About pancreatic cancer
What is pancreatic cancer?
What is the pancreas, and what is the function of the pancreas?
The pancreas is an organ in the abdomen that sits in front of the spine above the level of the belly button. It performs two main functions. First, it makes insulin, a hormone that regulates blood sugar levels (an endocrine function); and second, it makes digestive enzymes which help break down proteins, fats, and carbohydrates (an exocrine function). The enzymes help digestion by chopping proteins, fats, and carbohydrates into smaller parts so that they can be more easily absorbed by the body and used for energy. Enzymes leave the pancreas via a system of tubes called "ducts" that connect the pancreas to the intestines where the enzymes mix with ingested food. The pancreas sits deep in the abdomen and is in close proximity to many important structures such as the small intestine (the duodenum) and the bile ducts, as well as important blood vessels and nerves.
Cancer that starts in the pancreas is called pancreatic cancer. This picture of the pancreas shows its location in the back of the abdomen, behind the stomach.
What is cancer?
Every second of every day within our body, a massive process of destruction and repair occurs. The human body is comprised of trillions of cells and every day billions of cells wear out or are destroyed. Each time the body makes a new cell to replace one that is wearing out, the body tries to make a perfect copy of the cell that dies off, because that dying cell had a job to do and the newly made cell must be capable of performing that same function. Despite remarkably elegant systems in place to edit out errors in this process, the body makes tens of thousands of mistakes daily in normal cell division either due to random errors or from environmental pressure within the body. Most of these mistakes are corrected, or the mistake leads to the death of the newly made cell and another new cell then is made. Sometimes a mistake is made that, rather than inhibiting the cell's ability to grow and survive, allows the newly made cell to grow in an unregulated manner. When this occurs, that cell can begin to divide independent of the checks and balances that control normal cell growth resulting in a cancer cell. When this happens, the cancer cell multiplies, and a cancerous or malignant tumor can develop.
Tumors fall into two categories: "benign" tumors and "malignant," or cancerous, tumors. So what is the difference? The answer is that a benign tumor grows only in the tissue from which it arises. Benign tumors can sometimes grow quite large or grow rapidly and cause severe symptoms. For example, a fibroid in a woman's uterus can cause bleeding or pain, but it will never travel outside the uterus and grow as a new tumor elsewhere. Fibroids, like all benign tumors, lack the capacity to shed cells into the blood and lymph systems and cannot travel to other places in the body and grow. A cancer, on the other hand, can shed cells from the primary tumor that can float like dandelion seeds in the wind through the bloodstream or lymphatics, landing in tissues distant from the primary tumor, growing new tumors in various other sites. This process, called metastasis, is the defining characteristic of a cancerous tumor. Pancreatic cancer, unfortunately, is a particularly good model for this process. Pancreatic cancers can metastasize early to other organs in this manner. They also can grow and invade adjacent structures directly, often rendering the surgical removal of the tumor impossible.
Cancers are named by the tissues from which the primary tumor arises. Hence, a lung cancer that travels to the liver is not a "liver cancer" but is described as metastatic lung cancer and a patient with a breast cancer that spreads to the brain is not described as having a "brain tumor" but rather as having metastatic breast cancer.
What is pancreatic cancer?
Cancers that develop within the pancreas fall into two major categories: (1) cancers of the endocrine pancreas (the part that makes insulin and other hormones) are called "islet cell" or "pancreatic neuroendocrine" cancers and (2) cancers of the exocrine pancreas (the part that makes enzymes). Islet cell cancers are rare and typically grow slowly compared to exocrine pancreatic cancers. Islet cell tumors often release hormones into the bloodstream and are further characterized by the hormones they produce (insulin, glucagon, gastrin, and other hormones). Cancers of the exocrine pancreas develop from the cells that line the system of ducts that deliver enzymes to the small intestine and are commonly referred to as pancreatic adenocarcinomas. Adenocarcinoma of the pancreas comprises most of all pancreatic ductal cancers and is the main subject of this review.
Cells that line the ducts in the exocrine pancreas divide more rapidly than the tissues that surround them. For reasons that we do not understand, these cells can make a mistake when they copy their DNA as they are reproducing to replace other cells. In this manner, an abnormal cell can be made. When an abnormal ductal cell begins to divide in an unregulated way, a growth can form that is made up of abnormal looking and functioning cells. The abnormal changes that can be recognized under the microscope are called "dysplasia." Often, dysplastic cells can undergo additional genetic mistakes over time and become even more abnormal. If these dysplastic cells invade through the walls of the duct from which they arise into the surrounding tissue, the dysplasia has become a malignant tumor (cancer).
