Pancreatic cancer

Pancreatic cancer starts in the tissues of your pancreas, a small, spongy, hockey stick-shaped gland located deep within your abdomen between your stomach and spine. The pancreas releases enzymes that aid digestion and releases hormones, insulin and glucagon, that regulate blood sugar levels.

As a result of the body’s failure to remove old cells and form new ones, pancreatic cancer occurs. The pancreatic cells continue to grow out of control and form tumors. The cancerous cells can also spread to other parts of the body. The most common type of pancreatic cancer begins in the cells that line the ducts that transport digestive enzymes from the pancreas (pancreatic ductal adenocarcinoma). The disease often does not show any symptoms until it has spread to other organs, so it is difficult to detect at an early stage when it is curable. The treatment options are based on the extent of cancer and may include surgery, chemotherapy, radiation therapy, or a combination of these. The prognosis or outcome of the disease is generally poor due to late detection.

Most people don’t experience early signs of pancreatic cancer. As the disease progresses, however, people may notice:

• Abdominal pain that radiates to your back
• Loss of appetite or unintended weight loss
• Yellowing of your skin and the whites of your eyes (jaundice)
• Light-colored stools
• Dark-colored urine
• Itchy skin
• New diagnosis of diabetes or existing diabetes that’s becoming more difficult to control
• Blood clots
• Fatigue

If you have diabetes or pancreatitis – a painful condition caused by pancreatic inflammation – your doctor may suspect pancreatic cancer.
Pancreatic neuroendocrine cancer symptoms can differ from traditional pancreatic cancer symptoms, such as jaundice or weight loss. This is because some PNETs overproduce hormones.

• To diagnose any kind of symptoms.
• To find out how well our organs are working.
• It can monitor chronic health conditions and diseases and find out problems in their early stages.

To Diagnose and monitor pancreatic cancer some of the following tests are :

• Complete Blood Count
• Amylase
• Lipase
• Insulin
• Glucose-Fasting Blood (FBG) Test
• HbA1c (Glycated hemoglobin)
• CA 19.9
• Liver function tests

The exact cause of pancreatic cancer is unknown. The development of pancreatic cancer occurs when abnormal cells begin to grow within the organ.
DNA changes (mutations) cause these abnormal cells to develop. As a result of this mutated DNA, the cells grow uncontrollably and continue to live even after the normal cells have died. These masses of cells can form a tumor. Without treatment, these cells continue to grow and metastasize (spread throughout the body).

The average lifetime risk of developing pancreatic cancer is about 1 in 64. Risk factors are things that increase your chances of contracting a disease. There are risk factors that are a result of behavior and that can be changed.

For pancreatic cancer, these types of risk factors include:

• Smoking cigarettes, cigars, and using other forms of tobacco.
• Obesity is also a risk factor. Carrying weight around the waist is a risk factor even if you do not have obesity.
• Having diabetes, especially type 2 diabetes, is linked to obesity. The new development of diabetes at an older age and in someone with a normal weight or body mass index could be a sign of pancreatic cancer.
• Being exposed to chemicals used by dry cleaners and metal workers.
• Having chronic pancreatitis, a permanent inflammation of the pancreas usually associated with smoking and drinking a lot of alcohol.

There are also risk factors that you can’t change. These include:

• Hereditary chronic pancreatitis due to gene changes (mutations) passed from parent to child.
• Hereditary syndromes with gene changes (mutations) in genes — such as BRCA genes passed from parent to child.
• Being older than 45
• Being male
• Being of Ashkenazi Jewish descent.
• Your healthcare provider might suspect pancreatic cancer if you have certain symptoms or if you’ve recently developed diabetes or pancreatitis.

Most cases of pancreatic cancer present late, with either locally advanced or metastatic disease.

Depending on the size and location of the tumor, as well as whether the cancer has spread, pancreatic cancer can be diagnosed. Depending on this, the cancer is divided into 5 stages. There are:

• Stage 0: This is also known as carcinoma in situ and is characterized by abnormal cells in the pancreatic lining. The cells could become cancerous and spread to nearby tissue.

