 3 pancreatic cancer is difficult to cure, but treatments can help prevent the spread of the cancer and ease symptoms caused by the tumor. These treatments may include:

• surgery to remove a portion of the pancreas (Whipple procedure)
• anti-cancer drugs
• radiation therapy

The five-year survival rate for stage 3 pancreatic cancer is 3 to 12 percent. The majority of people with this stage of the cancer will have a recurrence. That’s likely due to the fact that micrometastases, or small areas of undetectable cancer growth, have spread beyond the pancreas as the time of detection.

Pancreatic cancer stage 2

Stage 2 pancreatic cancer is cancer that remains in the pancreas and may have spread to a few nearby lymph nodes. It has not spread to nearby tissues or blood vessels, and it has not spread to sites elsewhere in the body. Pancreatic cancer is difficult to detect in the early stages, including stage 2. That’s because it’s unlikely to cause detectable symptoms. If you do have symptoms at this early stage, you may experience:

• jaundice
• changes in urine color
• pain or tenderness in the upper abdomen
• weight loss
• loss of appetite
• fatigue

Treatment may include:

• surgery
• radiation
• chemotherapy
• targeted drug therapies

Your doctor may use a combination of these approaches to help shrink the tumor and prevent possible metastases. The five-year survival rate for people with stage 2 pancreatic cancer is around 30 percent.

Treatment of pancreatic cancer

Treatment for pancreatic cancer depends on the stage of cancer. It has two goals: to kill cancerous cells and to prevent the spread of the disease.

Weight loss, bowel obstruction, abdominal pain, and liver failure are among the most common complications during pancreatic cancer treatment.

Surgery

The decision to use surgery to treat pancreatic cancer comes down to two things: the location of the cancer and the stage of the cancer. Surgery can remove all or some portions of the pancreas. This can eliminate the original tumor, but it will not remove cancer that has spread to other portions of the body. Surgery may not be suitable for people with advanced stage pancreatic cancer for that reason.

Radiation therapy

Other treatment options must be explored once the cancer spreads outside of the pancreas. Radiation therapy uses X-rays and other high-energy beams to kill the cancer cells.

Chemotherapy

In some cases, your doctor might combine other treatments with chemotherapy, which uses cancer-killing drugs to help prevent future growth of cancer cells.

Targeted therapy

This type of cancer treatment uses drugs or other measures to specifically target cancer cells and work to destroy them. These drugs are designed not to harm healthy or normal cells.

Prevention of pancreatic cancer

You may reduce your risk of pancreatic cancer if you:

• Stop smoking. If you smoke, try to stop. Talk to your doctor about strategies to help you stop, including support groups, medications and nicotine replacement therapy. If you don’t smoke, don’t start.
• 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) a week. Combine daily exercise with a diet rich in vegetables, fruit and whole grains with smaller portions to help you lose weight.
• Choose a healthy diet. A diet full of colorful fruits and vegetables and whole grains may help reduce your risk of cancer.

Consider meeting with a genetic counselor if you have a family history of pancreatic cancer. He or she can review your family health history with you and determine whether you might benefit from a genetic test to understand your risk of pancreatic cancer or other cancers.

For details on pancreatic cancer treatment and second opinion, do call us at +91 96 1588 1588 or write to cancerfax@gmail.com.