Pancreatic cancer

Pancreatic cancer is the fourth leading cause of cancer deaths, being responsible for 7% of all cancer-related deaths in both men and women.

Cancer that develops within the pancreas are two major categories:

1. cancers of endocrine pancreas (the part that makes insulin and other hormones) are called “islet cell” “or” pancreatic neuroendocrine tumors and
2. cancers of the exocrine pancreas (the part that makes enzymes for digestion).

Islet cell tumours are rare and typically grow slowly compared to exocine pancreatic cancers.

Islet cell tumours often release hormones into the bloodstem. They are named after the hormones they produce, e.g. insulin,glucagon,gastrin etc.

Cancers of exocine pancreas develop from the cells that line the ducts of pancreas commonly referred to as pancreatic adenocarcinomas, Squamous cell pancreatic cancer is rare.

Adendocarcinoma of the pancreas comprises almost all pancreatic ductal cancers and is the main subject of this review.

By enlarge, there are no known causes as per pancreas cancer doctor.

Certain risk factors that increase the risk of cancer are as follows:

1. Cigarette smoking
2. Alcohol consumption

Symptoms of pancreatic carcinoma include:

Pain – Pain usually starts in epigastrium & spreads to the back. The pain will come and go, and it will intensify after eating.

Yellowing of the skin referred to as jaundice – both the skin and the white a part of the eyes will turn yellow. When jaundice occurs in people with pancreatic cancer, it’s because one of the tubes that carry digestive juice from the gallbladder to the intestines is blocked. If the duct gets blocked, it may also cause the intestine movements to look grey rather than brown.

Anorexia & Weight loss – Patient won’t feel hungry or may feel full after eating little.

Diarrhoea – intestine movements can look greasy or be tough to flush within the toilet bowl.

Vomiting – Can occur secondary to compression of the intestine by the growing tumour.

Black coloured stool – Secondary to the passage of blood in the stool.

These symptoms can even be caused by conditions that aren’t pancreatic cancer. However, if you have these symptoms, tell your doctor about them.

Blood tests – CA-19-9 is a blood test that is elevated in pancreas cancer. However, its interpretation is tricky & only a qualified doctor should order this test.

Imaging tests, such as an ultrasound, a CT scan, MRCP or EUS – These tests produce photos of the inside of the body and might show abnormal growths. The most commonly performed test is a CT scan. The pictures created by the CT scan/MRI will help the doctor locate the tumour, its relationship with body structures & whether it has spread inside the abdomen.

Biopsy – For a biopsy, a doctor takes a small sample of tissue from the pancreas. The biopsy can be taken via a CT guided or EUS guided technique. All patients do not require to undergo biopsy procedure. The biopsy sample will be examined in laboratory & the report is usually available in 3-4 days.

Pancreas cancer doctor stages the pancreas cancer from stage-1 to stage-4.

CT Scan, MRI & PET-CT Scan helps in staging the disease. Stage 4 is considered to be advanced cancer where cancer has spread to other organs. The operation is not performed in stage-4.

Accurate differentiation between stage 1 & 2 can be achieved only after operation as per pancreas cancer doctors. Stage 1 & 2 tumours are called resectable pancreatic cancer. Stage 3 tumours that involve nearby blood vessels are termed as locally advanced(unresectable) pancreas cancer.

If the pancreatic cancer is found at an early stage (stage I and II) and is contained locally within or around the pancreas, surgery is recommended (resectable pancreatic cancer).

Approximately 75% of all pancreatic carcinomas occur within the head or neck of the pancreas, 15-20% occur in the body of the pancreas, and 5-10% occur in the tail.

Surgery is the only potentially curative treatment as per pancreas cancer doctor.

Whipple’s Procedure

The surgical procedure most commonly performed to remove pancreatic cancer located in the head or periampullary region is a Whipple procedure (pancreatoduodenectomy). It comprises removal of a portion of the stomach, the duodenum (the first part of the small intestine), pancreas, a portion of the main bile duct, lymph nodes, and gallbladder. In the experienced hands, the mortality from the surgery itself is less than 4%.

After the Whipple surgery, patients typically spend about one week in the hospital recovering from the operation. Complications from the surgery can include blood loss ( low haemoglobin level ), leakage from the reconnected intestines or ducts, or slow return of bowel function. Recovery to presurgical health often can take 2-4 months.

