Pancreatic Cancer

What is Pancreatic Cancer?

Pancreatic cancer is when a tumor is formed in your pancreas. It is the result of the development abnormal cells that grow out of control.

What are the types of Pancreatic Cancer?

Cancers of the pancreas are commonly identified by the site of involvement within the pancreas. There are two types of cells in the pancreas,

  • exocrine cells and
  • endocrine cells.

These different cells also have different functions.

  • Exocrine Cells - More than 95% of pancreatic cancers are classified as exocrine tumors. These tumors start in the exocrine cells that make pancreatic enzymes that help in digestion. Within this category, the vast majority of tumors are adenocarcinomas. There are many other sub types of pancreatic exocrine tumors.
  • Endocrine Cells - Pancreatic neuroendocrine tumors are either functional (produce hormones) or nonfunctional (produce no hormones).  The majority of PNETs are nonfunctional tumors. Once again there are many other sub types of pancreatic exocrine tumors.
pancreatic cancer treatment

Where is your pancreas?

The pancreas is a vital gland. The organ sits in the abdominal cavity behind the stomach just below the liver. 

What does your pancreas do?

The pancreas is part of both your digestive and endocrine system. It produces several digestive enzymes and also plays a vital role in maintaining the blood glucose levels.

Pancreas is both an exocrine and an endocrine gland. The exocrine part produces enzymes that help in digestion and absorption of nutrients from food. The endocrine part of the pancreas secretes hormones involved in the metabolism of sugar and maintenance of blood sugar levels.

Any disease or injury to the pancreas may cause several problems. 

  • Digestive System Function - Involves the secretion of digestive enzymes that aid the digestion and absorption of nutrients in the small intestine.
  • Endocrine System Function - Involves the production of several hormones, such as insulin, glucagon, somatostatin and pancreatic polypeptide.

How Does Pancreatic Cancer Affect Your Body?

Any change to your digestive or hormonal functions can have serious impact on your body and life. Some common effects related to Pancreatic Cancer are:

  • General Malaise and Lack of Energy
  • Loss of appetite and Weight Loss
  • Elevated blood sugars and Diabetes

What Causes Pancreatic Cancer?

Despite the high mortality rate associated with pancreatic cancer, its causes are poorly understood. What is indicated by some statistical research is that risk factors for development of pancreatic cancer include the following:

  • Family history of pancreatic cancer
  • Cigarette smoking.
  • Obesity.
  • Chronic pancreatitis.

What are the signs or symptoms of Pancreatic Cancer?

Pancreatic cancer symptoms depend on the site of the tumor within the pancreas and the degree of tumor involvement. In the early stages of pancreatic cancer there are not many noticeable symptoms. As the cancer grows, symptoms may include the following:

  • Jaundice.
  • Light-colored stools or dark urine.
  • Pain in the upper or middle abdomen and back.
  • Weight loss for no known reason
  • Loss of appetite.
  • Fatigue.

What are the stages of Pancreatic Cancer?

Pancreatic cancer is difficult to detect and diagnose for the following reasons:

  • There are no noticeable signs or symptoms in the early stages of pancreatic cancer.
  • The signs of pancreatic cancer, when present, are like the signs of many other illnesses, such as pancreatitis or an ulcer.
  • The pancreas is obscured by other organs in the abdomen and is difficult to visualize clearly on imaging tests.
  • To appropriately treat pancreatic cancer, it is crucial to evaluate whether the cancer can be resected.

What pre treatment tests used to diagnose Pancreatic Cancer?

The use of imaging technology may aid in the diagnosis of pancreatic cancer and in the identification of patients with disease that is not amenable to resection. Imaging tests that may be used include the following:

  • Helical computed tomographic scan.
  • Magnetic resonance imaging scan.
  • Endoscopic ultrasound.
  • Minimally invasive techniques, such as laparoscopy and laparoscopic ultrasound may be used to decrease the use of laparotomy.

Peritoneal cytology

Some studies indicate a positive peritoneal cytology result is a positive predictor in determining unresectability.

Tumor markers

No tumor-specific markers exist for pancreatic cancer. Markers such as serum cancer antigen (CA) 19-9 have low specificity.

Most patients with pancreatic cancer will have an elevated CA 19-9 at diagnosis. over time an increase of CA 19-9 levels may identify patients with progressive tumor growth. The presence of a normal CA 19-9, however, does not preclude recurrence.

TREATMENTS FOR PANCREATIC CANCER

What treatment choices or options are available for Pancreatic Cancer?

Surgical approaches differ for masses in the head, body, tail, or uncinate process of the pancreas. Surgical resection is the mainstay treatment for Pancreatic Cancer. It provides a survival benefit in patients with small, localized pancreatic tumors.

Patients with unresectable, metastatic, or recurrent disease are unlikely to benefit from surgical resection.

WHAT ALTERNATIVE TREATMENTS ARE AVAILABLE FOR PANCREATIC CANCER?

Pancreatic tumors are resistant to treatment with chemotherapy and radiation therapy.

Patients with any stage of pancreatic cancer can be considered candidates for clinical trials because of the poor response to chemotherapy, radiation therapy

How will my life change after Pancreatic Cancer Surgery?

For most patient Postoperative Care Plan are focused on palliative Care. This involves treatments for the reduction of symptoms and may be achieved with various conventional therapies.

Palliative measures that can improve quality of life while not affecting the overall survival rate include the following:

  • Surgical or radiologic biliary decompression.
  • Relief of gastric outlet obstruction.
  • Pain control.
  • Psychological care to address the potentially disabling psychological events associated with the diagnosis and treatment of pancreatic cancer.

What are the range of recovery outcomes after Pancreatic Cancer Surgery?

The primary factors that influence prognosis are:

  • Whether the tumor is localized and can be completely resected.
  • Whether the tumor has spread to lymph nodes or elsewhere.

The highest cure rate occurs if the tumor is truly localized to the pancreas, however, this stage of disease accounts for less than 20% of cases. Exocrine pancreatic cancer is rarely curable and has a poor overall survival rate.

For patients with localized disease and small cancers (<2 cm) with no lymph node metastases and no extension beyond the capsule of the pancreas the post-operative survival rate improves. Where a complete surgical resection is successful a 5-year survival rate for one quarter of patients is possible.

What are the Specific PROCEDURES FOR PANCREATIC CANCER?

Pancreatic surgery comprises of a wide range of surgical procedures. Some of the commonly performed pancreatic surgeries include:

  • Whipple Procedure: Also known as pancreaticoduodenectomy, is performed to treat cancers at the head (wide part) of the pancreas. During the procedure, the head of the pancreas, the gallbladder, duodenum, a part of the bile duct, and sometimes a part of the stomach are removed. The remaining bile duct, intestine, and pancreas are then reconnected so that enzymes and bile can flow back into the intestines.
  • Distal pancreatectomy is usually performed when the cancer is found in the middle or tapering end of the pancreas. This procedure takes less time and has a shorter period of recovery when compared to Whipple procedure.
  • Pancreatic necrosectomy is usually performed in terminally ill patients with severe acute pancreatitis and in patients with dead or infected pancreas.