This article has been reviewed and approved by Dr Niti Raizada for authenticity and medical correctness on 21 Jun 2020

All about Pancreatic Cancer

Pancreatic cancers start in the cells of the pancreas. It occurs when a few cells in the pancreas starts dividing without control and also live for a longer time. 

Pancreatic cancer is among the top ten cancers that affect both men and women. It usually affects those above the age of sixty.  

You will have very few symptoms of pancreatic cancer in the early stages. In most the disease causes symptoms in its advanced stages. It is thus one of the most 'silent' cancers a person can have.

A common symptom is a pain in the upper abdomen that extends to the back, indigestion, bloating, etc.

There are a few factors that increase your risk of getting pancreatic cancer. Persons in this risk group need to have periodic blood tests to rule out the disease.

Causes and risk factors of pancreatic cancer

Your pancreas is at the left upper part of your abdomen and lies behind the stomach. Around it are organs like the liver, spleen, etc. Its main function is to control the blood sugar level in your body. It also produces a few hormones that help in digestion of the food you eat.

The exact cause of pancreatic cancer is still not clear. Some changes in the DNA of the cells may be a reason. But why these changes happen is not very clear. 

Some people are more likely to have pancreatic cancer than others.

The common risk factors include:

  • Age - You are more at risk if you are above sixty 
  • Smoking - It doubles the risk
  • Diabetes- Those who have it for a long time are at increased risk
  • Family history- If you have a close family member with the disease, your risk is more 
  • Having genetic conditions like Lynch syndrome and FAMMM syndrome
  • Being obese 
  • Having chronic pancreatitis

What are the symptoms of pancreatic cancer? 

The common symptoms and signs of pancreatic cancer are: 

  • Jaundice and associated signs like yellowing of the skin and whites of the eyes, itchy skin, etc.
  • Sudden onset of diabetes and appearance of symptoms of low blood sugar like fainting, light-headedness, etc.
  • Sudden and unexplained weight loss
  • Pain in the upper abdomen radiating to the upper back
  • Lack of appetite
  • Indigestion that does not respond to medications
  • Pale and foul-smelling stools
  • A depressed mood without reason.
  • Blood clot in the vein, causing swelling in the arms or legs
  • Stomach feels bloated and swollen

Pancreatic cancer diagnosis

If you have symptoms that point to pancreatic cancer, your doctor will advise a few tests. These include 

  • Blood tests- Persons with pancreatic cancers, will have higher levels of an antigen called CA 19-9. 
  • Physical examination- If you have pancreatic cancer, you are very likely to have jaundice. So the doctor will look for its signs. The doctor will also feel your abdomen to know whether you have bloating or fluid build-up.
  • Ultrasound scans- It uses sound waves to create a picture of the pancreas on a computer screen. The doctor will place a transducer over the location of the pancreas to do it. 
  • CT Scan - CT scans help the doctor to know the size and location of the tumor. It will also help to understand whether cancer has spread to any lymph nodes.  
  • PET Scan- It helps the doctor to know the spread of cancer to other parts of your body. 
  • Endoscopy- In this, the doctor will insert a small camera into your stomach through the mouth and throat. The camera will transmit pictures of the pancreas to a computer screen. Your doctor will also be able to take a small sample of the tissue with cancer during it. 
  • Biopsy - During this, the doctor will look at a tissue sample from the pancreas under a microscope for cancer cells. It helps the doctor to identify the type of cancer you have as well as its stage.

Stages of pancreatic cancer 

There are four stages 

  • Stage 0 (referred to as carcinoma in situ)- The disease is confined to the superficial layers of the pancreas and has not gone deep.
  • Stage 1A- the cancer is less than 2cm in size and has not spread to lymph nodes
  • Stage 1B- the tumor is less than 4cm, and there is no lymphatic spread
  • Stage 2A - the cancer is more than 4cm, no involvement of lymph nodes
  • Stage 2B- the tumor is more than 4cm and has spread to about three lymph nodes 
  • Stage 3 - The tumor may be of any size and maybe within the pancreas or involve the adjacent structures. Any number of lymph nodes may be involved.
  • Stage 4- Cancer may have outgrown the pancreas to include adjacent structures and any number of lymph nodes. It may also have spread to various other parts. 

 

The staging of cancer is vital in the decision regarding treatment. The treatment may vary according to the stage. 

Treatment for pancreatic cancer

There are different treatments for pancreatic cancer.

Surgery- It is the best treatment if the cancer is small or has not spread to nearby organs. If the tumor is small, the surgeon will remove only cancer. He or she will leave behind as much of the pancreas without cancer as possible.

The surgeon will plan the surgery with the help of various imaging studies. Ultrasound, CT, MRI, and CT scans and endoscopy will help in this regard. 

There are different types of surgery, according to the stage of the disease.

  • Whipple procedure-  You will have this if the cancer is at the head of the pancreas. During the surgery, the surgeon will remove the head of the pancreas along with the tumor. He or she will also remove the small intestine, gall bladder, surrounding lymph nodes, etc. At times the surgeon will remove a part of the stomach as well. 
  • Pancreatectomy- You will have this surgery if the surgeon feels that cancer has spread through your pancreas. During this, the surgeon will remove the pancreas. You will then need to take hormones as injections or tablets for the rest of your life.

 

Chemotherapy for pancreatic cancer- It uses medicines to treat cancers. You will have it as pills or as injections to your veins. You will have the treatment for a few days at a stretch called a 'cycle' with a period of rest in between. It is an ideal treatment for large cancers, where surgery is not an option.

Radiation therapy for pancreatic cancer It uses high energy x-rays or other particles to destroy cancers. The x-rays will be from an external source. The x-rays or particle beams will target the tumor with precision to destroy it. You may have this before surgery to shrink the tumor or after it to destroy any remnants of cancer. In advanced cancers, it helps to provide relief from the symptoms

Pancreatic cancer treatment In India
Pancreatic cancer treatment In India

References / Additional Reading
This article has been reviewed by Dr Niti Raizada for authenticity and medical correctness on 21 Jun 2020
Dr Niti Raizada
Dr Niti Raizada
MBBS, MD, DM-Medical Oncology, MRCP
Dr. Niti Raizada is a senior Medical Oncologist with over fifteen years of experience in the field. Dr Niti has special interests in the areas of Thoracic, Gastrointestinal, Breast, Gynaecological Oncology, and Bone Marrow Transplants. She did her MBBS at Gandhi Medical College, Bhopal; MD-General Medicine at G R Medical College, Gwalior, DNB-General Medicine from National Board Of Examination,DM from Adyar Cancer Institute Chennai and Fellowship in Hematology from Hammersmith Hospital and Imperial College,London. She is a member of American Society of Clinical Oncology,USA; Royal College of Physicians,Edinburgh,UK; Member of Pharmacy Committee,Member of DNB teaching program in Medical Oncology and European Society of Medical Oncology (ESMO).
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