After patients recover from a Whipple procedure for pancreatic cancer, treatment to reduce the risk of cancer returning is a standard recommendation. This treatment, referred to as “adjuvant therapy (chemotherapy),” has proven to lower the risk of recurrent cancer. Typically, physicians recommend six months of adjuvant chemotherapy, sometimes with radiation incorporated into the treatment plan.

Some patients with pancreatic cancer experience blockage of bile or pancreas ducts and thus may need a surgeon to place a stent to allow drainage through the stent, before the operation.

Distal Pancreato-splenectomy (DPS)

When the tumour is located in the body or tail of pancreas, the surgery performed is called ‘Distal Pancreatosplenectomy’. In this operation body & tail of the pancreas is removed along with the spleen. Vaccination against Pneumococcal, H. Influenza & Meningococci is performed before surgery.

After DPS patient typically spends 5 to 7 days in the hospital. There is a risk of leakage from the pancreatic duct, which can usually be managed by medicines, e.g. octreotide or drainage tube placement.

Unfortunately, only about 20 people out of 100 diagnosed with pancreatic cancer are found to have a tumour that is amenable to surgical resection or is borderline resectable. The rest have pancreatic tumours that are too locally advanced to completely remove or have metastatic spread at the time of diagnosis. Even among patients whose cancers are amenable to surgery, statistical data suggest that only 20% live five years.

If pancreatic cancer is found when it has grown into critical local structures but not yet spread to distant sites, this is described as locally advanced, unresectable (inoperable) pancreatic cancer (stage III). The standard of care for the treatment of locally advanced cancer is a combination of low-dose chemotherapy given simultaneously with radiation treatments to the pancreas and surrounding tissues. Radiation treatments are designed to lower the risk of local growth of cancer, thereby minimizing the symptoms that local progression causes (back or belly pain, nausea, loss of appetite, intestinal blockage, jaundice).

Radiation treatments are typically given Monday through Friday for about five weeks. Chemotherapy given concurrently (at the same time; FOLFOX combination therapy) may improve the effectiveness of the radiation and may lower the risk for cancer spread outside the area where the radiation is delivered.

When the radiation is completed, and the patient has recovered, more chemotherapy often is recommended. Recently, newer forms of radiation delivery (proton therapy, stereotactic radiosurgery, gamma knife radiation, Nanoknife, CyberKnife radiation) have been utilized in locally advanced pancreatic cancer with varying degrees of success, but these treatments can be more toxic and are, for now, mostly experimental; individuals should discuss with their doctors what treatment(s) are best for their condition.

Once pancreatic cancer has spread beyond the vicinity of the pancreas and involves other organs, it has become a systemic problem. As a result, a systemic treatment is most appropriate, and chemotherapy, for example, nab-paclitaxel in combination with gemcitabine is recommended.

Chemotherapy travels through the bloodstream and goes anywhere the blood flows and, as such, treats most of the body. It can attack cancer that has spread through the body wherever it is found. In metastatic pancreatic cancer, chemotherapy is recommended for individuals healthy enough to receive it.

It has been proven to both extend the lives of patients with pancreatic cancer and to improve their quality of life. These benefits are documented, but unfortunately, the overall benefit from chemotherapy in pancreatic cancer treatment is modest, and chemotherapy prolongs life for the average patient by only a few months.

The aggressiveness of the treatment is determined by the cancer doctor (medical oncologist) and by the overall health and strength of the individual patient.

As per pancreas cancer specialist, the five-year survival rate for localized pancreatic cancer is 34 per cent.

The five-year survival rate for people with stage 2 pancreatic cancer is around 30 per cent.

The five-year survival rate for regional pancreatic cancer that has spread to nearby structures or lymph nodes is 12 per cent.

Distant pancreatic cancer, or stage 4 cancer that has spread to other sites like the lungs, liver, or bones, has a 3 per cent survival rate.

The five-year survival rate for all stages of pancreatic cancer is 9 per cent.

As per pancreas cancer specialist, pancreatic cancer patients do not qualify for a pancreas transplant; Pancreas transplants are done in patients with diabetes that results from the removal of the endocrine portion of the pancreas and not for pancreatic cancer. For more information you may read here.