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Pancreatic Cancer: Causes, Symptoms, Treatment And Prevention

The pancreas is a pear-shaped organ, lying behind the stomach and in front of the spine. It produces certain important hormones and help in the process of digestion. Pancreatic cancer starts when the cells of the pancreas grow and divide uncontrollably. Symptoms of the cancer are not identifiable in the early stages. Treatment of this type of cancer depends upon the stage of cancer. Pancreatic cancer is common, and it affects both men and women equally.

Pancreatic Cancer

What is Pancreas?

The pancreas is situated in the lower part of the abdomen. It has two types of cells. They are:

  • Exocrine cells: It forms the major bulk of the pancreatic cells. These cells are chiefly responsible for producing enzymes that help in digestion of food.
  • Endocrine cells: These cells form a small percentage of the pancreatic cells. Endocrine cells are also called as Islets of Langerhans. These cells release hormones such as insulin and glucagon in the bloodstream. These hormones help in regulating the blood sugar levels.

Causes of Pancreatic Cancer:

Research studies show genetic mutations as the primary reason for pancreatic cancer. The variations may occur either, due to the inheritance of mutant genes or due to any sudden genetic changes that occur in the human body. These mutations result in the abnormal growth and multiplication of the pancreatic cells, leading to the formation of a tumor.

Along with these genetic factors, some risk factors like (sudden onset) diabetes also cause pancreatic cancer.

Types of Pancreatic Cancer:

Pancreatic cancer can be divided into the following types based on the cells that are affected.

  1. Exocrine tumours: These are the most common types of all the pancreatic cancers. Pancreatic exocrine tumors begin in the ducts of the pancreas. This cancer affecting the exocrine cells is called as pancreatic adenocarcinoma.
  2. Endocrine tumours: This type of cancer occurs rarely. Pancreatic endocrine tumours begin to form in the islets of Langerhans and are known as pancreatic neuroendocrine tumours.

Symptoms of Pancreatic cancer:

Symptoms do not appear in the initial stages of pancreatic cancer. But, symptoms begin to appear as the cancer progressed.

Some of the common symptoms include:

  • Pain or discomfort in the abdomen
  • Pain radiating to the mid-back region
  • Yellowish discoloration of the skin and eyes (signs of jaundice)
  • Nausea and vomiting
  • Sudden or newly onset diabetes
  • Unexplained weight loss
  • Loss of appetite
  • Indigestion
  • Smelly stools
  • General fatigue
  • Psychological symptoms like depression and anger

Risk factors of Pancreatic cancer:

Some of the common risk factors include:

  • Family history of pancreatic cancer
  • Ageing
  • Lifestyle habits like smoking and drinking
  • Obesity
  • Long-term infection or inflammation of the pancreatic cells

Complications of Pancreatic cancer:

Early diagnosis and treatment of pancreatic cancer is essential to avoid the development of further complications. Common complications of this type of cancer include:

  • Jaundice
  • Excessive weight loss
  • Severe pain in the abdomen
  • Bowel obstruction
  • Death

Even after the treatment with chemotherapy, the prognosis of this cancer is not good.The rate of mortality is higher if there is a delay in the diagnosis of this type of cancer.

Diagnosis of Pancreatic cancer:

Diagnosis of Pancreatic cancer includes both physical examination and diagnostic tests.

Physical Examination:

Detailed history taking includes a questionnaire about the patients’ symptoms, underlying disease conditions, medications being used and the family history of cancer. Physical examination provides analysis of vitals and observation for abnormal signs like weight loss or irritability.

Diagnostic Tests Include:

Blood test:

This test involves removal of a sample of blood from the patient, to check for the presence of specific proteins called tumor markers which are indicative of cancer. CA 19-9 is the common tumor marker present in the individuals with pancreatic cancer.

Ultrasound test:

This test uses ultrasonic waves to obtain the images of the pancreas. In cases of pancreatic cancer, endoscopic ultrasound (a small transducer of the ultrasound is inserted at the tip of the endoscope tube) is the method of choice for diagnosis, as it offers a clear view of the pancreas.

