Pancreatic cancer occurs when unchecked development of the cells starts in a portion of the pancreas. Tumors form, and these interfere with the functioning of the pancreas.
Pancreatic cancer sometimes does not display any symptoms until the later stages. It can be difficult to handle, for that reason.
Approximately 3 percent of all cancers in the United States are pancreatic cancers, according to the American Cancer Society. Approximately 55,440 people are predicted to be diagnosed with pancreatic cancer in 2018.
What is pancreatic cancer?
The pancreas is a 6-inch long organ found in the back of the abdomen, next to the gall bladder, behind the stomach.
It includes glands that produce insulin, hormones and pancreatic juices.
Cancer may affect either the pancreatic endocrine glands or exocrine glands.
The exocrine glands produce juices, or enzymes, which enter the intestines and help digest fat, protein and carbohydrates. These make up most of the pancreas.
The endocrine glands are tiny groups of cells known as the islets of Langerhans. They release the hormones insulin and glucagon into the bloodstream. We control blood sugar concentrations there. Perhaps the result is diabetes when they aren’t functioning properly.
The type and outlook for growing cancer depends on what feature the cancer affects.
Pancreatic cancer has two distinct forms, depending on how it affects exocrine or endocrine functions. Their risk factors, causes, signs, medical tests, therapies and outlook are distinct.
Exocrine pancreatic cancer
The most common type of tumors which affect exocrine functions.
We can be sinister or benign. Benign tumors are called cystadenomas, or cysts. Most pancreatic tumors are cancerous, or malignant.
The exocrine functions can be impaired by different forms of pancreatic cancers.
Tumor forms include:
- adenocarcinomas, which typically start in gland cells in the ducts of the pancreas
- acinar cell carcinoma, which starts in the pancreatic enzyme cells
- ampullary cancer, which starts where the bile duct and pancreatic duct meet the duodenum of the small intestine
- adenosquamous carcinomas
- squamous cell carcinomas
- giant cell carcinomas
Endocrine pancreatic cancer
Tumors that affect the pancreatic endocrine functions are called tumors in the neuroendocrine or islet cells. These are relatively rare.
The name comes from the sort of cell that contains hormones, where the cancer begins.
- insulinomas (insulin)
- glucagonomas (glucagon)
- gastrinomas (gastrin)
- somatostatinomas (somatostatin)
- VIPomas (vasoactive intestinal peptide or VIP)
Functioning islet cell tumors continue to make hormones. Non-functioning ones do not. Most of these tumors are benign, but non-functioning tumors are more likely to be malignant, islet-cell carcinomas.
Causes and risk factors
Scientists don’t know precisely why uncontrolled growth of cells happens in the pancreas, but they’ve identified several possible risk factors.
Damage or changes in a person’s DNA may cause damage to the genes that regulate the division of the cells.
The genetic inherited variations pass through a generation. There is evidence that families may develop pancreatic cancer.
Many genetic modifications, for instance cigarettes, arise due to exposure to an environmental cause.
A individual with certain genetic syndromes has a greater chance of developing pancreatic cancer.
- hereditary breast and ovarian cancer syndrome
- non-polyposis colorectal cancer (Lynch syndrome)
Pancreatic cancers more frequently affect men than women.
This year the American Cancer Society expects a diagnosis of pancreatic cancer to be made to 29,200 male and 26,240 women.
Substances that may increase the risk of pancreatic cancer include certain:
- chemicals used in metal refining
The free radicals form when the body comes into contact with a carcinogen. These damage cells, and affect their normal functioning capacity. This can result in cancerous growths.
Other medical factors
Age is a significant risk factor particularly after age 60.
Scientists have found a correlation between pancreatic cancer and several other illnesses.
- cirrhosis or scarring of the liver
- infection of the stomach with the ulcer-causing bacteria, Helicobacter pylori (H. pylori)
- diabetes mellitus
- chronic pancreatitis, or inflammation of the pancreas
- gingivitis or periodontal disease
Some lifestyle factors may increase the risk:
- smoking cigarettes or exposure to tobacco smoke
- excess weight and a lack of exercise
- a diet that is high in red meat and fat and low in fruits and vegetables
- long-term, heavy consumption of alcohol, which can lead to chronic pancreatitis, a risk factor for pancreatic cancer
Pancreatic cancer is also referred to as a “silent” illness, because symptoms do not appear until the later stages.
