What is Pancreatic Cancer | Gastroenterology

Pancreatic cancer

Overview of pancreatic cancer

Pancreatic cancer begins when abnormal cells in the pancreas grow and divide uncontrollably and form a tumor. The pancreas is a gland located in the abdomen area between the stomach and the spine. It produces enzymes that aid digestion and hormones that regulate blood sugar levels.

Organs like the pancreas are made up of cells. In general, cells divide and form new cells according to the needs of the body. As cells age, they die and new cells replace them. Sometimes this process is broken. New cells form when the body doesn’t need them or when old cells die. The excess cells form a mass of tissue called a tumor.

Types

Based on the diagnosis, the type of cancer is determined. There are several types of pancreatic cancer, including:

Pancreatic adenocarcinoma: This is the most common pancreatic cancer that occurs in the lining of the pancreatic duct.

Adenosquamous carcinoma: This is a rare pancreatic cancer.

Squamous cell carcinoma: This is pancreatic cancer which is very rare.

There are also tumors in the pancreas called endocrine tumors because they secrete hormones. They can be benign (non-cancerous) or malignant (cancerous).

Gastrinoma: A tumor in the pancreas or duodenum. It can occur as part of a hereditary endocrine syndrome. Gastrinomas secrete more than the average level of gastrin, which stimulates the stomach to secrete acids and enzymes. Gastrinoma causes peptic ulcers.

Glucagonoma: A tumor of the pancreas that secretes glucagon, a hormone that raises the level of glucose in the blood, causes skin eruptions.

Insulinoma: A rare pancreatic tumor that secretes insulin, a hormone that lowers blood glucose levels. It is a genetic condition that is often hereditary.

Vipoma: A pancreatic neuroendocrine tumor that secretes vasoactive intestinal polypeptide (VIP). This can lead to severe intermittent diarrhea, which can lead to further complications, including a dramatic loss of potassium.

Symptoms

The signs and symptoms often do not appear until the disease has progressed. They may include:

  • Abdominal pain that radiates to the back
  • Loss of appetite or unexpected weight loss
  • Your skin is yellow and your eyes are white (jaundice)
  • Light-colored stool
  • Dark-colored urine
  • Skin itch
  • Diabetes or a new diagnosis of pre-existing diabetes can be very difficult to control
  • Blood clots
  • Fatigue

Causes

The cause of pancreatic cancer is unknown. This type of cancer occurs when abnormal cells begin to grow within the pancreas and form tumors. In general, healthy cells grow and die in moderation. In the case of cancer, the production of abnormal cells is high and these cells eventually take over healthy cells.

Doctors and researchers don’t know what causes cell changes, but they do know some common factors that increase a person’s risk of developing this type of cancer. Two important risk factors are inherited genetic mutations and acquired genetic mutations. Genes control the way cells work, so changes in those genes can lead to cancer.

Risk factors

Risk factors for pancreatic cancer include:

Cigarette smoking: An example of individual smoking cigarettes doubles the risk. Some scientists estimate that smoking causes one in four cases or one in five cases of pancreatic cancer.

Smoking is also associated with an early age at diagnosis. More importantly, the risk of pancreatic cancer returns to normal in those who quit smoking. Simply put, the number one preventable cause of pancreatic cancer is cigarette smoking.

Age: The risk of pancreatic cancer increases with age. More than 80% of pancreatic cancers develop between the ages of 60 and 80.

Gender: Pancreatic cancer is more common in men than in women. Men smoke more than women.

Religious Background: Pancreatic cancer is more common in Ashkenazi Jews than in any other population. This may be due to an inherited mutation in the working breast cancer gene (BRCA2) in some Ashkenazi Jewish families.

Chronic pancreatitis: Chronic inflammation of the pancreas (pancreatitis) is associated with pancreatic cancer.

Diabetes mellitus: Diabetes mellitus can be a symptom of pancreatic cancer, and chronic adult-onset diabetes also increases the risk.

Pending: It is exceptional significantly increases the risk of pancreatic cancer. It is estimated that 8% of cancers are related to arrears.

Diet: A diet high in meat, cholesterol, fried foods, and nitrosamines increases the risk, while a diet high in fruits and vegetables reduces the risk. Vitamin folate can be protective.

Genetics: As mentioned above, many inherited cancer syndromes increase the risk of pancreatic cancer. These include breast cancer syndrome (BRCA2 and PALB2), familial atypical multiple melanoma syndrome (FAMMM), Lynch syndrome (also known as hereditary nonpolyposis colorectal cancer syndrome), and Putez syndrome. More information on these syndromes can be found in the Genetics section of this website and on the website of the National Registry of Familial Pancreatic Tumors.

