Pancreatic Cancer: Types, Symptoms, Causes, Risks, Complications, Diagnosis, Treatment, Outlook and Prevention

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Illustration of Pancreatic Cancer

1Overview

The pancreas plays a pivotal role in the body. It is an organ located in the abdominal areas and helps convert the food people eat into fuel and energy for the body’s cells.
The pancreas has two major functions – endocrine function and exocrine function.
For its endocrine function, it releases insulin to regular blood sugar. For its exocrine function, it aids in digestion.

Pancreatic cancer usually starts in the tissues of the pancreas. This organ lies in the lower part of the stomach. Cancer begins when the healthy cells in the body start of grow rapidly and out of control. The cells in almost all parts of the body can become cancerous.

In the pancreas, the pancreatic cells undergo mutation and begin to grow out of control. When a person has pancreatic cancer, it typically spreads quickly to nearby organs.
This is an aggressive type of cancer and it is seldom detected in its early stages.
When there are clinical manifestations, the cancer is already in the late stages.

An estimated 53,670 people in the United States will have a diagnosis of pancreatic cancer in 2017. This type of cancer is more common in men than in women. However, it usually starts with people who are 45 years old and above. In 2017, more than 43,000 people are expected to die from this aggressive cancer.

2Types

Pancreatic cancer is classified depending on the part of the pancreas that is affected by cancer. The exocrine cells and endocrine cells of the pancreas may develop different tumors. Hence, it is important to know what cells of the pancreas are affected. This is because each type of pancreatic cancer has distinct causes and risk factors. They also have different tests, signs and symptoms and outlooks.

Exocrine pancreatic cancers

Exocrine cancers are the most common types of pancreatic cancer. It has many types including”

Pancreatic adenocarcinoma

The majority of exocrine pancreatic cancers are adenocarcinomas. These tumor cells start to grow in the pancreatic ducts.

Less Common:

  • Squamous cell carcinomas
  • Undifferentiated carcinomas
  • Adenosquamous carcinomas
  • Signet ring cell carcinomas
  • Ampullary cancer (carcinoma of the ampulla of Vater)

Pancreatic endocrine tumors (neuroendocrine tumors)

Some cells of the pancreas produce hormones that are released directly into the bloodstream. Tumors of the endocrine pancreas are rare, making up less than 5 percent of all pancreatic endocrine tumors or neuroendocrine tumors (NETs).

Types of NETs:

  • Gastrinomas
  • Insulinomas
  • Glucagonomas
  • VIPomas
  • PPomas
  • Somatostatinomas

3Symptoms

The signs and symptoms of pancreatic cancer depend on the stage and severity of the disease and the type of tumor present. However, most of these symptoms appear when the cancer is already in its late stages. The early stages of the disease may have no symptoms at all.

  • Nausea
  • Vomiting
  • Weight loss
  • Itching skin
  • Loss of appetite
  • Pain in the upper abdomen that radiates to the back
  • New-onset diabetes
  • Depression
  • Blood clots
  • Jaundice (yellow skin)
  • Fatigue
  • Unexplained weight loss
  • In some cases, patients may have back pain, pale stools, dark urine, swollen lymph nodes and diarrhea.

4Causes

Pancreatic cancer happens when the pancreatic cells grow and divide uncontrollably. However, the exact cause of pancreatic cancer is still unknown. However, scientists have linked some genes that control when the cells grow, divide and die.

When there are changes in the DNA caused by genetic mutations that trigger oncogenes and stop tumor suppressor genes.

Inherited Gene Mutations

Some individuals have inherited gene mutations or changes from their parents. This may increase the risk of developing cancer in the pancreas.

Acquired Gene Mutations

These gene changes may begin after the individual is born. This means that exposure to the environment and cancer-causing chemicals has triggered changes in the DNA.

5Risk Factors

Since the exact cause of pancreatic cancer is unclear, some factors may increase one’s risk of developing pancreatic cancer. There are risk factors that are modifiable, non-modifiable, and those with unclear links to pancreatic cancers but may increase its risk.

Modifiable Risk Factors (Risk factors that can be changed)

Smoking

Tobacco use has been linked to the development of pancreatic cancer. The risk of acquiring cancer of the pancreas is twice as high in people who smoke as those who have never smoked. In fact, approximately 20 to 30 percent of pancreatic cancers have been associated with cigarette smoking.

Being Overweight or Obese

Excess weight may increase a person’s risk of pancreatic cancer. People who are overweight and obese are more likely to have pancreatic cancer than those who have normal weights.

Exposure to cancer-causing chemicals in the workplace

People who work in places that deal with chemicals may have an increased risk of having pancreatic cancer. Heavy exposure to metal working industries may affect the person’s chances of developing cancer.