Pancreatic cancer tumors are usually too small to cause symptoms, and symptoms are also unspecific in later years.
Furthermore, when the cancer is grows, there might be:
- pain in the upper abdomen as the tumor pushes against nerves
- jaundice, when problems with the bile duct and liver lead to a painless yellowing of the skin and eyes and darkening of the urine.
- loss of appetite, nausea, and vomiting
- significant weight loss and weakness
- pale or grey fatty stool
However, a variety of other illnesses will cause the same symptoms, and a doctor will likely not be able to detect pancreatic cancer until later.
Other possible signs and symptoms include:
- Trousseau’s sign, when spontaneous blood clots form in the portal blood vessels, deep veins of the arms and legs, or other superficial veins
- clinical depression, which people sometimes report before a diagnosis
Pancreatic islet cells or neuroendocrine cancers may cause too much insulin or hormones to be produced by the pancreas.
The person may experience:
- weakness or dizziness
- muscle spasms
Pancreatic cancer behaves differently based on the section of the pancreas in which the tumor resides, whether the “head” or the “tail.” Tumors at the tail end are more likely to result in discomfort and weight loss. At the other hand, oily stools, weight loss and jaundice are caused by head tumours.
If the cancer spreads, or metastasizes, new symptoms in the affected area and the rest of the body may develop.
When to see a doctor
Pancreatic cancer signs often will not show up until the later stages. You can see a doctor if you experience jaundice, or any other odd symptoms.
When someone in the family is currently suffering from pancreatic cancer, or if you have any of the risk factors and are worried about the likelihood of developing it, you should always talk to a doctor. They might be implying screening.
A doctor will inquire about symptoms, take a family history and medical history, and do a physical exam. They’ll definitely suggest some tests as well.
The physician will pay special attention to common symptoms such as:
- abdominal or back pain
- weight loss
- poor appetite
- digestive problems
- gallbladder enlargement
- blood clots, deep venous thrombosis (DVT), or pulmonary embolism
- fatty tissue abnormalities
- swelling of lymph nodes
- steatorrhea, or fatty stools
Atypical diabetes mellitus, the symptom of Trousseau and recent pancreatitis may also be signs of the presence of pancreatic cancer.
Possible tests include:
- blood tests
- urine tests
- stool tests
Blood tests can detect a chemical which releases into the blood pancreatic cancer cells. Tests on liver function test for blockage of bile ducts.
The doctor might ask for imaging tests to detect the presence of a tumor and, if so, to see how far the cancer has spread.
Common imaging tests include:
- ultrasound or endoscopic ultrasound
- CT, MRI, or PET scans
- X-rays, possibly with a barium meal
- an angiogram
It does have the ability to validate a diagnosis. The doctor pulls out a small amount of tissue under the microscope for analysis.
Stages of pancreatic cancer
Next, the doctor must examine the cancer level, or how far the cancer has spread, to decide which treatment options are acceptable.
The stage depends on:
- the size and direct extent of the primary tumor
- how far the cancer has spread to nearby lymph nodes
- whether the cancer has metastasized, or spread, to other organs in the body
The stages range from stage 0 to stage IV.
Step 0: The top layers of the pancreatic duct cells contain cancerous cells. They have not entered, or spread, deeper tissues beyond the pancreas.
Step IV: The cancer that has spread across the body to distant locations.
Effective treatment is available at stage 0. The tumors spread to remote organs at level IV. A doctor may prescribe surgery just to ease discomfort or to unblock ducts.
Cancer treatment depends on a variety of factors:
- the type of cancer
- the stage of the cancer
- the person’s age, health status, and other characteristics
- the individual’s personal choices
Surgery, radiation, and chemotherapy are the most common treatment options.
The aim of treatment is to:
- remove the cancer
- relieve painful symptoms
Surgery can remove the pancreas in whole or in part.
If the cancer cells are still in one location, as is the case in the early stages, all cancer will be removed. The more the cells grow, the easier this is.
For this reason an early diagnosis is best for any cancer.