• Stage 1: Presence of tumor (cancerous cells) in the pancreas.

• Stage 2: Presence of tumor in the pancreas and has either spread to nearby tissues, organs, or lymph nodes.

• Stage 3: Spread of cancer to major blood vessels near the pancreas. It may have also spread to nearby lymph nodes.

• Stage 4: Cancer has spread to distant organs like the liver, lungs, or abdominal cavity, as well as tissues or lymph nodes near the pancreas.

Pancreatic cancer can be difficult to treat.
The treatment you have will depend on:

• the size and type of pancreatic cancer you have
• where it is
• if it has spread
• your general health
• It may include surgery, chemotherapy, radiotherapy, and supportive care.

Surgical management

The best way to cure pancreatic cancer is through surgery, which can significantly prolong survival. The surgical procedures include:

• Pancreatectomy

It consists of the Whipple procedure (pancreaticoduodenectomy), which is an operation to remove the head of the pancreas. Depending on the anatomic location of the tumor or tumors, a distal or total pancreatectomy (removal of the pancreas) is the best surgical option for resection of pancreatic cancer.

• Laparoscopic surgery

During laparoscopy, a surgeon can access the inside of the abdomen (tummy) and pelvis without making large incisions. This minimally invasive surgery requires laparoscopic distal pancreatectomy for the resection. There was no difference in the rate of positive resection margins and outcomes.

• Vascular resection

A pancreatic tumor’s relationship to the surrounding vasculature determines how much resection is needed. Pancreatic cancer resection includes total pancreatectomy, distal pancreatectomy plus splenectomy (removal of the spleen).

Chemotherapy

Chemotherapy uses drugs to help kill cancer cells. These drugs can be injected into a vein or taken orally. One or more chemotherapy drugs may be given to you. Chemotherapy can also be combined with radiation therapy (chemoradiation). In most cases, chemotherapy is used to treat cancers that haven’t spread beyond the pancreas. In specialized medical centers, this combination may be used before surgery to shrink tumors. In some cases, it is used after surgery to reduce the risk of recurrence of pancreatic cancer. Chemotherapy may be used to control cancer growth, relieve symptoms, and prolong the life of patients with advanced pancreatic cancer and cancer that has spread to other parts of the body.

Radiation therapy

To destroy cancer cells, radiation therapy uses high-energy beams, such as X-rays and protons. Radiation treatments are often administered before and after cancer surgery, often in conjunction with chemotherapy. Or your doctor may recommend a combination of radiation and chemotherapy treatments when your cancer can’t be treated surgically.
Radiation therapy usually comes from a machine that moves around you, directing radiation to specific points on your body (external beam radiation). In specialized medical centers, radiation therapy may be delivered during surgery (intraoperative radiation). Some medical centers offer a newer form of radiation therapy that uses protons instead of X-rays to treat cancer. In certain situations, proton therapy can be used to treat pancreatic cancer and it may offer fewer side effects compared with standard radiation therapy.

Clinical trials

Clinical trials for pancreatic cancer might give you a chance to try new targeted therapy, chemotherapy drugs, immunotherapy treatments, or vaccines. It is not possible to guarantee a cure from clinical trials, and they may have serious or unexpected side effects. On the other hand, cancer clinical trials are closely monitored to ensure they’re conducted as safely as possible. Furthermore, they offer treatments that you would not otherwise be able to access.

Supportive (palliative) care

A palliative care specialist provides pain relief and other symptoms of a serious illness through specialized medical care. Palliative care is not the same as hospice care or end-of-life care. Palliative care is provided by teams of doctors, nurses, social workers, and other specially trained professionals. Patients and their families benefit from these teams by improving the quality of their lives. A palliative care specialist works with you, your family, and your other doctors to provide additional support. In addition to surgery, chemotherapy, and r adiation therapy, it is often used during aggressive treatments. Patients with cancer may feel better and live longer when palliative care is used in conjunction with other appropriate treatments.