What Is Pancreatic Cancer?
Pancreatic cancer occurs when cells in the pancreas begin to grow abnormally and uncontrollably, forming a malignant tumor. The cancer can spread into nearby organs and, through the bloodstream or lymphatic system, to other parts of the body. This spread is called metastasis.
- Pancreatic cancer is the fifth leading cause of cancer death worldwide and the third in the United States.
- It is more common in developed countries.
- Pancreatic cancer is more common in older adults and is somewhat more common in men. (In approximately 80% of cases, it occurs in individuals over the age of 60.)
- Approximately 90% of pancreatic cancers are adenocarcinomas, while only about 10% are neuroendocrine tumors.
- About 60–70% of tumors occur in the head of the pancreas, 15% in the body, and 15% in the tail.
Causes and Risk Factors for Pancreatic Cancer
The exact cause is not always known.
Risk factors include:
- Smoking is the cause of approximately 25% of cancers.
- There is a higher incidence among alcohol consumers.
- Increased susceptibility in diabetic patients.
- Excess weight (obesity) increases the risk by about 20%.
- Pancreatic stones are the cause of 0.8%–25% of pancreatic cancer cases.
- Chronic pancreatitis.
- Diet: Red meat, saturated fats, and sugary drinks.
- Chemicals, pesticides, benzene, certain dyes, and petrochemicals.
- Genetic factors: Approximately 5%–10% probability.
Symptoms of Pancreatic Cancer
Pancreatic cancer may cause few or no symptoms in its early stages.
Possible symptoms include:
- Severe and recurrent abdominal pain.
- Loss of appetite.
- Unexplained weight loss.
- Jaundice, itching, dark-colored urine and pale or clay-colored stools. These symptoms can occur when the bile duct is blocked, leading to obstructive jaundice.
- Nausea and vomiting.
- A feeling of fullness after eating.
- Digestive tract obstruction in advanced disease.
- A mass or lump in the abdomen.
Tests Used to Diagnose Pancreatic Cancer
Evaluation may include:
- Abdominal ultrasound.
- Blood tests and liver function tests.
- CA 19-9 tumor marker.
- CT scan.
- MRCP.
- ERCP.
- Endoscopy.
- Biopsy.
- CT-guided FNAC or biopsy.
Treatment of Pancreatic Cancer
Treatment depends on the type, stage, location, and spread of the cancer, as well as the patient's overall health. For cancers that can be completely removed, surgery offers the main possibility of long-term disease control or cure.
Whipple's Procedure
The Whipple's procedure is a complex operation.
During this operation, the surgeon may remove:
- The head of the pancreas (pancreatic head).
- Part of the stomach.
- Part of the bile duct.
- The duodenum.
- Part of the intestine.
After these structures are removed, the digestive system must be reconstructed. The surgeon creates new connections between:
- The remaining pancreas and the intestine (pancreatojejunostomy).
- The bile duct and the intestine (hepaticojejunostomy).
- The stomach and the intestine (gastrojejunostomy).
- The remaining intestine to the small intestine (enteroenterostomy).
Distal Pancreatectomy
A distal pancreatectomy removes the body and/or tail of the pancreas.
Middle Pancreatectomy
The middle part of the pancreas is removed during a middle pancreatectomy.
Treatment for Advanced or Blocked Disease
When pancreatic cancer causes blockage of the bile duct or digestive tract, treatment may include:
- Bypass surgery of the bile duct and digestive tract (hepaticojejunostomy and gastrojejunostomy).
- ERCP with placement of a bile duct stent (ERCP and stenting).
- Chemotherapy and radiotherapy.
- Palliative care and pain management to control symptoms and improve quality of life.
Prevention of Pancreatic Cancer
- Do not smoke.
- Avoid excessive alcohol use.
- Maintain a healthy body weight.
- Receive appropriate treatment for pancreatic stones.
- Properly manage chronic pancreatitis.
- Keep diabetes under control.
- Manage high cholesterol and other metabolic conditions.
- Avoid excessive intake of high-fat foods.
- Avoid regularly eating heavily charred or burned meat.
- Reduce unnecessary exposure to chemicals, pesticides, benzene, certain industrial dyes, and petrochemicals by following appropriate workplace safety measures.
- People with a strong family history of pancreatic cancer should discuss their risk with a doctor or genetic counselor and receive appropriate follow-up when indicated.
Conclusion
- Pancreatic cancer is a serious disease, and its incidence has increased in many populations.
- Awareness and appropriate preventive measures are important.
- When pancreatic cancer is detected at an early, treatable stage, appropriate treatment can provide the best opportunity for long-term survival.