Pancreatic Cancer

Introduction : Pancreatic cancer occurs when cells in your pancreas mutate (change) and multiply out of control, forming a tumor. Your pancreas is a gland in your abdomen (belly), between your spine and stomach. It makes hormones that control blood-sugar levels and enzymes that aid in digestion.

Most pancreatic cancers start in the ducts of your pancreas. The main pancreatic duct (the duct of Wirsung) connects your pancreas to your common bile duct.

Unfortunately, there aren’t any early signs of pancreatic cancer. Symptoms typically emerge once the tumor starts impacting other organs in your digestive system.

Pancreatic cancer symptoms may include:

Jaundice (yellowing of your skin).
Dark urine (pee).
Light-colored stool (poop).
Upper abdominal pain.
Middle back pain.
Fatigue.
Itchy skin.
Nausea and vomiting.
Gas or bloating.
Lack of appetite.
Blood clots.
Weight loss.
New-onset diabetes.

Your healthcare provider might suspect pancreatic cancer if you’ve recently developed diabetes or pancreatitis — a painful condition due to inflammation in your pancreas.

There isn’t a clear answer. We don’t know exactly what causes pancreatic cancer. But experts have identified some risk factors.

Pancreatic cancer risk factors

A risk factor is something that increases your chances of getting a certain disease. Common pancreatic cancer risk factors include:

Smoking cigarettes, cigars and using other forms of tobacco.
Obesity, particularly if you carry extra weight around your waist.
Diabetes, especially Type 2 diabetes. Sudden-onset diabetes could be a sign of pancreatic cancer.
Exposure to certain chemicals, like pesticides and petrochemicals.
Chronic pancreatitis, a permanent inflammation of your pancreas.
Hereditary chronic pancreatitis due to gene changes (mutations) passed from biological parent to child.
Hereditary syndromes with changes (mutations) in genes, such as BRCA1 or BRCA2 genes passed from biological parent to child.

It’s difficult to detect pancreatic cancer in the early stages. This is because healthcare providers can’t feel your pancreas during routine exams and it’s difficult to see these tumors on routine imaging tests.

If your provider suspects pancreatic cancer, they’ll recommend a combination of pancreas function tests, which may include:

Imaging tests

Your healthcare provider may need to take one or more of the following imaging tests:

CT (computed tomography) scans.
MRI (magnetic resonance imaging).
PET (positron emission tomography).
Endoscopic ultrasound (EUS).

Blood tests

A pancreas blood test can detect tumor markers. A tumor marker is a substance that may indicate the presence of cancer.

For pancreatic cancer, high levels of carbohydrate antigen (CA) 19-9 — a type of protein released by pancreatic cancer cells — might indicate a tumor.

Staging laparoscopy

Sometimes, providers use laparoscopy to determine the extent of pancreatic cancer and whether removal is possible.

During this procedure, a surgeon creates a few small incisions (cuts) in your abdomen and inserts a long tube with a camera on the end. This allows them to see inside your abdomen and look for abnormalities. Often, they’ll take a biopsy during the same procedure.

Genetic testing

If you receive a pancreatic cancer diagnosis, you should consider genetic testing. This can tell you if there’s a hereditary reason you developed pancreatic cancer. It can also help your healthcare provider determine which type of treatment will be most effective for you.

Some people with pancreatic cancer have mutations in genes BRCA1 and BRCA2. Though you may recognize these genes as the “breast cancer genes,” mutations in BRCA1 and BRCA2 may also indicate other types of cancer, including prostate, ovarian and pancreatic.

If you’re a first-degree relative (a parent, child or sibling) of someone who has pancreatic cancer, you should consider genetic testing. Your results can tell you if you have a BRCA1 or BRCA2 gene mutation. Keep in mind, even if you have the mutation, it doesn’t mean you’ll get cancer. But knowing your risk is important.

Pancreatic cancer treatments include:

Surgery

Surgery is the only realistic way to cure pancreatic cancer. But surgeons only recommend it when they think they can remove all of the cancer. Otherwise, there’s little to no benefit.

For surgery to be successful, the cancer must be completely confined to the pancreas. Even then, total cancer removal may not be possible.

There are a few different surgical techniques, depending on the location and size of the tumor:

Whipple procedure (pancreaticoduodenectomy)

If the tumor is in the head of your pancreas (the widest part of your pancreas, near your small intestine), your provider may recommend the Whipple procedure. This surgical approach removes the head of your pancreas, your duodenum (the first portion of your small intestine), your gallbladder, a portion of your bile duct and nearby lymph nodes.

Your surgeon will then attach your remaining bile duct and pancreas to your small intestine. This reestablishes your digestive tract.

Distal pancreatectomy

If the tumor is in the tail of your pancreas, a surgeon can perform a distal pancreatectomy. During this procedure, a surgeon removes the tail of your pancreas and some of the pancreas body. In most cases, they’ll also remove your spleen.

As your spleen helps fight infections, your healthcare provider may recommend getting certain vaccinations before having a distal pancreatectomy.

Total pancreatectomy

If cancer has spread throughout your entire pancreas, but resection (removal) is still possible, your healthcare provider may consider a total pancreatectomy. This surgery removes your entire pancreas, gallbladder, spleen and part of your stomach and small intestine.

It’s possible to live without a pancreas, but it can cause major side effects. Your pancreas makes insulin and other hormones that keep blood sugar at a safe level. Without a pancreas, you’ll develop diabetes and need insulin shots to survive. Additionally, you’ll need to take pancreatic enzyme pills to help with digestion.

Chemotherapy

Chemotherapy uses drugs that kill cancer cells. Healthcare providers give these drugs in pill form or through an IV in your arm.

Providers use chemotherapy as a stand-alone treatment — especially for people with advanced pancreatic cancer. They may also recommend chemotherapy before surgery to shrink the tumor or after surgery to kill any remaining cancer cells.

Radiation therapy

Radiation therapy uses high-energy X-rays to kill cancer cells. Healthcare providers commonly use this approach to treat pancreatic cancer.

Most often, providers combine radiation therapy with chemotherapy (chemoradiation). They may recommend it before surgery, after surgery or as part of your main cancer treatment. Radiation therapy can also help ease pancreatic cancer symptoms in people who don’t qualify for surgery (in cases of advanced cancer).

Targeted therapy

This treatment uses drugs that “target” certain proteins. These proteins control how cancer cells grow and spread. Providers may combine targeted therapy with other treatments like radiation therapy.

Common targeted therapy drugs for pancreatic cancer include:

Erlotinib.
Olaparib.
Larotrectinib.
Entrectinib.

Pain management

Pancreatic cancer could be very painful as it may involve nearby nerves. Your healthcare provider can help you manage pain with oral medications, anesthesia or steroid injections.

If you have pancreatic cancer and start to develop severe and persistent pain, tell your healthcare provider. They can find a treatment that will ease your symptoms.

The stage wise 5-year survival percentages