Non-modifiable Risk Factors

Age

The risk of developing pancreatic cancer heightens as people grow older. Most of the patients with pancreatic cancer are over 45 years old.

Gender

Men are at a higher risk of developing cancer than women.

Race

African Americans are more likely to develop cancer in the pancreas than Caucasians.

Family History

People with immediate family members who have pancreatic cancer are more likely to develop same cancer.

Inherited Genetic Syndromes

When people have genetic syndromes or inherited gene mutations, these may lead to as many as 10 percents of pancreatic cancers. The genetic syndromes include:

  • Familial atypical multiple mole melanoma (FAMMM) syndromes
  • Hereditary breast and ovarian cancer syndrome
  • Familial pancreatitis
  • Peutz-Jeghers syndrome
  • Lynch syndrome
  • Fatigue
  • Von Hippel-Lindau syndrome
  • Multiple endocrine neoplasias, type 1 (MEN1)
  • Neurofibromatosis (type 1)

Diabetes

Individuals with diabetes are more likely to have pancreatic cancer. Though the exact reason behind this is unknown, the risk is higher in people with type 2 diabetes.

Chronic pancreatitis

Chronic pancreatitis is the long-term inflammation of the pancreas. People with this disorder may have a higher risk of developing pancreatic cancer.

Liver Cirrhosis

Liver cirrhosis is the condition where there is scarring of the liver. Those with this condition are at a raised risk of developing pancreatic cancer.

6Complications

When cancer in the pancreas progresses into the later stages, it can cause various complications like:

Jaundice

Jaundice is characterized by yellow skin and eyes, pale-colored stools and dark-colored urine. This may be a symptom or a complication of pancreatic cancer.

Weight loss

In most patients with pancreatic cancer, weight loss is inevitable. Cancer itself may cause weight loss. However, the various symptoms of pancreatic cancer may lead to weight loss such as lack of appetite, nausea, and vomiting.

Pain

One of the most common complications of pancreatic cancer is a pain in the abdomen. This is caused by the pressing of the tumor on the nerves in the abdominal area.

Bowel Obstruction

Pancreatic cancer may press the first part of the small intestine called the duodenum. When this happens, bowel obstruction may occur.

7Diagnosis

Physical Examination and Medical History

It is important for the doctor to conduct a thorough physical examination and medical history interview. He can determine if you are at risk of developing pancreatic cancer.

The physical examination will most likely involve the abdomen. The doctor will examine the abdominal area for liver and gallbladder inflammation. He may also examine the skin for jaundice.

Imaging Tests

Imaging tests such as ultrasound, computed tomography scan (CT scan), magnetic resonance scan (MRI) and positron emission tomography (PET) scans. These tests are used to look for suspicious areas in the pancreas that might be cancer, learn how far the cancer has spread, look for signs of cancer after treatment and determine if the treatment is working.

Blood Tests

The doctor may request for blood tests to detect specific proteins, which are dubbed as tumor markers, shed by the cancer cells in the pancreas. For pancreatic cancer, the tumor marker is called CA19-9.

Endoscopic Ultrasound (EUS)

This procedure uses a scope to produce ultrasound photos of the pancreas.

Biopsy

To perform a biopsy, a tissue sample is removed from the pancreas for examination under a microscope.

8Treatment

The treatment of pancreatic cancer relies on the location and stage of cancer. Pancreatic cancer treatment aims to eradicate cancer, when possible. When this is already not possible, the treatment will focus on the improvement of the quality of life and prevent the cancer cells from spreading to the other parts of the body.

Surgery

Surgery depends on which part of the pancreas is affected by cancer. The doctor may perform surgery for tumors in the pancreatic head, tumors in the pancreatic tail and body, to remove the entire pancreas and surgery on tumors that have invaded nearby blood vessels.

Chemotherapy

This treatment option uses drugs to kill the cancer cells and prevent them from spreading further. The doctor may prescribe a single medicine or a combination of drugs.

Radiation Therapy

Radiation therapy uses high-energy beams to kill cancer cells.

9Outlook

For some people with pancreatic cancer, the treatment may destroy cancer. The outlook and prognosis of pancreatic cancer depend on the kind of treatment chosen and the stage of cancer.

While pancreatic survival rates have been improving over the past decades, this type of cancer is still considered incurable. In fact, the overall one-year relative survival rate is just 20 percent and the five-year rate is 7 percent.

10Prevention

Though some experts believe that pancreatic cancer can’t be prevented, there are many ways to do to reduce the risk of developing this aggressive type of cancer.

  • Stop smoking or don’t smoke
  • Maintain a healthy diet
  • Limit alcohol use
  • Avoid exposure to cancer-causing chemicals
  • Eat a well-balanced diet