Pancreatic Cancer – A disease mostly diagnosed late

Pancreatic stellate cell activation in chronic...
Pancreatic stellate cell activation in chronic pancreatitis and pancreatic cancer. Pancreatic stellate cells are activated by profibrogenic mediators, such as ethanol metabolites and cytokines/growth factors. Perpetuation of stellate cell activation under persisting pathological conditions results in pancreatic fibrosis. Jaster Molecular Cancer 2004 3:26 doi:10.1186/1476-4598-3-2 (Photo credit: Wikipedia)

The Pancreas is a 6-inch long organ located behind the stomach in the back of the abdomen. It is spongy and shaped somewhat like a fish, extended horizontally across the abdomen. The head of the pancreas is on the right side of the abdomen where the stomach is attached to the first part of the Small Intestine (The Duodenum). The tail of the pancreas – its narrowest part – extends to the left side of the abdomen next to the spleen.

The pancreas contains exocrine and endocrine glands that create pancreatic juices, hormones, and insulin. Pancreatic juices, or enzymes, made by the exocrine glands are released into the intestines by way of a series of ducts in order to help digest fat, proteins, and carbohydrates. Over 95% of the pancreas is made up of exocrine glands and ducts. The endocrine cells are arranged in small clusters called islets of Langerhans, which release insulin and glucagon into the bloodstream. These two hormones manage levels of sugar in the blood. When they are not working properly, the result is often diabetes.

Pancreatic Cancer

Cancer is a class of diseases characterized by out-of-control cell growth, and Pancreatic Cancer occurs when this uncontrolled cell growth begins in the Pancreas. Rather than developing into healthy, normal pancreas tissue, these abnormal cells continue dividing and form lumps or masses of tissue called tumors. Tumors then interfere with the main functions of the pancreas. If a tumor stays in one spot and demonstrates limited growth, it is generally considered to be benign. More dangerous, or malignant, tumors form when the cancer cells migrate to other parts of the body through the blood or lymph systems. When a tumor successfully spreads to other parts of the body and grows, invading and destroying other healthy tissues, it is said to have metastasized. This process itself is called metastasis, and the result is a more serious condition that is very difficult to treat.

Causes of Pancreatic Cancer

Pancreatic Cancer

Cancer is ultimately the result of cells that uncontrollably grow and do not die. Normal cells in the body follow an orderly path of growth, division, and death. Programmed cell death is called apoptosis, and when this process breaks down, cancer results. Pancreatic Cancer cells do not experience programmatic death, but instead continue to grow and divide. Although scientists do not know exactly what causes these cells to behave this way, they have identified several potential risk factors.

Symptoms and Signs of Pancreatic Cancer

The main symptoms of pancreatic cancer include the following:-

  • Pain in the abdomen, the back, or both
  • Weight loss, often associated with the following:
    • Loss of appetite (anorexia)
    • Bloating
    • Diarrhea or fatty bowel movements that float in water (steatorrhea)
  • Rarely may present with new diabetes in a person with weight loss and nausea
  • Jaundice (yellowing of the skin)

The symptoms of pancreatic cancer are generally vague and can easily be attributed to other less serious and more common conditions. This lack of specific symptoms explains the high number of people who have a more advanced stage of disease when pancreatic cancer is discovered.

Pancreatic Cancer Diagnosis

On physical exam, the doctor may feel a mass in the center of the abdomen. However, pancreatic cancer is seldom diagnosed using a physical exam, and the absence of any abnormalities should not dissuade the doctor from obtaining an imaging test if the symptoms of pancreatic cancer are present and persistent. The main imaging tests used to help detect pancreatic cancer are as follows:

  • Abdominal ultrasound: This may be the initial test if a person has abdominal pain and jaundice. This test is effective at looking for gallstones, a common condition that presents with similar symptoms as that of pancreatic cancer. If a pancreatic tumor is seen on ultrasound, a CT scan is still necessary to obtain more information.
  • Abdominal computed tomography (CT): This is the test of choice to help diagnose pancreatic cancer. A CT scan can locate small tumors in the pancreas that might be missed by ultrasound. In addition, a CT scan can accurately show whether the mass has extended beyond the pancreas and what the relation is to nearby blood vessels and organs – information vital to a surgeon planning an operation to remove the cancer. If a pancreatic tumor is suspected, then a specialized CT scan, called a pancreatic protocol scan, is preferred prior to surgery.

Pancreatic Cancer Treatment

The optimal treatment of pancreatic adenocarcinoma depends on the extent of the disease. The extent of cancer can be divided into the following 3 categories:

  • Localized: The cancer is completely confined within the pancreas.
  • Locally advanced: The cancer has extended from the pancreas to involve nearby blood vessels or organs.
  • Metastatic: The cancer has spread outside the pancreas to other parts of the body.

Because pancreatic cancer is often advanced when it is first found, very few pancreatic tumors can be removed by surgery. The standard surgical procedure is called a ancreaticoduodenectomy (Whipple procedure). This surgery should be done at centers that perform the procedure often. Some studies suggest that surgery is best performed at hospitals that do more than five of these surgeries per year.

When the tumor has not spread out of the pancreas but cannot be removed, radiation therapy and chemotherapy together may be recommended.When the tumor has spread (metastasized) to other organs such as the liver, chemotherapy alone is usually used. The standard chemotherapy drug is gemcitabine, but other drugs may be used. Gemcitabine can help about 25% of patients. Patients whose tumor cannot be totally removed, but who have a blockage of the tubes that transport bile (biliary obstruction) must have that blockage relieved. There are two approaches:

  • Surgery
  • Placement of a tiny metal tube (biliary stent) during ERCP

Managing pain and other symptoms is an important part of treating advanced pancreatic cancer. Palliative care teams and hospice can help with pain and symptom management, and provide psychological support for patients and their families during the illness.

 

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