Before answering what the pancreatic cancer is, we must first explain what the pancreas is. Pancreas is an organ in approximately 15 cm, accepted as a part of digestive system, situated behind stomach and liver in body. Digestive enzymes secreted from pancreas join the duodenum and insulin hormone which regulates sugar metabolism in body joins directly to blood. Pancreatic cancer is a malignant disease caused by the hyperproliferation of the cells that comprise the pancreas.
What is Pancreatic Cancer?
Pancreatic cancer develops by the mutational changes in pancreas DNA. These mutations cause the pancreatic cells to grow uncontrollably, form a mass, cause healthy cells to die or render them ineffective. They also spread to nearby organs if left untreated. Pancreatic cancers generally originate from the cells which lay inside the duct from which the enzymes for digestive system are secreted from pancreas. This cancer is called pancreatic adenocarcinoma or exocrine cancer of pancreas. Rarely, tumors that secrete hormones or originating from neuroendocrine cells can also be seen. These tumors are called pancreatic neuroendocrine tumors or endocrine cancer of pancreas.
What causes pancreatic cancer is not well understood, however some risk factors are defined: Age is the most important of them all, because the disease usually affects people between 50 and 70 years old. Some of the risk factors that may cause the formation of pancreatic cancer are:
- Chronic pancreas inflammation (pancreatitis)
- Pancreatic cancer history in family
Pancreatic cancer is inherited in 1 of 10 cases. Some genes can cause pancreatitis, and this increases the risk of developing pancreatic cancer. Pancreatic cancer incidence increases if 2 or more close relatives have the disease, in the presence of a hereditary disease like Lynch or Peutz-Jeghers syndrome or in the case of some syndromes like BRCA2 gene mutation, which leads to an increased risk of overall tendency to develop a cancer. So, these patients should be checked in more frequent intervals.
What Are the Symptoms of Pancreatic Cancer?
A tumor in pancreas does not generally cause any symptoms in early stages and this could complicate the diagnosis. Pancreas tumors usually start to give out symptoms after they spread to surrounding organs.
- Abdominal pain permeating to back: First noticeable symptom of pancreatic cancer is pain in the back or stomach region.
- Weight loss: Sudden weight loss without loss of appetite or any dietary adjustments can be an early sign of pancreatic cancer.
- Jaundice: Jaundice observed in the skin or in white areas of the eye can be caused by the obstruction of the bile duct by pancreas.
- Darkening in urine color.
Other than these, severe fatigue/malaise, paleness in bowel movement color, changes in bowel habits (diarrhea or constipation), fever and shaking, indigestion and thrombosis can emerge. These symptoms can be caused by many different diseases and are not cancer specific. However, a physician must be consulted if these symptoms begin suddenly and worsen gradually.
What are the Stages of Pancreatic Cancer?
Cancer staging is a term used in treatment in the spread of cancer. Treatment method is decided by observing the cancer’s spread in pancreatic cancer, which has 4 stages.
Stage 0: No spread is present. Pancreatic cancer is confined within the uppermost layers of pancreatic duct only. Cancer cannot be detected by naked eye or any imaging modality at this stage.
Stage I: Local growth. Cancer is confined within pancreas at this stage. It is defined as Stage IA when tumor is less than 2 cm and Stage IB when it is between 2-4 cm.
Stage II: Local invasion is present. Tumor size is larger than 4 cm. Tumor is either confined within pancreas or growth towards exterior of pancreas can be observed at this stage. Lymph nodes close to pancreas may be invaded but no distant spread is present.
Stage III: Even wider spread. Tumor has surrounded large veins or nerves close to it but no distant metastasis is detected.
Stage IV: Distant organ metastasis is present.
Pancreatic Cancer Diagnosis and Treatment
Physicians can get suspicious in the patients with the symptoms described above and some tests are performed. Pancreatic cancer can be suspected if a palpable mass in abdomen or hepatomegaly (enlargement of liver) findings are present. Abdominal ultrasound, tomography, MRI or PET/CT is necessary for definitive diagnosis and staging. Since pancreas is between stomach and liver, it is hard to visualize fully in ultrasound. Therefore EUS, meaning endoscopic ultrasonography, which is a thin tube inserted from the mouth and examination of pancreas from inside the stomach can be performed. Another method called ERCP (endoscopic retrograde cholangiopancreatography) again involves the insertion of a tube from the mouth. A special stain is injected to bile and pancreatic ducts and detailed imaging of pancreas is done that way. Another detailed imaging of pancreas with MRI is MRCP (magnetic resonance cholangiopancreatography). Definitive diagnosis is made by biopsy via obtaining a small specimen from the suspicious mass in guidance of endoscopic imaging methods. Pathologic examinations, molecular analyses reveal the subtype of the cancer in this biopsy material and staging is done to determine treatment method. Cancer marker CA19-9, which can be measured in blood is beneficial in diagnosis and treatment follow-up of pancreatic cancer. However, it should be noted that this marker can be normal in some pancreatic cancers.
It is hard to diagnose pancreatic cancer in early stage, because it rarely causes any symptoms then. Therefore, cancer is most frequently undetected until it is really advanced. It will be harder to treat the cancer if the tumor is large or has spread to other regions of the body. Pancreatic cancer treatment is arranged as per the cancer’s type and stage. Age, general health condition and organ function tests should be considered when planning treatment. 3 main methods of treatment of pancreatic cancer are surgery, systemic treatment and radiotherapy. Systemic treatment is comprised of chemotherapy (smart molecules) and immunotherapy (treatment affecting the immune system). While some stages of pancreatic cancer necessitate one treatment method only, others may require combinations of multiple treatment modalities.
Since pancreatic cancer is usually detected at advanced stage, chance of surgery is limited to certain cases only. If cancer is located in the head of pancreas, then pancreas can be removed via a wide surgical method called Whipple procedure. This procedure is technically hard, including the removal of pancreas head, some portion of duodenum, gallbladder, some portion of bile duct and nearby lymph nodes. Remaining of the pancreas and stomach are connected later. Tumors located in other sites of pancreas can also be removed surgically. Patients whose pancreas is completely removed are bound to receive insulin and other pancreatic enzymes via external means for the rest of their lives. Surgical treatment is usually not performed if pancreatic cancer has spread to large veins in pancreas vicinity.
Technological developments taking place in recent years in medicine field also increase the chance of success for pancreatic cancer. Positive results can be achieved in treatment of pancreatic cancer which is caught in an early stage. Numerous clinical trials are ongoing with newly discovered or produced multiple systemic treatment agents in this field.
If you also exhibit the symptoms described above or you have family history of pancreatic cancer, do take care to undergo regular checkups.