The “KILLER” Cancer (Pancreatic Cancer)

What is the pancreas?

It is a gland that lies horizontally behind the lower part of the stomach and in front of the spine. The pancreas secretes digestive juices and hormones (insulin and glucagon) that regulate blood sugar. Cells called exocrine cells produce the digestive juices, while  endocrine cells produce the hormones. The majority of pancreatic cancers start in the exocrine cells.

What is pancreatic cancer?

Pancreatic carcinoma is cancer of the pancreas. This type of cancer falls into two major categories:

Cancers of the endocrine pancreas (this part makes insulin) are called “islet cell” or “pancreatic neuroendocrine” cancers.  The second type  is cancers of the exocrine pancreas (the part that makes enzymes). Neuroendocrine cancers are rare and typically less aggressive compared to exocrine pancreatic cancers.  Exocrine pancreatic cancers develop from the cells that line the system of ducts that deliver enzymes to the small intestine and are referred to as pancreatic adenocarcinomas. Adenocarcinoma of the pancreas comprises 95% of all pancreatic ductal cancers. Pancreatic cancer alway have very poor prognosis hence it being the deadliest of all cancers

ANATOMY OF THE PANCREAS

Causes, incidence and risk factors

The exact cause of pancreatic cancer is unknown. However it is believed that the cancer occurs when cells in your pancreas develop mutations in their DNA. These mutations cause cells to grow uncontrollably and out number the normal cells. These cells continue to live even after the normal cells die. Accumulation of these cells form a tumor. Most pancreatic cancer begins in the cells that line the ducts of the pancreas (pancreatic adenocarcinoma). Rarely, cancer develops in the hormone-producing cells of the pancreas (pancreatic endocrine cancer). About 40,000 cases of pancreatic cancer occur yearly in the United States. Most people who develop pancreatic cancer do so without any predisposing risk factors. Age (being over 60 years) however puts you at a greater risk of getting this type of cancer. Other conditions like chronic pancreatitis  (inflammation of the pancreas), diabetes, familial pancreatic cancer syndrome and obesity. Smokers are also at increased risk of getting pancreatic cancer.

Pancreatic cancer is slightly more common in women than in men. Also a small number of cases are related to genetic syndromes that are passed down through families.

Symptoms

Signs and symptoms of pancreatic cancer often do not  occur until the disease is in the advanced stage. Signs and symptoms include pain or discomfort in upper  part of belly or abdomen that radiate to the back, jaundice (yellowing of the skin and whites of the eyes), unexplained weight loss, loss of appetite, nausea and vomiting and fatigue. Other possible symptoms include diarrhea, blood clots and indigestion.

 

Tests and diagnosis

Your doctor will perform physical examinations and ask you a bunch of questions about your health history. Your doctor may order several tests to determine the cause of your problem or extent of the condition. These include:

 

• CT scan of the abdomen
• MRI of the abdomen
• Endoscopic ultrasound
• Endoscopic retrograde cholangiopancreatography (ERCP)
• Pancreatic biopsy
• Laparoscopy (surgical procedure to look at organs)
• Percutaneous transhepatic cholangiography (PTC; procedure used to X-ray liver and bile ducts)

This disease may also affect the results of the following tests:

• Complete blood count
• Serum bilirubin
• Liver function tests

 Stages of Pancreatic Cancer

Your doctor will assign your pancreatic cancer a stage test using information from  staging tests. The stages of pancreatic cancer are:

Stage I. At this stage the cancer is confined to the pancreas.

Stage II. Cancer at this stage 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 also spread to the lymph nodes.

Stage IV. At this stage the cancer has spread to distant sites beyond the pancreas, such as the liver, lungs and the lining that surrounds your abdominal organs (peritoneum).

Treatment

Treatment for pancreatic cancer depends on the stage and location of the cancer.  It also depends 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 main focus will be to prevent the cancer from growing or causing more harm. When pancreatic cancer is advanced and treatments  will not offer any benefit, your doctor will help to relieve symptoms and make you as comfortable as possible.

There are various treatments for pancreatic cancer, including surgery, chemotherapy, and radiation therapy. However because pancreatic cancer is often advanced when it is first found, very few pancreatic tumors can be removed by surgery. The standard surgical procedure is called a pancreaticoduodenectomy (Whipple procedure). This is the most commonly performed surgery to remove tumors in the pancreas. During this procedure, the surgeon removes the head of the pancreas, the gallbladder, part of the duodenum (uppermost portion of the small intestine), a small portion of the stomach called the pylorus, and the lymph nodes near the head of the pancreas. The surgeon then reconnects the remaining pancreas and digestive organs so that pancreatic digestive enzymes, bile, and stomach contents will flow into the small intestine during digestion. Another type of  Whipple procedure known as pylorus preserving Whipple may be performed. During surgery the bottom portion of the stomach or the pylorus is not removed. In both cases, the surgery usually lasts between 6-10 hours.

When the tumor has not spread out of the pancreas but cannot be removed, radiation therapy, together with chemotherapy may be recommended. Chemotherapy uses drugs to treat the cancer and radiation therapy uses X-rays or other kinds of radiation to kill the cancer cells.

In patients whose tumor has spread (metastasized) to other organs such as the liver, chemotherapy alone is usually recommended. The standard chemotherapy drug used is gemcitabine, but other drugs may be used.

If a patient has tumor that cannot be totally removed but have biliary obstruction, ( a blockage of the tubes that transport bile) the blockage must be relieved. There are two approaches to this problem: surgery and placement of a tiny metal tube (biliary stent) during ERCP. Pain management is also an important part of treating advanced pancreatic cancer. Palliative care teams and hospice can help with pain and symptom management, and provide psychological support for patients and their families during the illness.

Prognosis

Ninety-five percent of the people diagnosed with this cancer will not be alive 5 years later.  If the pancreatic cancer can be surgically removed you will cured. However, in more than 80% of patients the tumor has already spread and cannot be completely removed at the time of diagnosis. Chemotherapy and radiation are often given after surgery to increase the cure rate. This is called adjuvant therapy. For pancreatic cancer that cannot be removed completely with surgery, a cure is not possible and the average survival is usually less than 1 year.

 Prevention

Although there’s no proven way to prevent pancreatic cancer, steps can be taken to reduce your risk, These include maintaining a healthy weight and diet. People who smoke should talk to their doctors about strategies to help you stop smoking, including support groups, medications and nicotine replacement therapy.

Support Groups

You can ease the stress of illness by joining a support group with members who share common experiences and problems. Also come to terms with your illness, learn more about it and consider hospice when necessary.

 

The following organizations are good resources for information on cancer:

American Cancer Society – www.cancer.org

Cancer Care – www.cancercare.org

National Cancer Institute – www.cancer.gov