PANCREAS CANCER

Types of Pancreatic Cancer

Pancreatic cancer is classified based on the type of cells it starts in:

1. Exocrine Tumors:

   • Adenocarcinoma: The most common type, making up about 95% of cases. It begins in the exocrine cells that line the ducts of the pancreas.
   • Acinar Cell Carcinoma: A rare form that starts in the cells that produce digestive enzymes.
   • Intraductal Papillary Mucinous Neoplasm (IPMN): A tumor that begins in the pancreatic ducts and produces thick mucus. It can be benign or malignant.
   • Mucinous Cystadenocarcinoma: A rare, slow-growing cancer that forms in mucus-filled cysts in the pancreas.
   • Pancreatoblastoma: A rare type of pancreatic cancer that usually occurs in children.

2. Endocrine Tumors:

   • Also known as Pancreatic Neuroendocrine Tumors (PNETs) or Islet Cell Tumors.
   • Insulinoma: A tumor that produces excessive insulin.
   • Gastrinoma: Produces excessive gastrin, a hormone that stimulates acid production in the stomach.
   • Glucagonoma: A tumor that produces excessive glucagon, raising blood sugar levels.
   • Somatostatinoma: Produces excessive somatostatin, a hormone that inhibits other hormones.
   • VIPoma: A tumor that produces vasoactive intestinal peptide, leading to severe diarrhea.

Risk Factors

• Age: Most pancreatic cancers are diagnosed in people over the age of 60.
• Gender: Men are slightly more likely to develop pancreatic cancer than women.
• Family History: A family history of pancreatic cancer or certain genetic syndromes can increase risk.
• Smoking: Smoking significantly increases the risk of pancreatic cancer.
• Diabetes: Long-standing diabetes, particularly type 2, is associated with an increased risk.
• Chronic Pancreatitis: Long-term inflammation of the pancreas, often associated with heavy alcohol use or hereditary conditions, increases the risk.
• Obesity: Being overweight or obese is linked to a higher risk of pancreatic cancer.
• Diet: A diet high in red and processed meats may increase risk.
• Exposure to Chemicals: Exposure to certain chemicals in the workplace, such as pesticides, dyes, and chemicals used in metal refining, may increase risk.

Symptoms

Pancreatic cancer often does not cause symptoms until it has reached an advanced stage. When symptoms do appear, they may include:

• Jaundice: Yellowing of the skin and eyes, dark urine, and pale stools, often due to a tumor blocking the bile duct.
• Abdominal Pain: Pain or discomfort in the upper abdomen that may radiate to the back.
• Weight Loss: Unintentional and significant weight loss, often accompanied by loss of appetite.
• Nausea and Vomiting: Particularly when the cancer blocks part of the digestive tract.
• New-Onset Diabetes: Pancreatic cancer can cause diabetes, especially in people over 50.
• Fatigue: A general feeling of tiredness and weakness.
• Digestive Problems: Including bloating, steatorrhea (oily, foul-smelling stools), and difficulty digesting fatty foods.

Diagnosis

Diagnosing pancreatic cancer typically involves a combination of the following tests:

• Physical Examination and Medical History: To check for signs of jaundice, abdominal masses, and other symptoms.

• Imaging Tests:

  • CT Scan: Provides detailed images of the pancreas and surrounding organs to detect tumors.
  • MRI: Offers detailed images, especially useful for detecting smaller tumors.
  • Endoscopic Ultrasound (EUS): Combines endoscopy and ultrasound to produce detailed images and allows for biopsy.
  • Positron Emission Tomography (PET) Scan: Helps to determine if the cancer has spread to other areas of the body.
  • Endoscopic Retrograde Cholangiopancreatography (ERCP): Used to examine the bile and pancreatic ducts, and can help place stents to relieve blockages.

• Biopsy: A sample of tissue is removed and examined under a microscope to confirm the presence of cancer.

• Blood Tests:

  • CA 19-9: A tumor marker that may be elevated in pancreatic cancer, though it is not specific enough for diagnosis.
  • Liver Function Tests: To check for jaundice and liver involvement.

Treatment

The treatment of pancreatic cancer depends on the stage of the cancer, the location, and the patient’s overall health:

• Surgery:

  • Whipple Procedure (Pancreaticoduodenectomy): The most common surgery, removing the head of the pancreas, part of the small intestine, bile duct, and sometimes part of the stomach.
  • Distal Pancreatectomy: Removal of the tail and body of the pancreas, often along with the spleen.
  • Total Pancreatectomy: Removal of the entire pancreas, part of the stomach, part of the small intestine, the bile duct, gallbladder, and spleen.

• Radiation Therapy:

  • Often used before surgery to shrink the tumor or after surgery to kill any remaining cancer cells.
  • Can also be used to relieve pain and other symptoms in advanced stages.

• Chemotherapy:

  • Often used in combination with radiation therapy (chemoradiation).
  • Can be given before surgery to shrink tumors or after surgery to reduce the risk of recurrence.
  • Chemotherapy is also used to treat advanced or metastatic pancreatic cancer.

• Targeted Therapy:

  • Drugs that target specific mutations or proteins involved in cancer growth. For example, PARP inhibitors for patients with BRCA mutations.

• Immunotherapy:

  • A treatment that uses the body’s immune system to fight cancer, particularly in certain genetic types of pancreatic cancer.

• Palliative Care:

  • Focuses on relieving symptoms and improving the quality of life for patients with advanced pancreatic cancer. This may include pain management, nutritional support, and psychological support.

Prognosis

Pancreatic cancer has a poor prognosis compared to many other cancers, largely because it is often diagnosed at an advanced stage. The five-year survival rate for localized pancreatic cancer (cancer that has not spread outside the pancreas) is around 37%, but it drops significantly for advanced stages. For metastatic pancreatic cancer (cancer that has spread to distant organs), the five-year survival rate is about 3%. However, ongoing research and advances in treatment are offering new hope for improved outcomes.

Prevention and Early Detection

• Quit Smoking: Smoking is a major risk factor for pancreatic cancer.
• Maintain a Healthy Weight: Obesity is linked to an increased risk of pancreatic cancer.
• Healthy Diet: A diet rich in fruits, vegetables, and whole grains, while limiting red and processed meats, may help reduce risk.
• Manage Chronic Conditions: Properly managing diabetes and chronic pancreatitis may help reduce the risk.
• Family History and Genetic Counseling: For those with a family history of pancreatic cancer or known genetic mutations, genetic counseling and regular screening may be recommended.
• Screening for High-Risk Individuals: Endoscopic ultrasound or MRI may be recommended for people at high risk due to family history or genetic syndromes