Pancreatic cancer should not be confused with the term pancreatitis. Pancreatitis is simply defined as inflammation of the pancreas and is mainly caused by alcohol abuse and /or gallstone formation (about 80%-90%).
What are the symptoms for pancreatic cancer?
Signs and symptoms of pancreatic cancer often don't occur until the disease is advanced. They may include:
- Pain in the upper abdomen that radiates to your back
- Loss of appetite or unintended weight loss
- New-onset diabetes
- Blood clots
- Yellowing of your skin and the whites of your eyes (jaundice)
When to see a doctor
See your doctor if you experience unexplained Weight loss or if you have persistent fatigue, abdominal pain, jaundice, or other signs and symptoms that bother you. Many conditions can cause these symptoms, so your doctor may check for these conditions as well as for pancreatic cancer.
What are the causes for pancreatic cancer?
It's not clear what causes pancreatic cancer in most cases. Doctors have identified factors, such as smoking, that increase your risk of developing the disease.
Understanding your pancreas
Your pancreas is about 6 inches (15 centimeters) long and looks something like a pear lying on its side. It releases (secretes) hormones, including insulin, to help your body process sugar in the foods you eat. And it produces digestive juices to help your body digest food.
How pancreatic cancer forms
Pancreatic cancer occurs when cells in your pancreas develop mutations in their DNA. These mutations cause cells to grow uncontrollably and to continue living after normal cells would die. These accumulating cells can form a tumor. Untreated pancreatic cancer spreads to nearby organs and blood vessels.
Most pancreatic cancer begins in the cells that line the ducts of the pancreas. This type of cancer is called pancreatic adenocarcinoma or pancreatic exocrine cancer. Rarely, cancer can form in the hormone-producing cells or the neuroendocrine cells of the pancreas. These types of cancer are called islet cell tumors, pancreatic endocrine cancer and pancreatic neuroendocrine tumors.
What are the treatments for pancreatic cancer?
Treatment for pancreatic cancer depends on the stage and location of the cancer as well as on your overall health and personal preferences. For most people, the first goal of pancreatic cancer treatment is to eliminate the cancer, when possible. When that isn't an option, the focus may be on improving your quality of life and limiting the cancer from growing or causing more harm.
Treatment may include surgery, radiation, chemotherapy or a combination of these. When pancreatic cancer is advanced and these treatments aren't likely to offer a benefit, your doctor will focus on symptom relief (palliative care) to keep you as comfortable as possible for as long as possible.
Operations used in people with pancreatic cancer include:
Surgery for tumors in the pancreatic head. If your cancer is located in the head of the pancreas, you may consider an operation called a Whipple procedure (pancreaticoduodenectomy).
The Whipple procedure is a technically difficult operation to remove the head of the pancreas, the first part of the small intestine (duodenum), the gallbladder, part of the bile duct and nearby lymph nodes. In some situations, part of the stomach and colon may be removed as well. Your surgeon reconnects the remaining parts of your pancreas, stomach and intestines to allow you to digest food.
- Surgery for tumors in the pancreatic body and tail. Surgery to remove the left side (body and tail) of the pancreas is called distal pancreatectomy. Your surgeon may also need to remove your spleen.
- Surgery to remove the entire pancreas. In some people, the entire pancreas may need to be removed. This is called total pancreatectomy. You can live relatively normally without a pancreas but do need lifelong insulin and enzyme replacement.
- Surgery for tumors affecting nearby blood vessels. Many people with advanced pancreatic cancer aren't considered eligible for the Whipple procedure or other pancreatic surgeries if their tumors involve nearby blood vessels. At highly specialized and experienced medical centers, surgeons may offer pancreatic surgery operations that include removing and reconstructing affected blood vessels.
Each of these surgeries carries the risk of bleeding and infection. After surgery some people experience nausea and vomiting if the stomach has difficulty emptying (delayed gastric emptying). Expect a long recovery after any of these procedures. You'll spend several days in the hospital and then recover for several weeks at home.
Extensive research shows pancreatic cancer surgery tends to cause fewer complications when done by highly experienced surgeons at centers that do many of these operations. Don't hesitate to ask about your surgeon's and hospital's experience with pancreatic cancer surgery. If you have any doubts, get a second opinion.
