Dr. Navneet Sharda provides this information as an educational source. It is not intended as a substitute for a consultation with a qualified healthcare provider.
Worldwide, Pancreatic cancer makes up 2–3% of all cancers. In the USA, pancreatic cancer has become the third highest cause of cancer death. Typically, Pancreatic cancer spreads rapidly to nearby organs. It is seldom detected in its early stages due to almost no early symptoms and poor screening tests. But for people with pancreatic cysts or a family history of pancreatic cancer, some screening steps might help detect a problem early.
Pancreatic cancer accounts for about 3% of all cancers in the US and about 7% of all cancer deaths. The American Cancer Society’s estimates that about 43,090 people (22,300 men and 20,790 women) will die of pancreatic cancer in 2017. The states including California, Florida, Illinois, New York, Pennsylvania and Michigan are estimated to have maximum number of deaths due to pancreatic cancer in 2017. Pancreatic cancer is seen more in adult males and lifetime risk is highest after the age of 70. Non-Hispanic black people tend to have a higher chance of getting pancreatic cancer. If the cancer is localized, the 5-year survival rate is about 29 and it drastically reduces with more advanced cancers.
ANATOMY AND PHYSIOLOGY
Pancreas is an organ that sits behind the stomach shaped like a fish with a wide head, a tapering body, and a narrow, pointed tail. The pancreas has 2 main types of cells exocrine and endocrine cells. Exocrine are the cells that produce the digestive enzymes, and endocrine are the cells that produce hormone like substances such as insulin and glucagon. Exocrine cells represent the majority of the cells in the pancreas and form the exocrine glands and ducts. The exocrine glands make pancreatic enzymes that are released into the intestines to help you digest foods. The enzymes are first released into tiny tubes called ducts which drain to larger ducts. Finally, they merge to form the pancreatic duct. The pancreatic duct merges with the common bile duct (the duct that carries bile from the liver), and empties into the first part of the small intestine called duodenum. Endocrine cells make up a much smaller percentage of the cells in the pancreas. These cells are in small clusters called islets. These islets make important hormones like insulin and glucagon (which help control blood sugar levels), and release them directly into the blood. More than 85% of pancreatic cancers are the type called ductal adenocarcinomas which has an exocrine cell origin and are commonly found in the head of the pancreas. The small amount of remaining tumors constitute a variety of pathologies with individual characteristics. Endocrine tumors of the pancreas are rare.
The risk of developing pancreatic cancer goes up as people age more than 45. Male sex and African American ethnicity are slightly more likely to develop pancreatic cancer. Cigarette smoking a well-known risk factor for pancreatic cancer. The risk of getting pancreatic cancer is about twice as high among smokers in comparison to those who have never smoked. About 20% to 30% of pancreatic cancers are thought to be caused by cigarette smoking. The more a person smokes, the higher the risk. Obesity and being overweight are risk factors for pancreatic cancer. Obese people are about 20% more likely to develop pancreatic cancer. People who work in dry cleaning and metal working industries may raise the risk of pancreatic cancer if they are heavily exposed to certain chemicals (benzene, chlorinated hydrocarbons). Family history is a risk factor for developing pancreatic cancer. Inherited gene changes (mutations) may cause about 10% of it. Sometimes these changes result in genetic syndromes that can cause exocrine pancreatic cancer like hereditary breast and ovarian cancer syndrome, familial pancreatitis, Peutz-Jeghers syndrome and multiple endocrine neoplasia, type I (MEN1). Pancreatic cancer is more common in people with diabetes and people with cirrhosis; scarring of liver due to alcohol and hepatitis. Chronic pancreatitis, a long-term inflammation of the pancreas, is linked with an increased risk of pancreatic cancer.
Early pancreatic cancers are often symptom free. When the symptoms start to develop, they have often already spread outside the pancreas. Most people with pancreatic cancer have jaundice (yellowish discoloration of skin and eyes) as one of their first symptoms as due to obstruction to bile flow, bilirubin (Bile pigment) gets accumulated in blood. Sometimes, the first sign of jaundice is darker urine. If the bile duct is blocked, stools might be pale or gray. Also, if bile and pancreatic enzymes can’t get through to the intestines to help break down fats, the stools can become greasy and might float in the toilet. When bilirubin builds up in the skin, it can start to itch as well as turning yellow. Pain in the abdomen (belly) or back is common in pancreatic cancer. Pain is common. It usually develops in the upper abdomen as a dull ache that wraps around to the back. The pain can come and go, and it might get worse after eating.The cancer may also spread to the nerves surrounding the pancreas, which often causes back pain or a boring pain from the center through the back. Unintended weight loss is very common in people with pancreatic cancer. Some people lose weight because of a lack of appetite, feeling full after eating only a small amount of food, or diarrhea. These people often have little or no appetite. If the cancer presses on the far end of the stomach it can partly block it; causing nausea, vomiting, and pain that tend to be worse after eating. Sometimes people develop blood clots in a large vein, often in the leg. This is called a deep vein thrombosis or DVT. Symptoms can include pain, swelling, redness, and warmth in the affected leg. Sometimes a piece of the clot can break off and travel to the lungs, which might make it hard to breathe or cause chest pain causing a pulmonary embolism. Rarely, pancreatic cancers cause diabetes (high blood sugar) because they destroy the insulin-making cells. Symptoms can include feeling thirsty and hungry, and having to urinate often.
