Pancreatic Cancer

The pancreas is a gland located at the upper back of the abdomen below and behind the stomach. It contains exocrine cells, which produce enzymes for digestion of food, and endocrine cells, which produce hormones for regulation of blood sugar levels. The pancreas has three main parts; head, body and tail. The head of the pancreas is next to the common bile duct (which drains bile from the liver) and duodenum (the first part of the intestine).

Pancreatic cancer occurs when cells within the pancreas grow without order or control. This malignant growth has the potential to increase in size, invade surrounding structures and spread to other parts of the body. The most common type of pancreatic cancer is adenocarcinoma.

Risk factors

The following factors may increase your risk of developing pancreatic cancer:

  1. Age (older people have higher risk)
  2. Smoking or using tobacco (chewing tobacco leaves)
  3. Family history of pancreatic cancer (genetic)
  4. Obesity
  5. Precancerous pancreatic cysts

Symptoms

In the early stages, pancreatic cancer tends to be asymptomatic (no warning signs). As the cancer grows, the following symptoms may be experienced:

  1. Pain upper abdomen or back
  2. Yellowing of the eyes and skin (jaundice)
  3. Tea-colored urine
  4. Pale stools or diarrhea
  5. Poor appetite
  6. Weight loss
  7. Nausea and vomiting

Some of the above symptoms may be caused by other more common medical conditions; therefore it is important to seek medical attention if you have any of these symptoms.

Diagnosis

The first part of the diagnosis process is a medical evaluation of your symptoms, medical history and a physical examination by your doctor. After which, the following tests and investigations may be ordered:

  1. Blood tests
  2. CT (computed tomography) scan
  3. MR (magnetic resonance) scan
  4. Endoscopy – EUS (endoscopic ultrasound) +/- biopsy/aspiration or ERCP (endoscopic retrograde cholangiopancreatogram)
  5. PTC (percutaneous transhepatic cholangiogram)
  6. PET-CT (positron emission tomography-computed tomography)

Treatment

The results of the above investigations will determine the stage of the pancreatic cancer. The stage is determined by the size of the cancer and extent of spread. Treatment of each stage usually involves a combination of the below therapies.

  1. Surgery
    For early stage pancreatic cancer with no spread to other organs (resectable), the best chance for cure is surgical removal of the cancer. This may include the following operations:

    1. Whipple procedure – removal of the head of the pancreas, duodenum, bile duct, gallbladder
    2. Distal pancreatectomy – removal of the body and tail of pancreas, spleen
    3. Total pancreatectomy – removal of the whole pancreas, duodenum, bile duct, gallbladder, spleenOccasionally, surgery may be performed for relief of symptoms even if the cancer is unresectable (palliative) as it may cause blockage of the bile duct and stomach.
  2. Chemotherapy / Radiotherapy
    Chemotherapy is the primary form of treatment in unresectable cases of pancreatic cancers. It, however, is also commonly used to complete treatment after surgical removal of cancer, or given before surgery in the hope that it will shrink the cancer. These medications may be in the form of tablets or intravenous preparations. Chemotherapy may be combined with radiotherapy which is radiation treatment directed towards the cancer.

Prognosis

The best results of treatment are seen in patients who present to their doctor at the early stages of pancreatic cancer as they will be amenable to surgical removal. Even in unresectable cases, treatment exists to prolong survival, relief symptoms and improve quality of life.