Pancreatic cancer develops when cells in the pancreas grow out of control and form tumors. The pancreas is an organ located behind the stomach that produces enzymes to aid digestion and hormones to regulate blood sugar levels. It is a complex and often aggressive type of cancer that can be challenging to detect or treat. Their families need to understand the basics of pancreatic cancer, such as its risk factors, symptoms, diagnosis, and treatment.
There are two main types of pancreatic cancer:
- Exocrine pancreatic cancer – This type of cancer is the most common, accounting for about 95% of cases. It starts in the exocrine cells that make digestive enzymes. The most frequent type of exocrine cancer is pancreatic adenocarcinoma.
- Endocrine pancreatic cancer – Endocrine pancreatic cancer develops in the endocrine cells that produce hormones like insulin and glucagon. It is less common, but it tends to have a better prognosis than other types of pancreatic cancer. This cancer is sometimes referred to as pancreatic neuroendocrine tumors or islet cell tumors.
Pancreatic cancer cells often form silently in the body, causing no symptoms until they are formed. Some possible risk factors include smoking, obesity, diabetes, chronic pancreatitis, and family history. Genetic mutations can also increase the risk in some cases. As the cancer progresses, it can block the bile ducts, blood vessels, and intestines, causing symptoms such as jaundice, abdominal pain, and weight loss in the person with the cancer. Catching it early greatly improves the prognosis, but pancreatic cancer is not diagnosed until it is at an advanced stage.
Symptoms
Pancreatic cancer itself often does not show symptoms in its early stages. As a result, the disease is often not detected until it is in the advanced stages. Some of the early symptoms that may develop include:
- Jaundice
- Light-colored or greasy stools
- Dark urine
- Itchy skin
- Abdominal pain that radiates to the back
- Unexplained weight loss and loss of appetite
As the cancer grows and spreads to other organs, it can cause additional symptoms such as:
- Nausea and vomiting
- Gallbladder or liver enlargement
- Blood clots
- Fatigue
- Diabetes
Causes and Risk Factors
- Genetics – Having family members diagnosed with pancreatic cancer increases risk. Gene mutations including BRCA2, p16, and PRSS1 are linked to pancreatic cancer.
- Chronic pancreatitis – The risk of acquiring pancreatic cancer may rise in those with chronic pancreatitis.
- Diabetes – Type 2 diabetes is associated with increased risk, potentially due to shared risk factors like obesity.
- Smoking – Cigarette smoking doubles the risk, possibly due to cancer-causing chemicals reaching the pancreas.
- Obesity – Being overweight increases risk, potentially due to effects on hormones like insulin. Excess body fat may also cause chronic inflammation.
- Older age – Most patients are diagnosed after age 45, with increasing risk as people get older. The median age at diagnosis is 71.
- Gender – Men have a slightly higher risk than women.
- Ethnicity – African Americans are more likely to develop pancreatic cancer than other ethnic groups. The reasons are unknown but may involve higher rates of risk factors.
- Family history – Having a first-degree relative with pancreatic cancer increases risk.
Diagnosis
Physical Exam
During a physical exam, a doctor will press on the abdomen to check for any lumps, swelling, fluid build-up, or other signs that could point to pancreatic cancer. The skin and eyes may also be examined for jaundice (yellowing).
Imaging Tests
If pancreatic cancer is suspected, imaging tests will be ordered to get a closer look at the pancreas and surrounding organs. Tests may include:
- CT scan – Combines X-rays to create detailed cross-sectional images of organs and tissues. This is often the first test ordered if pancreatic cancer is suspected.
- MRI – Magnetic resonance imaging (MRI) is a medical imaging technique that uses strong magnetic fields and radio waves to generate detailed images of internal body structures such as organs and tissues. An MRI may provide additional information not seen on a CT scan.
- PET scan – Involves injecting a radioactive substance into the body which cancer cells absorb. A PET scan reveals areas of cancer metabolic activity.
- Endoscopic ultrasound: A thin, lighted tube with a small ultrasound probe on the end is inserted through the mouth to take ultrasound pictures of the pancreas and surrounding organs. Biopsy samples can also be taken through this tube.
- ERCP: Uses a scope to examine the pancreatic and bile ducts. The dye can be injected through the scope to show blockages or other abnormalities on X-rays.
Biopsy
The only definitive way to diagnose pancreatic cancer is through a biopsy. Cells or tissue samples can be collected through fine needle aspiration, endoscopic ultrasound, or surgery. A pathologist will examine the samples under a microscope to look for cancerous cells.
Staging
Once pancreatic cancer is diagnosed, tests will be done to determine the stage or how far the cancer has spread. Imaging tests can show if the cancer has spread to nearby blood vessels, lymph nodes, or other organs. Staging helps determine the best treatment options.
Complications of Pancreatic Cancer
Pancreatic cancer can lead to various complications as the disease progresses. Some common complications include:
- Jaundice: Blockage of the bile ducts by a tumor can cause bile to build up in the body, resulting in yellowing of the skin and eyes.
- Pancreatitis: Inflammation of the pancreas can occur due to blockage of the pancreatic duct by the tumor.
- Diabetes: Pancreatic cancer can affect the production of insulin, leading to new-onset diabetes or difficulty managing blood sugar levels.
- Malnutrition: The tumor may interfere with the digestion and absorption of nutrients, leading to weight loss and malnutrition.
- Blood clotting issues: Pancreatic cancer can increase the risk of developing blood clots, which can be potentially life-threatening.
Treatments available
- Surgery: When the cancer has not progressed outside of the pancreas, surgery is the most promising treatment option for pancreatic cancer patients. Tumors are removed by procedures like a Whipple surgery or total pancreatectomy, along with portions of the surrounding tissues and organs. While there is a chance for infections, effective surgery can increase survival time.
- Chemotherapy: Chemotherapy kills cancer cells by injecting anti-cancer medications intravenously or by oral means. It can be used either before or after surgery to reduce tumor size and get rid of any leftover malignancy. Chemotherapy can cause side effects like nausea, exhaustion, and hair loss, but it can also extend survival time.
- Radiation Therapy: Radiation therapy targets and destroys the DNA of cancer cells using high-energy beams. When cancer has spread, this treatment is frequently done before surgery or to relieve discomfort. Usually, a machine is used to apply radiation externally. On the other hand, it may result in adverse consequences like weariness, nausea, and skin irritation.
- Targeted Therapy: Drugs that target specific molecules and immunotherapy can prevent the growth and spread of cancer. For example, some target vascular endothelial growth factor (VEGF) to cut off the tumor’s blood supply. Targeted therapy causes fewer side effects than chemotherapy.
- Palliative Care: Relieving symptoms while improving quality of life are the main goals of palliative care. Painkillers, dietary advice, stress management methods, and emotional and social support are a few examples. To control discomfort and support patients during their therapy, palliative care is essential.