DIAGNOSIS OF PANCREATIC CANCER
Pancreatic cancer is often undetected during the early stages. By the time symptoms occur, diagnosing pancreatic cancer is usually relatively straightforward. Unfortunately, a cure is rarely possible at that point. Diagnosing pancreatic cancer usually happens when someone comes to the doctor due to symptoms that we have just discussed. During a physical exam, a doctor might feel a mass in the abdomen and notice swollen lymph nodes in the neck, jaundiced skin, or weight loss. The diagnostic evaluation of a patient with suspected pancreatic cancer includes blood testing and abdominal imaging. Additional testing is then directed based upon the findings of the initial tests as well as the patient’s presentation and risk factors.
Blood investigations include serum aminotransferases, alkaline phosphatase, and bilirubin to determine if there is obstruction to bile flow. If there is obstruction due to tumor of the pancreas, these markers will be
elevated. Tumor markers (substances found in the blood when a person has cancer) called CA 19-9 and Carcinoembryonic antigen (CEA) can be helpful, along with other tests, in figuring out if someone has cancer. Imaging tests which are available include abdominal and endoscopic ultrasound scan (EUS), Computed tomography (CT) scan, Magnetic resonance imaging (MRI), Positron emission tomography (PET) scan and an endoscopic test called endoscopic retrograde cholangiopancreatography (ERCP). Abdominal ultrasound scan might be the first test done because it is easy to do and it does not expose a person to radiation. EUS is more accurate than abdominal ultrasound and can be very helpful in diagnosing pancreatic cancer. This test is done with a small ultrasound probe on the tip of an
endoscope, which is a thin, flexible tube that doctors put through your mouth to look inside the digestive tract. But if signs and symptoms are more likely to be caused by pancreatic cancer, a CT scan is often more useful.
Endoscopic retrograde cholangiopancreatography (ERCP) is an imaging test that looks at the pancreatic ducts and bile ducts. This can help show if someone might have a pancreatic tumor that is blocking a duct and to help plan surgery. The test can be done in different ways, each of which has pros and cons. In ERCP, an endoscope is passed from mouth into the first part of the small intestine through upper digestive tract. This is usually done under sedation (make you sleepy). The doctor guides a catheter (a very small tube) through the tip of the endoscope and into the common bile duct. A small amount of dye (contrast material) is then injected into the common bile duct, and x-rays are taken.
The x-rays can show narrowing or blockage in these ducts that might be due to pancreatic cancer. The doctor doing this test can also put a small brush through the tube and remove enough cells to look under a microscope. If there are cancer cells present then the diagnosis has been made without needing a needle or more aggressive surgery. Although the imaging test results may strongly suggest pancreatic cancer, but usually the only way to be sure is to remove a small sample of tumor and look at it under the microscope. This procedure is called a biopsy. This can be taken in different ways including imaging guided biopsy (CT or ultrasound), endoscopic biopsy or surgical biopsy. The most common way to do a surgical biopsy is via laparoscopy where a sample is retrieved from a small hole made in the abdomen under camera guidance.
PANCREATIC CANCER STAGING
Once pancreatic cancer is diagnosed, the next step is to determine its stage. Staging is a system used to describe the aggressiveness and spread of a cancer. A pancreatic cancer’s stage is based on:
The final staging of a pancreatic cancer often depends on what is found during surgery.
Pancreatic cancer stages range from stage I, the earliest stage, to stage IV, which means that the cancer has spread to distant organs, such as the brain. In general, lower stage cancers are less aggressive and require less treatment than do higher stage cancers
PANCREATIC CANCER TREATMENT
Pancreatic cancer can be treated with several approaches. Early stage pancreatic cancer can often be treated and even cured with surgery. After surgery, further treatment, called adjuvant therapy, is often recommended. This might include chemotherapy or radiation therapy. In other cases, chemotherapy or radiation might be offered before surgery (termed neoadjuvant therapy).
However, surgery is often not possible; pancreatic cancer is often advanced by the time it is diagnosed. If surgery is not possible, radiation therapy chemotherapy, or both are often used to shrink the cancer, reduce symptoms, and prolong life.
Cancer Care Centers is located in Las Vegas under the supervision of Cancer Specialist Dr. Nav (Navneet) Sharda. Cancer Care Centers specialize in treatment of various types of cancers like multiforme, meningioma, tonsil, tongue, laryngeal, parotid, neck, lung, breast, lymphoma, non hodgkins lymphoma, hodgkins disease, hodgkins lymphoma, skin cancer, melanoma, esophageal, gastric, pancreatic, colon, renal, kidney, ovarian, sarcoma, uterine cancer, cervical cancer, vaginal, brain, breast, vulvar cancer, bone metastasis, bone, osteosarcoma, endometrial cancercarcinoma, tumor, malignant and cancerous Cancers. We offer threapy like chemotherapy, radiotherapy, radiation therapy, radiation oncology, oncology, oncologist, immunotherapy, brachytherapy, stereotactic radiosurgery, IMRT, intensity modulated radiation therapy, conformal therapy, anaplastic astrocytoma, gioblastoma.