Pancreatic Cancer

Pancreatic Cancer, Symptoms, Diagnosis, Risk Factors, and Treatment

The pancreas is a circa 15-cm-long intraabdominal organ, located in the backmost part of the abdomen and its front side is fully covered with the stomach, duodenum and colon. It plays an important role in the digestion of foods and regulation of blood sugar along with other critical functions. Although cancer can emerge in any part of the organ, the most common location is the head of the pancreas. It usually originates from the secretory cells, called adenocarcinoma.

Pancreatic cancer is difficult to diagnose and treat and considered the fourth most fatal cancer type. In spite of the recent development, no effective medical treatment is available yet, however surgical methods can be implemented. Pancreatic cancer, which generally invades other organs rapidly, is usually encountered after the age of 60 and early diagnosis is considered an essential factor regarding the success of the surgery. If pancreatic cancer is diagnosed in the early stage, Whipple surgery provides successful results.

Symptoms

1. Jaundice is usually not accompanied by pain, which emerges due to the obstruction of the bile ducts. Pancreatic cancer, located in the tail or corpus of the organ, may not lead to jaundice. Itching may be a preliminary finding of jaundice.
2. Abdominal pain spreading to the upper abdominal and upper back (pain partially relieves with bending over and increases after meals)
3. Loss of appetite, feeling of early satiety, dyspepsia, swellings unresponsive to the treatment, and flatulence are the less common symptoms
4. Impairment of taste perception, feeling of disgust against foods,
5. Weakness, weight loss
6. Unexplained back pain
7. The new and sudden emergence of diabetes mellitus
8. Depressive mood
9. Excess fat in feces (characterized by light color, bad smell, the stool cannot be easily removed with water flush) may also occur.

Some risk factors of pancreatic cancer:

1. Smoking: It is responsible for approx. 30% of pancreatic cancer.
2. Age: It is a risk factor of advanced-age pancreatic cancer.
3. Diet: Patients with high-calorie and high-protein diets along with inadequate vegetable and fruit consumption are under higher risk of pancreatic cancer.
4. Obesity: It is believed that individuals with higher BMI are more under the risk of pancreatic cancer compared to individuals with lower BMI.
5. Occupational exposure: Pancreatic cancer is more common in individuals exposed to petroleum products and other chemical substances.
6. Chronic pancreatitis: Chronic, prolonged and untreated pancreatitis increases the risk of cancer development.
7. Diabetes mellitus: Pancreatic cancer is twice more common in diabetic patients compared to healthy individuals. Of all the pancreatic cancer patients, 60%-80% have diabetes mellitus.

Diagnosis in pancreatic cancer

Ultrasonography (US), endoscopic ultrasonography (EUS), computerized tomography (CT) imaging, magnetic resonance imaging (MRI) and sometimes positron emission tomography (PET) scanning are used in the diagnosis of pancreatic cancer. The blood level of CA 19-9 (a tumor marker) is another reliable parameter used for the diagnosis and follow-up of the disease.

Staging

Staging after diagnosis, the first step is the determination of the spread of the disease so that a suitable treatment can be planned. The diagnostic methods are usually sufficient also for staging. The disease stage is determined according to the diameter of the tumor, its relation to the surrounding tissue and the presence of distant metastasis. The cancer cells may spread through lymph or blood vessels. The invasion of other tissues is called metastasis.

Stage 1

The tumor is only in the pancreas.

Stage 2

The tumor has already invaded the enclosing nonvascular tissues. Regional lymph nodes may also be involved.

Stage 3

The tumor has already penetrated the surrounding vessels.

Stage 4

The tumor has already spread to distant organs like the liver and lungs.

Treatment of pancreatic cancer

Surgery is usually the only way for the cure of the disease. However, surgery does not provide a satisfying result if the tumor has already invaded the whole body. A part or whole of the pancreas may be resected during surgery. The resection of the whole organ is called total pancreatectomy. If the tumor is in the head of the pancreas, the Whipple procedure can be preferred. The resection of the pancreas is the treatment of choice if the tumor is located in the tail or body of the organ. There are open and closed (laparoscopic, robotic) surgery techniques available. In advanced-stage pancreas tumors, chemotherapy and radiotherapy are implemented.

The Whipple Procedure

In the Whipple procedure; the gallbladder, a part of the main bile duct, duodenum, a part of the stomach and enclosing lymph nodes are removed en bloc along with the head of the pancreas. Adverse events like mortality or bleeding during and just after the procedure, fistulas in the stitches placed for the provision of the gastrointestinal continuity may be encountere in this long-lasting procedure, in which several organs are removed and their continuity is provided. The accepted mortality rate is under 5% worldwide. The accepted incidence of postoperative complications is 15-20%.