Pancreatic Cancer – Symptoms and Treatment

March 31 11:01 2023 by admin Print This Article

The Pancreas is a J-shaped organ that looks like a pear kept on its side. It is located at the back of the stomach, in front of the spine. Although small in size, it plays a significant role in human health. It secretes two hormones – insulin and glucagon which help in the conversion of blood-glucose into energy. It also secretes various enzymes that aid in the digestion of food.

Like with any other part of the body, the pancreas is vulnerable to cancer too. However, unlike other cancers, this is a silent killer. It does not show prominent symptoms till cancer has metastasized or spread from the pancreas to other organs in the abdomen such as the liver (secondary liver cancer). Even the signs and symptoms are similar to that of other ailments which can be misleading.

Further, the organ is sandwiched between other, larger organs of the abdomen, so routine physical examinations will not detect pancreatic cancer. That is why this article is being published to make you aware of the early warning signs so that you can approach an endocrine specialist immediately.

Types of Pancreatic Cancer

The broader end of the pancreas which looks like a ball is called the head. This is the endocrine part of the organ which secretes insulin and glucagon that are released directly into the bloodstream. The straight, cone-like portion is broader at the bottom and is called the body and narrower at the top and is called the tail. The body and tail are the exocrine part of the organ which means enzymes are produced here, and these are released through a duct into the digestive tract. The pancreatic duct lies at the center of the body and tail portion.

Accordingly, there are 2 types of Pancreatic Cancer (PC):

1. Adenocarcinoma: This is the most common type (93%) and originates in the body and tail portion. If it originates all around the duct, it is called ductal adenocarcinoma.
2. Neuroendocrine tumor (NET): This is less common (7%) and originates in the head portion of the pancreas. Also called pancreatic endocrine cancer or islet cell tumors. Islet cell tumors secrete their hormones which can also cause symptoms. They may secrete an excess of insulin, glucagon, gastrin, somastostatin and Vasoactive-Intestinal-Peptide.

Also Read: Different Types of Cancer which Affects the Digestive System

Risk Factors for PC

Non-genetic factors

• Smoking
• Type-2 diabetes
• Obesity
• Pancreatitis which is a chronic inflammation of the pancreas
• Age: Most people diagnosed with PC are 45 years or above
• Exposure to certain industrial or workplace chemicals
• Cirrhosis, a condition marked by scarring of the liver
• Excessive alcohol consumption
• Consuming two or more soft drinks a day
• Stomach infection caused by an ulcer-causing bacterium called Helicobacter pylori
• Sedentary lifestyle or not getting enough exercise
• A diet high in fat and red-meat, low in fruits and vegetables

 Genetic factors

• Gender: Men are more at risk than women
• Race: being Black or of Ashkenazi Jewish descent
• A family history of pancreatic cancer
• Chronic pancreatitis is hereditary due to gene mutations passed on from a parent
• Hereditary syndromes with gene mutations such as BRCA2 gene mutation, familial atypical mole-malignant melanoma (FAMMM) syndrome, Lynch syndrome, Peutz-Jeghers syndrome and von Hippel-Lindau syndrome

Early Warning Signs

• Jaundice and its symptoms – yellowish eyes, skin, gums and inner lips
• Urine that is dark in color
• Itchy skin
• Light-colored, abnormal-looking and fatty stools
• Nausea or vomiting
• Pain in the upper abdomen that extends up to the back
• Sudden loss of appetite, sudden weight loss

Symptoms as cancer progresses or metastasizes

• Swollen gallbladder. This is usually felt by a doctor during a physical examination
• Painful swelling in an arm or leg due to a blood clot getting formed
• Fatigue and Weakness
• Diabetes
• Fever, chills and sweating
• A burning feeling in the stomach, nausea, vomiting and stomach bloating
• Difficulty in breathing due to a blood clot in the lungs (pulmonary embolism)

Also Read: The Pancreas and its functions

Diagnosis

Pancreatic cancer is diagnosed through various means such as Imaging tests, blood tests, ultrasound and tissue biopsy.

Treatment

Depending on the age of the patient, his/her health, the type and stage of pancreatic cancer and his/her personal preferences, different treatment options can be examined. These options aim at either removing the cancerous tissues altogether or delay the advancement of the disease or relieving the symptoms, pain and discomfort from the disease.

• Surgical removal: If the cancer is still localized or has not yet metastasized to other organs in the body, the doctors may consider removing a part of or the entire pancreas. The first type is called distal pancreatectomy while the latter is called total pancreatectomy. Removing the pancreas comes with its challenges to the person but these are well-managed by medication and other therapies.
• Whipple Procedure: When pancreatic cancer has metastasized to surrounding organs, the doctors may choose to remove all the affected tissues. This may involve removing a part of or the entire pancreas, along with affected portions of the duodenum, stomach, and lymph nodes in case cancer spread through the lymphatic system.
• Palliative surgery: Palliative procedures aim to relieve pain, discomfort, obstruction or any other symptoms of a disease, to make treatment more effective and improve the comfort felt by the patient. In the case of pancreatic cancer, the growth of cancer can cause obstructions in the bile duct or duodenum. An obstructed bile duct means less bile being sent to the digestive tract and hence digestive issues. Palliative surgical options for this condition involve either bypassing the bile flow around the blocked bile duct or inserting a stent to keep the bile duct open. So also, a blocked duodenum can be opened out using a stent procedure.
• Embolization: Embolization aims at cutting off blood supply to cancerous tissue which automatically arrests their growth and helps destroy the tissue. This is done by injecting a special chemical into the cancerous tissue through specialized techniques.
• Ablation: Ablation for cancer treatment uses any of these: heat, cold temperature, electric shocks or ultrasound waves to break up and destroy the cancerous tissue. This is achieved through the use of special probes which will deliver the required energy in the required dosage.
• Radiation: This involves directing X-rays or proton beams onto the cancerous tissue to destroy it. It can also be used to unclog or remove a blockage.
• Chemotherapy: This uses special chemicals to melt down the cancerous tissue, and/or limit its spread. The treatment is given in cycles of 2 to 3 weeks with rest periods in between to help the person recover from the strain of the treatment.
• Radiation Chemotherapy: As the name implies, both radiation and chemotherapy in a specific sequence and specific dosages are given, to achieve better results
• Targeted therapy: This involves the use of chemicals to limit the spread of cancerous tissue by targeting all those substances that the tissue will require to grow. Depending on which substance is targeted, there are various therapies such as NTRK inhibitors which block Tropomyosin receptor kinase, EGFR inhibitors which block EGFR protein, PARP inhibitors which block PARP enzymes, etc.
• Immunotherapy: As the name implies, this uses drugs that boost the immune system and the body’s ability to recognize or fight cancerous cells. In the case of Pancreatic cancer, PD-1 Inhibitors may be used.

Reviewed by Dr Suresh S Venkita, Group Medical Director, Kauvery Hospitals

NOTE: Take medications only when prescribed by your doctors, self-medication must be avoided under any circumstances.

Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai, Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.

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