Pancreatic cancer
General information
Pancreatic cancer is a malignant neoplasm that affects the human organ responsible for the secretion of enzymes necessary for digestion. The tumor can affect any part of the pancreas and the entire organ. In 60% of cases, the neoplasm is localized in the head of the pancreas.
Pancreatic cancer is detected annually in more than 200 thousand people in the world. A hidden course and unfavorable prognosis characterize the pathology.
Types of Pancreatic Cancer
The pancreas is a small organ located in the abdomen below the liver and behind the lower half of the stomach. The gland has two types of cells: exocrine cells produce enzymes that help the body digest food, and endocrine cells produce hormones that control blood glucose. These include insulin.
Classification of pancreatic tumors is carried out according to the types of cells from which it developed. Thus, the following types of tumors are distinguished:
- ductal, which is the most common;
- glandular squamous cell;
- acinar;
- squamous cell;
- giant cell;
- mucinous.
In some cases, the histologic origin of the neoplasm cannot be determined, and then the neoplasm is classified as undifferentiated. Loss of differentiation, i.e., “specialization” of cells, is a poor prognostic sign. Such tumors develop very aggressively and begin to metastasize early.
Symptoms of pancreatic cancer
Common symptoms of pancreatic cancer:
- Poor appetite, indigestion, and nausea are characteristic manifestations of pancreatic cancer. Some or all of these symptoms may occur when the tumor presses on the stomach or the early part of the small intestine. In this case, food may remain in the stomach and cause digestive problems, including nausea and vomiting.
- Abrupt weight loss, also known as cancer cachexia, is a complex problem that affects how the body uses calories and protein.
- Abdominal bloating or ascites is an abnormal accumulation of fluid in the abdomen.
- Cancer causes changes in the blood that can increase the chance of clots (blood clots) forming.
- Icterus is the yellowing of the skin and eyes caused by an excess of the bile component bilirubin in the blood. A tumor in the head of the pancreas can cause a narrowing of the bile duct and block bile flow from the gallbladder into the small intestine.
Risk factors
The exact cause and mechanism of how pancreatic cancer develops is unknown, but there are several risk factors associated with the disease:
- Presence of cancer pathologies in close relatives, some hereditary mutations (for example, in the BRCA2 or PKD1 gene);
- Improper diet with excessive consumption of sausages, smoked meats, fatty and fried dishes, coffee, alcohol, carbonated drinks, simple carbohydrates, in particular, sweets;
- Age over 60 years of age. The risk of developing signs of pancreatic cancer increases dramatically as we age. According to international statistics, 97.5% of all new diagnoses occur in people 45 and older.
- various pathologies of the pancreas: chronic pancreatitis, i.e., inflammation, diabetes mellitus, cysts, adenoma;
- smoking;
- Excessive body weight is associated with an imbalance of hormones affecting the cells of the pancreas;
- liver disease, primarily cirrhosis, gastric and duodenal ulcer disease, nonspecific ulcerative colitis, Crohn’s disease, and other autoimmune diseases of the digestive system;
- various allergic pathologies such as eczema, atopic dermatitis, and oral diseases;
- chronic intoxications related to poor environmental conditions or occupational activities.
Stages of pancreatic cancer
The earliest stage of pancreatic cancer is stage 0 or carcinoma in situ, followed by stages I through IV. Generally, the lower the number, the less the cancer has spread. A higher number, such as stage IV, means the most advanced stage of cancer.
The most commonly used system for defining pancreatic cancer is the TNM system, which is based on three key elements:
- Tumor size (T): reflects not only how large the tumor is but also whether it has grown beyond the pancreas into nearby blood vessels.
- Spread to neighboring lymph nodes (N) and the number of nodes that cancer affects.
- Metastasis to distant sites (M): whether the cancer has spread to other lymph nodes or distant organs such as the liver, abdominal mucosa, lungs, or bones.
Tumor structure describes how much cancer cells look like normal tissue under a microscope. Low-grade (G1) cancer looks very similar to normal pancreatic tissue and tends to grow and spread more slowly than high-grade (G3) cancer. In most cases, grade 3 pancreatic cancer has a poor prognosis compared to cancer of grade 1 or 2 (G2) malignancy.
Resectability. An important factor for patients is whether the entire tumor will be removed:
- R0: the cancer is considered to be removed entirely, i.e., there is no visible or microscopic evidence that malignancy remains.