Chemotherapy uses drugs to help kill cancer cells. These drugs can be injected into a vein or taken orally. You may receive one chemotherapy drug or a combination of them.
Chemotherapy can also be combined with radiation therapy (chemoradiation). Chemoradiation is typically used to treat cancer that hasn't spread beyond the pancreas to other organs. At specialized medical centers, this combination may be used before surgery to help shrink the tumor. Sometimes it is used after surgery to reduce the risk that pancreatic cancer may recur.
In people with advanced pancreatic cancer and cancer that has spread to other parts of the body, chemotherapy may be used to control cancer growth, relieve symptoms and prolong survival.
Radiation therapy uses high-energy beams, such as those made from X-rays and protons, to destroy cancer cells. You may receive radiation treatments before or after cancer surgery, often in combination with chemotherapy. Or your doctor may recommend a combination of radiation and chemotherapy treatments when your cancer can't be treated surgically.
Radiation therapy usually comes from a machine that moves around you, directing radiation to specific points on your body (external beam radiation). In specialized medical centers, radiation therapy may be delivered during surgery (intraoperative radiation).
Traditional radiation therapy uses X-rays to treat cancer, but a newer form of radiation using protons is available at some medical centers. In certain situations, proton therapy can be used to treat pancreatic cancer and it may offer fewer side effects compared with standard radiation therapy.
Clinical trials are studies to test new treatments, such as systemic therapy, and new approaches to surgery or radiation therapy. If the treatment being studied proves to be safer and more effective than current treatments, it can become the new standard of care.
Clinical trials for pancreatic cancer might give you a chance to try new targeted therapy, chemotherapy drugs, immunotherapy treatments or vaccines.
Clinical trials can't guarantee a cure, and they might have serious or unexpected side effects. On the other hand, cancer clinical trials are closely monitored to ensure they're conducted as safely as possible. And they offer access to treatments that wouldn't otherwise be available to you.
Talk to your doctor about what clinical trials might be appropriate for you.
Supportive (palliative) care
Palliative care is specialized medical care that focuses on providing relief from pain and other symptoms of a serious illness. Palliative care is not the same as hospice care or end-of-life care. Palliative care is provided by teams of doctors, nurses, social workers and other specially trained professionals. These teams aim to improve the quality of life for people with cancer and their families.
Palliative care specialists work with you, your family and your other doctors to provide an extra layer of support that complements your ongoing medical care. It's often used while undergoing aggressive treatments, such as surgery, chemotherapy and radiation therapy.
When palliative care is used along with other appropriate treatments — even soon after the diagnosis — people with cancer may feel better and live longer.
What are the risk factors for pancreatic cancer?
Factors that may increase your risk of pancreatic cancer include:
- Chronic inflammation of the pancreas (pancreatitis)
- Family history of genetic syndromes that can increase cancer risk, including a BRCA2 gene mutation, Lynch syndrome and familial atypical mole-malignant melanoma (FAMMM) syndrome
- Family history of pancreatic cancer
- Older age, as most people are diagnosed after age 65
A large study demonstrated that the combination of smoking, long-standing diabetes and a poor diet increases the risk of pancreatic cancer beyond the risk of any one of these factors alone.
Is there a cure/medications for pancreatic cancer?
The course of treatment for pancreatic cancer depends on cancer's stage and location, as well as your general health and preferences. When possible, the primary objective of pancreatic cancer treatment for most patients is to eradicate the disease. The emphasis may shift to enhancing your quality of life and preventing cancer from spreading or harming you if that isn't a possibility.
1. Surgery, radiation, chemotherapy, or a combination of these may be used as treatments. Palliative care is the emphasis on treatment when pancreatic cancer has advanced and these treatments are unlikely to be beneficial. The goal of palliative care is to keep you as comfortable as possible for as long as possible.
2. Drugs are used in chemotherapy to help kill cancer cells. These medications can be ingested or administered intravenously. One chemotherapy drug or a combination of them may be administered to you.
3. Radiation therapy can be coupled with chemotherapy (chemoradiation). Typically, chemotherapy is used to treat cancer that has not progressed to other organs from the pancreas. This mixture may be used before surgery in specialized medical facilities to aid in the tumor's reduction. It is sometimes administered following surgery to lower the possibility of a recurrence of pancreatic cancer.
Fatigue,Blood clots,Itchy skin
Dark colored urine,Yellowing of skin and whitening of eyes