Pancreatic Cancer: Information on Causes, Diagnosis & Treatments

Pancreas Cancer Blood Sugar Pancreatic Cancer involves cancerous (malignant) cells that form in the pancreas, a gland in the body that produces hormones and digestive juices for regulating blood sugar levels. The gland produces and drug prints cells that make endocrine and exocrine cells that make digestive juices (enzymes), where most forms of the disease begin.

Both endocrine and exocrine cells make different forms of tumors and have distinct causes and risk factors, different symptoms, and required different tests for an accurate diagnosis. Most individuals with pancreatic cancer have damaged exocrine cells. More than 9 out of every 10 cases of pancreatic cancer involve pancreatic adenocarcinoma that begins in the duct system of the pancreas. The most common forms of exocrine cancer cases involve:

  • Pancreatic Adenocarcinoma

  • Squamous Cell Carcinomas

  • Undifferentiated Carcinoma

  • Adenocarcinomas

  • Undifferentiated Carcinoma with Giant Cells

  • Signet Rain Cell Carcinoma

  • Ampullary Cancer that begins in the ampulla of Vader where the pancreatic duct and bile duct connect before it empties into the small intestine. While not technically a cancer of the pancreas, ampullary cancer usually requires the same form of treatment.

In some cases, patients will develop pancreatic tumors also referred to as neuroendocrine tumors (islet cell tumors) that will develop as a noncancerous (benign) 4 cancerous (malignant) mass. This tumor can disrupt formal production and cause distinct symptoms including:

  • Gastrinoma that affects cells that produce gastrin

  • Somatostatinomas that produce somatostatin

  • Glucagonomas that produce glucagon

  • Insulinomas that produce insulin

  • PPomas that produce pancreatic polypeptide

  • VIPomas that produce vasoactive intestinal peptide

Who Is at Risk for Pancreatic Cancer?

There are specific risk factors that can increase the potential risk of developing pancreatic cancer. This includes:

  • Pancreatitis (Chronic inflammation of the pancreas gland)

  • Smoking

  • Obesity

  • Diabetes

  • Genetic predisposition where other family members have developed pancreatic cancer

  • Genetic syndromes including Lynch syndrome, BRCCA2 gene mutation, and FAMMM (familial atypical mole-malignant melanoma) syndrome

Some studies have revealed that a combination of consuming a poor diet, smoking, and long-term diabetes can increase the potential risk of developing pancreatic cancer compared to patients who had just one of the risk factors listed above.

Common Symptoms

The most common symptoms associated with pancreatic cancer include:

  • Upper abdominal pain radiating to the back

  • Blood clots

  • New onset diabetes

  • Depression

  • Fatigue

  • Unexpected weight loss caused by a diminished appetite

  • Jaundice that yellows the skin and the whites of the eyes

Any symptom listed above should be of concern especially if the individual is experiencing persistent jaundice, Donald pain, fatigue, or symptoms associated with pancreatic cancer. Without treatment, the disease can cause significant complications.

Complications

At the pancreatic cancer is allowed to progress, it often develops serious complications that include:

  • Associated Weight Loss – There are numerous factors that could lead to weight loss associated with progressing pancreatic cancer. This includes vomiting and nausea associated with a tumor causing pressure on the stomach making it difficult to consume food or as a side effect of cancer treatments.

  • Jaundice – Bile released by the liver can be blocked by pancreatic cancer tumors that lead to jaundice where the eyes and skin become yellow. Other signs of jaundice include pale-colored stools and dark-colored urine.

  • Pain – Pancreatic cancer tumors growing in size can put pressure on nerves in the abdomen, causing severe pain. While many over-the-counter pain drugs can provide comfort to this type of abdominal pain, long-term treatment typically requires radiation therapy to stop a tumor from growing. The doctor might also perform a celiac plexus block where alcohol is injected into the affected nerves to stop them from sending pain signals to the spinal cord to the brain.

  • Bowel Obstruction – In some cases, pancreatic cancer tumors or tissue mass will grow and press on the duodenum part of the small intestine, which could block digestive food leaving the stomach and entering the intestines.

Some individuals undergo a stent (tube) placement in the small intestines to ensure it remains open as the cancer progresses.

Diagnosing Pancreatic Cancer

If the physician suspects with the patient’s suffering from pancreatic cancer, they typically perform a variety of tests to verify a diagnosis of the condition. These include:

  • Imaging Tests – This includes MRI (magnetic resonance imaging), CT (computerized tomography), and PET (positron emission tomography) scans that provide a visual image of the pancreas and surrounding organs.

  • Endoscopic Ultrasound Test – The doctor will use a scope to generate pictures of the pancreas using ultrasound waves. The device involves inserting a flexible, thin endoscope (tube) down the esophagus to reach the stomach and capture images.

  • Biopsy – By removing a small sample of pancreas tissue, the doctor can examine healthy and cancerous cells under a microscope. The biopsy usually requires the insertion of a needle (fine needle aspiration) through the skin to remove a small portion of the pancreas.

  • Blood Test – The physician may recommend a variety of blood tests to seek out tumor markers (specific proteins) that are known to be shed by cancer cells of the pancreas. This includes identifying the CA19-9 tumor marker.

If a diagnosis of pancreatic cancer has been verified, the doctor often determines the stage (extent) of the cancer to identify how much the condition has progressed. There are four stages of pancreatic cancer that include:

  • Stage I – Pancreatic cancer has been confined to a localized area that can be removed through surgical procedures.

  • Stage II – The condition has progressed and now spread to neighboring tissue and organs and possibly into the lymph nodes. Removing the cancer from the body might still be possible using surgical procedures.

  • Stage III – The cancer has metastasized (spread) from the pancreas out to lymph nodes and blood vessels. Surgical procedures might not remove all the cancer at this advanced stage.

  • Stage IV – The condition has now spread (metastasized) to distant sites that might include the lungs, liver, and peritoneum (the lining of the abdominal organs). Because the disease has progressed to its final stage, surgery is typically not an option.

Pancreatic Cancer Treatments

Achieving a successful outcome when treating pancreatic cancer will depend on how far the disease has progressed and its location. Doctors will usually recommend surgical procedures, chemotherapy, radiation, or a combination of two or all three treatments.

  • Surgical Procedures – The doctor may recommend a pancreatic duodenectomy (Whipple procedure) that removes the head of the pancreas, bile duct, and gallbladder. However, this surgical operation is considered technically challenging. Other procedures involve:
    • Pancreas Tumor Surgery (distal pancreatectomy) – This procedure removes the body and tail (left side) of the pancreas and possibly removal of the spleen.

    • Pancreas Removal Surgery – It might be necessary in extreme cases to remove the entire pancreas, requiring the patient to continually receive lifelong enzyme insolent replacement therapy.

    • Tumor Affected Surgery – Removal and reconstruction of affected blood vessels might be the only option left if pancreatic surgeries or the Whipple procedure are not possible or have not produced an optimal outcome.

    • Chemotherapy uses chemical medications to destroy cancer cells.

    • Radiation Therapy uses x-ray beams and protons to kill cancer cells.

    • Palliative Care provides relief from extreme pain and other associated symptoms of pancreatic cancer.

Some patients are ideal candidates for clinical trials using targeted therapy, immunotherapy, and chemotherapy treatments or vaccines.

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Sources:

https://ephtracking.cdc.gov/showPancreaticCancer

http://www.mayoclinic.org/diseases-conditions/pancreatic-cancer/home/ovc-20268502

https://my.clevelandclinic.org/health/articles/pancreatic-cancer

https://www.cancer.org/cancer/pancreatic-cancer.html

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