- R1: all visible tumors have been removed, but laboratory tests of the removed tissue show that some small areas of cancer probably remain.
- R2: some visible tumors could not be removed.
Diagnosis of pancreatic cancer
In the initial stages of cancer, there are almost no symptoms. It can make diagnosis difficult, so to detect pancreatic cancer, in addition to examination and standard tests, the following tests should be performed:
- A biopsy involves taking a tissue sample from a suspected tumor, which can then be tested to determine if it is cancerous.
- Ultrasound is a painless procedure that uses high-frequency sound waves to create images of body organs.
- A CT scan provides a detailed image of internal organs through a series of images. Your doctor can use CT scans to check for abnormalities and estimate the size of a tumor.
- Magnetic resonance imaging (MRI) also provides images of internal organs but uses strong magnetic and radio waves instead of X-rays. MRI allows the doctor to check for signs of metastases.
- Positron emission tomography (PET) scans can also show where the cancer is located and whether it has spread throughout the body.
- Endoscopic retrograde cholangiopancreatography is a procedure used to insert a plastic tube or stent into the bile duct.
- Laparoscopy is a surgical procedure that allows the doctor to access the inside of the abdomen and pelvis. During the study, a small incision is made in the abdomen, and a thin, flexible microscope is inserted. It will allow the specialist to look inside the abdomen and make sure the tumor has not spread before recommending its removal.
Treatment
The choice of treatment method depends on the disease stage and whether the patient has metastases. The first goal will be to completely remove the tumor and any other cancer cells in your body. If this is not possible, the focus will be on preventing the tumor from growing while improving your overall condition.
There are three main ways to treat it:
- chemotherapy;
- operation;
- radiation therapy.
Some types of cancer in this localization require only one treatment, while others may require two or a combination of all three.
Chemotherapy
Chemotherapy is a type of cancer treatment that uses drugs that either kill malignant cells or stop them from multiplying. Chemotherapy treatment is often used along with surgery and radiation therapy to make sure that as much of the cancer as possible is eliminated.
Chemotherapy may be administered:
- before surgery to try to shrink the cancer;
- after surgery to reduce the risk of cancer recurrence;
- when surgery is not possible to try to shrink the cancer, slow its growth, and relieve symptoms.
Before surgery, conservative therapy may be prescribed to slow tumor growth and reduce its size as much as possible, destroying as many malignant cells as possible. After surgery, the main point of using these methods is to fight possible metastases and recurrences. At late stages of the cancer process, when radical surgery seems inappropriate, conservative therapy becomes the basis of treatment.
Surgery
Surgery is usually the only way to cure pancreatic cancer completely. However, because the condition is usually advanced by diagnosis, surgery is only suitable for about 15-20% of people. It is unsuitable if the tumor is localized around essential blood vessels and has spread to other body parts. When surgery may not be an appropriate way to remove the tumor, doctors may suggest it to relieve symptoms. This type of surgery will not cure the cancer, but it will delay complications.
Surgical methods include pancreaticoduodenal resection, also known as Whipple’s surgery. This technique removes a tumor in the head of the pancreas, the large papilla, or the upper part of the duodenum. Whipple’s surgery removes the entire tumor and reconstructs the pancreatic ducts and bile ducts. It is virtually the only effective method of treating pancreatic cancer. Contraindications are severe general medical conditions in the decompensation stage, cachexia, and significant metastasis of cancer.
Radiation therapy
Radiation therapy has also shown some effectiveness for pancreatic tumors. It is a form of cancer treatment that uses high-energy beams of radiation to shrink tumors and relieve pain.
All these treatment options are available in more than 850 hospitals worldwide (https://doctor.global/results/diseases/pancreatic-cancer). For example, distal pancreatectomy is performed in 25 clinics across Turkey for an approximate price of $8.4 K (https://doctor.global/results/asia/turkey/all-cities/all-specializations/procedures/distal-pancreatectomy).
Pancreatic cancer prevention
The following rules will help to reduce the risk of this pathology: avoid smoking and alcohol consumption and reduce the amount of sweets, baked goods, and fatty foods in the diet. Positive for prevention affects an increase in vegetable fiber consumption, normalization of body weight, constant moderate physical activity, and, if necessary, the use of personal protective equipment in harmful production.
