Pancreatic cancer is a type of cancer that originates in the pancreas, a small organ located near the stomach. This cancer is typically very aggressive and challenging to treat. Risk factors include a family history of pancreatic cancer, smoking, long-term diabetes, and chronic pancreatitis. Symptoms of pancreatic cancer may include abdominal pain, jaundice, weight loss, and fatigue. Treatment options may include surgery, chemotherapy, and radiation therapy. Pancreatic adenocarcinoma is the most common type and usually found more in males than females. The incidence of pancreatic cancer increases with age.
Stages of pancreatic cancer:
- stage 1: Cancer confined to pancreas
- stage 2: Cancer has spread to nearby abdominal tissues or lymph nodes
- stage 3: Cancer has spread to major blood vessels and lymph nodes
- stage 4: Cancer has spread to other organs, such as the liver.
What Causes Pancreatic cancer?
Though the cause of Pancreatic cancer is unknown, it was found to be linked to DNA mutations. Certain factors may increase a person’s risk. These factors include smoking, old age, obesity, a family history of pancreatic cancer, and certain genetic conditions, such as hereditary pancreatitis, familial atypical multiple mole melanoma syndromes, and Lynch syndrome. Some research also suggests that certain environmental factors, such as air pollution, may increase the risk of pancreatic cancer.
What are the Risk factors?
- Cigarette smoking
- Age
- Race
- Gender
- Diabetes mellitus
- Obesity, diet
- Chronic pancreatitis
- Family history
- Inherited conditions (Lynch syndrome)
Signs and symptoms
- Jaundice
- Dark urine
- Light colored stool
- Itchy skin
- Abdomen pain
- Weight loss
- Vomiting, nausea
- Diabetes
- Blood clots
- Gallbladder or liver enlargement
What are the Complications?
- Pain
- Pancreatic insufficiency
- Bile duct obstruction
- Stomach or small intestine obstruction
- Diabetes
- Cachexia (extreme weight loss)
- Blood clots
Diagnosis: How to diagnose Pancreatic cancer?
Pancreatic cancers are diagnosed at an advanced stage.
- Medical history – Check for symptoms and other risk factors.
- Physical examination – Appearance of the patient (malnutrition), Palpation.
- Diagnostic tests – The tests performed are:
- Biopsy: Removal of a small amount of tissue for examination under a microscope to look for precancerous cells or cancer cells.Cholangiopancreatography: Procedure to observe pancreatic ducts and bile ducts.Angiography: x-ray to look at blood vessels.CT scan: A procedure that makes a series of detailed pictures of areas inside the body
- MRI: A procedure that uses a magnet, radio waves, and a computer to make detailed pictures of areas inside the body.
- PET scan: A procedure that uses radioactive glucose to find malignant tumor cells in the body.
- Endoscopic ultrasound (EUS) is a procedure in which high-energy sound waves (ultrasound) bounce off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram.
- Blood tests– A blood test to assess liver functions and check for tumor markers (CA19-9)
Treatment: How is Pancreatic cancer treated?
- Surgery
- Whipple procedure (pancreaticoduodenectomy) – Surgery to remove the head of the pancreas
- Distal pancreatectomy – Surgery to remove the tail of the pancreas and sometimes a portion of the body also.
- Total pancreatectomy – Surgery to remove the entire pancreas, spleen, gall bladder, and some parts of the stomach.
- Palliative surgery ( to relieve symptoms)
- Radiotherapy: used in combination with chemotherapy
- External radiation therapy uses a machine outside the body to send radiation toward cancer.
- Chemotherapy
- Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing.
- Medications –
- Gemcitabine (Gemzar)
- 5-fluorouracil (5-FU)
- Oxaliplatin (Eloxatin)
- Albumin-bound paclitaxel (Abraxane)
- Capecitabine (Xeloda)
- Cisplatin
- Irinotecan (Camptosar)
- Targeted therapy: Identify and attack specific cancer cells without harming normal cells
- EGFR inhibitor Erlotinib (Tarceva)
- PARP inhibitor Olaparib (Lynparza)
- Immunotherapy
- Immune checkpoint inhibitor– The immunotherapy drug pembrolizumab (Keytruda) is approved to treat tumors with either high microsatellite instability (MSI-high) or dMMR, regardless of the tumor’s location in the body.
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Prevention: Can we prevent it?
- Prevention of Pancreatic cancer –
- Quit smoking
- Healthy weight
- Physical activities
- Avoid alcohol
- Living with Pancreatic cancer –
- Follow-up care ( doctor visits and tests)
- Avoid alcohol
- Staying at a healthy weight
- Consult nutritionist
- Regular physical activities
When to see a doctor? :
It is wise to consult with a gastroenterologist immediately if observed any symptoms. The typical consultation fee for a gastroenterologist ranges from Rs. 1000 to Rs. 2000 in India.
References:
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