The pancreas is a glandular organ in the gastro-intestinal system. Its size is approximately 6 inches long. It is located just under the liver and surrounded by the intestine, on the right side of the body.
The function of the pancreas is to basically make pancreatic juices. The pancreatic juices contain enzymes that help in breaking down or catabolism of food. The juices flow through ducts leading to the main pancreatic duct (the exocrine function). The pancreatic juices flow through the main pancreatic duct into the duodenum or small intestine’s first portion.
The pancreas is also a gland with endocrine function (secretes substances that have action far away from secreting organ also). It makes insulin and other hormones. These hormones circulate through the entire body by entering via the bloodstream. These pancreatic hormones such as insulin aid the body to utlilze and store the energy supplied from food. One of insulin’s functions is to control and regulate the amount of blood sugar.
What is a pancreatic cancer ?
Pancreatic cancer is basically a cancer that starts in the pancreas.
What are the risk factors for pancreatic cancers ?
The following factors contribute to Pancreatic Cancer.
- Smoking: The primary risk factor for Pancreatic Cancer is Smoking tobacco. People who smoke tobacco are at great risk as compared to the non smokers. The highest risk group in this category is that of heavy smokers.
- Diabetes: Diabetics are also more liable than others to get affected by pancreatic cancer.
- Family History: Having a family history of pancreatic cancer elevates the risk of developing the disease.
- Inflammation of the Pancreas or Pancreatitis: Pancreatitis is a very painful condition, in which the pancreas is inflamed. Having pancreatitis for a long time may increase the chances of pancreatic cancer.
- Obesity: People who are overweight or obese are slightly more likely than other people to develop pancreatic cancer.
- Genetics: Genes increasing the risk of pancreatic cancer are under investigation.
What are the types of pancreatic cancers ?
There are two main types of pancreatic cancer.
- Exocrine pancreatic cancer: Most often, pancreatic cancer originates in the ducts that carry the pancreatic juices to their destined location.
- Endocrine pancreatic cancer or Islet cell cancer: Much less, pancreatic cancer starts in the cells that produce hormones.
What are the clinical features of pancreatic cancers ?
The early tumours of the pancreas have no specific clinical symptoms and most of the patients are asymptomatic. The diagnosis is commonly made at an advanced stage. Patients with advanced cancers may present with darker urine, pale stools, yellow skin and eyes (jaundice), pain in the upper abdomen, nausea and vomiting, weakness or tiredness, loss of appetite or weight loss.
How are pancreatic cancers diagnosed ?
- A complete physical examination of the body is mandatory. Your doctor will check for changes in abdomen near the pancreas, liver, gallbladder, and spleen.
- Biochemical tests : A raised bilirubin causing jaundice will be seen.
- Tumor markers : Elevated levels of tumour marker in the blood, CA 19-9 can point to pancreatic cancer in the body. However, it can be produced by other cancers as well, so it is not that specific.
- Imaging tools : Ultrasound (USG), Computed Tomographic (CT) scan, as well as Magnetic Resonance Imaging (MRI) and Magnetic resonance cholangio-pancreatography (MRCP) are used as required to detect structure of the tumour, and to establish cancer staging.
- Endoscopic ultrasound scan (EUS) : This test has to be conducted at a specialist centre. A thin, flexible tube (or an endoscope) with a mounted light and a minute ultrasound probe is passed through the mouth and down into the stomach. The ultrasound creates an exact picture of cancer location, its size and its spread.
- Endoscopic Retrograde Cholangio-Pancreatography (ERCP) : An ERCP is sometimes used to diagnose pancreatic problems. It is more typically used for unblocking the bile duct by a stent, if required.Similar to the EUS, an ERCP also uses an endoscope but it also involves an additional function, that is taking x-rays after injecting dye into the pancreas.
- Biopsy : A biopsy involves taking small tissue samples to be examined under a microscope. There is another type of biopsy called fine-needle aspiration cytology (FNAC) in which a needle is inserted into the tissue to collect tissue samples.
- Staging Laparoscopy should be done in patients to rule out distant metastases.
How are pancreatic cancers staged ?
These are the stages of cancer of the pancreas:
- Stage I: The tumor is found only in the pancreas and has not extended outside.
- Stage II: The tumor has spread and invaded nearby tissue such as lymph nodes but NOT affected the near blood vessels.
- Stage III: The tumor has invaded the blood vessels in proximity to the tumour.
- Stage IV: The cancer has spread to distant sites, such as the liver or lungs.
How are pancreatic cancers treated ?
Treatment options for people with cancer of the pancreas are primarily surgery, then chemotherapy, radiation therapy as well as targeted therapy.
- Surgery : If the cancer is in its earlier stages, it is a surgically removable or resectable tumour. The surgical removal of all or part of the pancreas is known as Pancreatectomy. There are various types of Pancreatectomy. Pancreaticoduodenectomy (or Whipple procedure is the removal of both pancreas and duodenum), segmental pancreatectomy, and total pancreatectomy are the surgeries done, based on spread of the tumour.
- Chemotherapy : When the cancer spreads and you can’t have surgery, treatment options of chemotherapy or both chemotherapy combined with radiotherapy (chemoradiotherapy) are also available.
- Radiotherapy : Radiotherapy treats cancer by using radiation to destroy the cancer cells, whilst trying to spare normal unaffected cells. Radiotherapy is often used after surgery but may also be a primary treatment option wherever surgery is difficult or not possible. Radiotherapy has its own side effects such as reddening of skin, loss of hair and tiredness. These side effects will have to be tolerated or treated, depending on their severity.
- Adjuvant Chemotherapy or Adjuvant Radiotherapy : These can be given, either alone or together following surgery with curative intent.
What is the care to be taken after the removal of a pancreatic cancer ?
Metastatic diagnostic workup and monitoring post-treatment has to include imaging and scanning of the limbs, thorax, chest, retroperitoneum, and abdomen with radiography, MRI or CT scans. Adjuvant chemotherapy or radiotherapy may be required in cases wherein excision cannot be done completely.
How to find and reach cancer specialists for pancreatic cancer treatment ?
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Disclaimer: The content provided here is meant for general informational purposes only and hence SHOULD NOT be relied upon as a substitute for sound professional medical advice, care or evaluation by a qualified doctor/physician or other relevantly qualified healthcare provider.