Computed Tomography (CT) scan:

The scan procedure involves the use of x-rays to get the cross-sectional images of the pancreas. It also helps to assess the spread of the cancer to the surrounding structures.

Magnetic Resonance Imaging (MRI) scan:

This scan involves the use of both radio and magnetic waves to create detailed images of the pancreas and its surrounding blood vessels.

Positron Emission Tomography (PET) scan:

This scan involves the use of a radioactive drug to mainly study the extent of spread of the cancer cells beyond the pancreas.

Biopsy:

This test procedure involves the extraction of a small amount of tissue from the pancreas and examining it under the microscope. It is helpful to detect the cancer cells and determine the severity of cancer.

Pancreatic cancers are divided into different stages based on the extent of the size of a tumor and the spread of a tumor to the surrounding body parts.

Stages of Pancreatic cancer:

Thetreatment and recovery depend upon the stage of cancer. The stage of the disease is decided upon by studying the factors like size of the pancreatic tissue involved and the extent of spread of the disease to surrounding areas.

Stage 0: Non-invasive stage; the cancer cells are present within the cells of the pancreas. It cannot be diagnosed on imaging tests.

Stage 1: Invasive stage; the cancer cells are invasive and they may spread to nearby structures for 2 to 4 centimeters range.

Stage 2: Invasive stage; the cancer cells are invasive and they grow across the pancreas, and also spread to the nearby lymph nodes.

Stage 3: Invasive stage; the cancer cells are invasive and they invade surrounding structures like blood vessels or nerves. But, the cells are not spread to much distant sites.

Stage 4: Advanced stage; the cancer cells are widely spread to distant body parts like heart, brain, lungs and kidneys.

Treatment of Pancreatic cancer:

Treatment of cancer is based upon the stage of cancer. Treatment aims to eliminate or at least reduce the progression of the disease symptoms.

Treatment includes:

Surgery:

Surgery consists of complete or partial removal of the pancreas. The different types of operations include:

  • Whipple procedure:

This surgery involves the removal of the head of the pancreas, along with the surrounding tissues.

  • Distal pancreatectomy:

It is the surgery involving the left side of the pancreas is called distal pancreatectomy. This surgery may also require the removal of a small amount of spleen.

  • Total pancreatectomy:

This surgery involves the removal of the whole of the pancreas and this method is called a total pancreatectomy.

In advanced stages of the disease, People should take insulin and enzyme replacement therapy after this process of complete removal of the pancreas, to lead a healthy life.

Radiotherapy:

In radiotherapy, high-intensity radiations or x-rays are used to kill the cancer cells of the pancreas. This radiation therapy is either external (machine sends radiations) or internal (radioactive substance is sealed and placed in the site of cancer).

Doctors may recommend radiotherapy post-surgically or along with chemotherapy.

Chemotherapy:

In chemotherapy, medicines are used to kill the cancer cells or to stop the cell division. The drugs are given orally or by injecting through a vein. Chemotherapy is given post-surgically, along with radiotherapy. It is also provided in advanced stages of the disease when the cancer cells spread to other body parts.

In some cases, surgery may not be considered for treatment due to some underlying complications. In such cases, the treatment for pancreatic cancer involves a combination of radiotherapy and chemotherapy.

Medications:

In this method of treatment, opioid painkillers are given for symptomatic pain relief. Opioids are of different types, stronger opioids and weaker opioids. These medications are given either in the form of tablets or as a liquid.

Enzyme replacement therapy (administration of pancreatic enzymes), to help in digestion is also considered for treatment in some cases of pancreatic cancer.

Prevention of Pancreatic cancer:

No specific method is available to prevent the occurrence of pancreatic cancer completely. But, some measures help to reduce the risk of acquiring cancer. They are:

  • To avoid smoking
  • To limit the consumption of alcohol
  • To maintain a healthy weight
  • To monitor blood pressure regularly
  • To reduce exposure to hazardous chemicals at work

Early diagnosis and appropriate management of the pancreatic cancers are essential to avoid further life-threatening complications of the disease.

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