The three main surgical procedures that can support pancreatic cancer sufferers are:
Whipple procedure: This is most common in cases where cancer affects the pancreas head. The surgeon removes the head of the pancreas, and often the entire pancreas, along with a part of the heart, duodenum, lymph nodes and other tissue. This is a dangerous and complicated process. Complications include issues with the leakage, wounds, vomiting and stomach.
Distal pancreatectomy: The surgeon extracts the pancreatic tail along with spleen, and often other parts of the pancreas. Doctor generally suggests this treatment to treat neuroendocrine or islet cell tumours.
Total pancreatectomy: The surgeon extracts spleen and the entire pancreas. Living without a pancreatic may be possible, but diabetes can result because the body no longer produces insulin cells.
Palliative surgery is an choice in cases where the cancer in the pancreas can not be removed.
If the typical bile duct or duodenum has a blockage, the surgeon can create a bypass so that bile may continue to flow from the liver. Pain and stomach disorders should be minimised.
Another way to relieve a blockage of the bile duct is by inserting a small stent into the duct to hold it open. This is a less invasive, endoscopic technique.
Chemotherapy is a type of medication which interferes with the process of cell division which causes the growth of cancer cells. When the drug moves across the body it will treat spreading cancer.
Treatment takes place in stages, so that the body has time between doses to recover.
Side effects comprise:
- hair loss
- nausea and vomiting
Combination treatments with other treatment methods may include various forms of chemotherapy or chemotherapy.
Gemcitabine (Gemzar) is the chemotherapy drug most widely used by the doctors to treat pancreatic cancer. The person typically receives it on a weekly basis, intravenously.
Adjuvant treatment is a chemotherapy accompanied by surgery. It aims to destroy any remaining cancer cells.
The purpose of palliative chemotherapy is to improve the quality of life of an person in the later stages of cancer.
Biologics are newer drugs which target different cancer cell sections. They also have less side effects, as they do not affect the entire body.
One such medication, erlotinib (Tarceva), has benefited many individuals with advanced pancreatic cancer. The person takes it like a pill, by mouth.
Radiation therapy breaks down cancer by directing high-energy radiation on cancer cells.
It can shrink a tumor as a stand-alone therapy, or kill cancer cells. It can also be paired by physicians with other cancer therapies, such as chemotherapy and operations.
Normally a person will undergo 5 to 6 weeks of radiation therapy for pancreatic cancer 5 days a week.
Radiation therapy as a palliative procedure can alleviate pain or digestive issues when a blockage occurs in the normal bile duct or duodenum.
The side effects comprise:
- mild skin changes resembling sunburn or suntan
- nausea, vomiting, and diarrhea
- loss of appetite
- weight loss
Most side effects subside a few weeks after completing treatment.
Treatment with bacteria
In 2013, scientists from Yeshiva University’s Albert Einstein College of Medicine released results of an experiment in which they used bacteria to deliver radioisotopes usually used directly into pancreatic cancer cells for cancer treatment.
The findings indicated a dramatic decrease in the occurrence of secondary tumours. Compared to other therapies the cancer was less likely to spread and there was no risk to healthy tissue.
According to the American Cancer Society, there is no special way to avoid pancreatic cancer.
Avoiding such behaviors can therefore reduce the risk.
- quitting smoking
- keeping a healthy weight
- eating plenty of fruits, vegetables, and whole grains
- consuming less red meat
Can vitamin supplements help?
Scientists have looked at the possible effect of other vitamins on the risk of pancreatic cancer.
Studies have linked vitamin D to a lower risk of various cancer types including pancreatic cancer. Nonetheless, researchers do need to perform large-scale studies to validate whether or not vitamin D will help prevent pancreatic diseases.
Consuming B vitamins like B12, B6, and folate in food — but not in the form of a pill or a tablet — can reduce the risk of pancreatic cancer.
A meta-analysis published in Medicine in 2018 endorsed the use of vitamin D and also indicated that it may be helpful for vitamin B12.
It is difficult to detect and treat pancreatic cancer, as it often does not show symptoms until the later stages.
People who have risk factors that increase their chances of pancreatic cancer may need to talk about screening with their doctor. An early diagnosis and early treatment would yield the best possible outcome.