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Pancreatic Cancer

Pancreatic Cancer is a cancer that starts in the tissues of the Pancreas – an organ in the body that lies behind a portion of the Stomach.  There a few different types of growths that can be found in the pancreas. Some of these growths can be cancerous and non-cancerous.

The Pancreas is an Organ that is partly responsible for releasing enzymes that help break down food, aid digestion, and help manage your sugar.

Cancer in the pancreas is difficult to detect in the early stages which may make treatment more difficult.

Risk Factors

–  Smoking
–  Alcohol
–  Chronic inflammation of Pancreas – Pancreatitis
–  Genetics
–  Family history of Pancreatic Cancer
–  Obesity
–  Older Age
–  Diabetes

Symptoms

1.)  Abdominal pain
2.)  Pain in the abdomen that radiates to the back
3.)  Decrease in appetite
4.)  Unexplained weight loss
5.)  Discoloration of skin – occasionally there can be yellowing of skin and eyes (Jaundice)
6.)  Itchy skin
7.)  Fatigue
8.)  Stool color changes – lighter colored stool
9.)  Urine color changes – darker urine
10.)  Nausea
11.)  Vomiting
12.)  Others

*** – In early stages – no symptoms may be seen.

Types:

1.)  Pancreatic Adenocarcinoma

–  An invasive and ductal cancer that is by far the most common
–  Is considered an Exocrine Cancer
–  Represents around 85% of all pancreatic cancers
–  Nearly all start in the ducts of the pancreas
–  About 60-70% of adenocarcinomas occur in the head of the pancreas

2.)  Acinar Cell Carcinoma

–  Arises in the clusters of cells that produce pancreatic enzymes
–  Is considered an Exocrine Cancer
–  Represents around 5% of all pancreatic cancers
–  Often causes overproduction of digestive enzymes
–  May cause symptoms of rashes and joint pains

3.)  Cystadenocarcinomas

–  Arises from the glandular epithelium
–  Is considered an Exocrine Cancer
–  Has a better prognosis than other Exocrine Cancers

4.)  Pancreatobolastoma

–  Arises inside the pancreas
–  Is considered an Exocrine Cancer
–  It mainly occurs in childhood
–  Has a relatively good prognosis

5.)  Others Exocrine Cancers

–  Adenosquamous Carcinomas
–  Colloid Carcinomas
–  Hepatoid Carcinomas
–  Solid pseudopapillary Tumor
–  Signet ring Cell Carcinomas
–  Undifferentiated Carcinomas
–  Undifferentiated Carcinomas with osteroclast-like giant cells

6.)  Neuroendocrine Pancreatic Tumor

–  Pancreatic Neuroendocrine tumors
–  Neuroendocrine Tumors  (Can be benign or malignant)

Diagnosis

– The symptoms of this cancer often do not begin until the later stages. Often the first symptom seen is weight loss which can cause an extensive workup.
– Blood work, CT, MRI may be done as indicated
– A biopsy is important to help the diagnosis – fine needle aspiration
– Ultrasound may be done to confirm or rule out other problems

Staging

Stage T1 – The cancer is no more than 2cm in size
Stage T2 – The cancer is more than 2 cm in size
Stage T3 – The cancer has grown into the tissues outside of the pancreas
STage T4 – The cancer has grown outside of the pancreas and into one of the blood vessels
Stage N1  –  The cancer is also found in the lymph nodes

Prevention and Screening

1.)  Stop Smoking
2.) Maintain a healthy weight
3.) Increase consumption of fruits, vegetables, and whole grains
4.)  Decrease consumption of red and processed meat

A.)  Screening large groups are not considered effective and may be harmful
B.) Regular MRI/CT imaging is only recommended for those at high risk from inherited genetics

Treatment

Surgery

–  Surgery with the intention of cure is only possible in 20% of new cases
–  Surgery may be done to remove a portion – close to a blood vessel, help control symptoms, or other problems
–  For cancers involving head of pancreas – Whipple Procedure – may be considered

Chemotherapy

–  Chemotherapy may be considered before or after surgery
–  It may be considered only to extend life or improve the quality of life
–  Staging, type of cancer, and other factors will be considered
–  Gemcitabine or 5-FU can be used after surgery
–  Gemcitabine
–  Gemcitabine with Erlotinib
–  Folfirinox chemo regimen
–  Others

Radiotherapy

–  Radiotherapy can be given along with surgery
–  Often radiotherapy is given for only those patients involved in Clinical Trials
–  However, the United States is apt to more quickly/often used Radiotherapy if indicated

Watchful waiting

–  Very few of the Pancreatic Neurodendocrine tumors that are smaller than 1 cm may be monitored over a period of time
–  CT scans, biopsy results, and other variables need to be considered.

Palliative Care

– This type of care focuses on treating the symptoms from a serious cancer
– The goal is not curing the cancer
– Often the severity of the cancer and the patients symptoms indicate that this is the only treatment available
– Treatment will consist of pain management, hospice care, nausea, vomiting, and others