Diagnosis

After clearing your medical history and undergoing a physical exam, your doctor may order several tests to determine the cause of your problem or the extent of the condition:

  • Computed tomography (CT scan)
  • MRI (magnetic resonance imaging)
  • Endoscopic Ultrasound (EUS)
  • Laparoscopy (a surgical procedure to look at organs)
  • Endoscopic retrograde cholangiopancreatography (ERCP)
  • Percutaneous transplant cholangiography (PTC; liver and bile duct X-ray procedure)
  • Biopsy (To examine the removed tissue)

Treatment

Pancreatic cancer can be cured if it appears at an early stage before it spreads to other parts of the body. However, 80% to 90% of people with pancreatic cancer have advanced disease at the time of diagnosis. For advanced diseases, treatment does not cure cancer, but it can improve the quality of life and prolong life.

Treatment for pancreatic cancer includes surgery, chemotherapy, and radiation. Your treatment plan depends on your general health, the stage of cancer, and whether the tumor can be surgically removed. Surgery to remove the cancer is often the first treatment option. The following are some common types of surgery to treat pancreatic cancer:

Whipple procedure: This surgery is done if there is a tumor on the head of the pancreas (the widest part) and part of the small intestine, bile duct, and stomach are removed.

Distal pancreatectomy: If there is a tumor in one of these two areas, the body and tail of the pancreas are removed. The spleen is also removed.

Total pancreatectomy: The total pancreas, part of the small intestine, part of the stomach, common bile duct, gallbladder, spleen, and proximal lymph nodes are removed.

When pancreatic cancer cannot be completely removed, some surgical procedures are done to help with symptoms. A metal tube or stent may be placed in the bile duct. Bypass procedures can help when the bile duct or stomach is blocked.

After surgery, your doctor may recommend chemotherapy (treatment with drugs that kill cancer cells) or radiation therapy (high-energy x-rays that kill cancer cells). These therapies can also be used in cases where surgery is not possible due to the location of cancer.

If the disease cannot be cured or controlled, treatment focuses on improving the quality of life by controlling pain and other complications and symptoms caused by the disease.

Complications

This cancer can cause problems for several reasons, including stress on nearby structures, lack of substances produced by normal pancreatic cells, cancer metabolism, or tumor metastasis to other parts of the body.

Specific potential problems may include:

Pancreatic insufficiency: These cancers occur mainly in cells that produce pancreatic enzymes (exocrine cells). The pancreas generally produces eight cups of enzymes a day, which neutralize stomach acid and help break down fats, proteins, and carbohydrates. When these cells are absorbed by the tumor, the lack of enzymes can cause malabsorption, abdominal cramps, and malnutrition even with a normal diet.

80 to 90 % of people with pancreatic cancer develop pancreatic insufficiency and are treated by resetting the pancreatic enzyme.

Bile duct obstruction: Common bile duct obstruction can be a very common complication of pancreatic cancer and at the time of diagnosis. Although surgery is not possible, a stent can be placed through endoscopy, in which a tube is inserted into the mouth and descends into the common bile duct.

Blockage of the stomach or small intestine: The obstruction caused by a growing tumor causes the contents of the stomach to pass into the small intestine (gastric outlet) or the first part of the small intestine (duodenum). If this happens, a stent can be placed to keep these areas open or surgery can be performed to cross the barrier.

Diabetes: As mentioned above, diabetes can indicate the presence of pancreatic cancer suddenly and unexpectedly. 85% of people with the disease develop insulin resistance or diabetes at some point, even if not at the time of diagnosis.

Cachexia: Cancer cachexia, also known as cancer-related anorexia-cachexia syndrome (CACS), is a syndrome of weight loss, muscle wasting, and loss of appetite, but it begins before any weight loss. It is estimated to be present in up to 80% of people diagnosed with pancreatic cancer at the time of diagnosis.

Cachexia can be a direct cause of death in up to 20% of people with cancer. However, in addition to “normal” cachexia, a lack of pancreatic enzymes can lead to malnutrition and further weight loss, which can become a very critical problem for anyone with pancreatic cancer.

Blood clots: As noted, blood clots (deep vein thrombosis) sometimes break off and travel to the lungs (pulmonary embolism) are not just a pancreatic cancer problem, they are your first symptom. These are very common at any time with the disease. People with pancreatic cancer are more likely to bleed thinner than those with other types of cancer, so treatment should be carefully considered.

Pain: The pain associated with pancreatic cancer can be very severe, but there are a variety of options for managing cancer pain. Pain relievers, radiation therapy to the abdomen, and many other techniques are often combined, such as an “abdominal block,” a procedure that stops nerves in the abdomen from transmitting pain signals to the brain. With the current opioid crisis, it is recommended that people with pancreatic cancer consult a pain or palliative care specialist to ensure that they are receiving safe, appropriate, and timely pain relievers when needed.

Prevention

There is absolutely no way to prevent pancreatic cancer. However, there are some steps available to prevent the occurrence of pancreatic cancer.

Know your risk factors: This is an important first step in reducing your risk of pancreatic cancer.

Talk to your doctor: Tell your doctor if you have a family history of pancreatic cancer.

Know the symptoms: If you notice any symptoms, see your doctor immediately. Learn more about the symptoms of pancreatic cancer.

Choosing a healthy lifestyle can help you reduce your risk of pancreatic cancer, be careful if you work with chemicals, and consult your doctor if you experience any symptoms.

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