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Pancreatic cancer

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What is pancreatic cancer?

Pancreatic cancer occurs when abnormal cells grow uncontrollably in the pancreas, an organ located behind the stomach. The pancreas produces enzymes for digestion and hormones for blood glucose regulation.

These abnormal cells in the pancreas can grow to form a cancer, which can spread to other parts of the body.

Causes

The cause of pancreatic cancer, as with other cancers, is due to damage to cellular DNA. This damage results in uncontrolled growth of damaged cells, which leads to formation of a cancer. A cancer can grow into nearby tissue, or cells can break off and spread throughout the body via the bloodstream or lymphatic system. The exact causes of this cellular damage in the pancreas are not known.

The pancreas and digestive system. 

Risk factors

Risk factors that increase the chances of developing pancreatic cancer include:

  • Smoking - it is associated with a two-to-threefold increase in the risk of developing pancreatic cancer;
  • Age - people between 60-80 years of age account for more than 80% of cases;
  • Chronic pancreatitis - inflammation of the pancreas is associated with cancer when it occurs over the long-term. The exact reason for this is unclear, but it is possible that prolonged inflammation causes damage to cellular DNA;
  • Stomach surgery - the surgical removal of part of the stomach, due to a stomach ulcer or a cancer, is associated with an increased risk of developing pancreatic cancer, and;
  • Diets high in meat, cholesterol and food preservatives.

Types

Exocrine tumors

Exocrine tumors are the most common type of pancreatic cancer. They are cancers of the exocrine pancreas, which is where the exocrine glands are located. These glands produce the pancreatic enzymes that are released into the intestine.

Adenocarcinomas

Adenocarcinoma cancers form in the exocrine glands and account for about 95% of all exocrine pancreatic cancers.

Less common types of pancreatic cancers

There are several other types of exocrine cancers that form in areas around the exocrine glands rather than in the glands themselves.

Endocrine tumors

Endocrine tumors arise from the endocrine glands, originating in the cells that produce hormones. They are also called neuroendocrine tumors and are an uncommon type of pancreatic cancer. Endocrine tumors are defined as functional if they secrete hormones and non-functional if they do not.

Some types of endocrine tumors include:

A cross-section of the pancreas showing the exocrine and endocrine glands. 

Stages of pancreatic cancer

Treatment outcomes can vary greatly, depending on the stage of cancer. Cancer is staged according to its size and location, and whether it has spread to nearby or distant lymph nodes or organs throughout the body.

Stage I

The cancer is located in the pancreas and has not spread.

Stage II

The cancer has spread to nearby lymph nodes or structures near the pancreas, but has not spread to other organs.

Stage III

The cancer has spread to nearby major arteries, with or without the lymph node being affected.

Stage IV

The cancer has spread to other organs such as the lungs or liver.

Signs and symptoms

Pancreatic cancer is uncommon and many of the following symptoms may also be due to other causes.

Jaundice and pale stools

If there is a blockage in a bile duct, it can cause jaundice, the symptoms of which include yellowing of the eyes and skin. It can also cause pale stools, if insufficient bile is present in the intestines to give stool its color.

Abdominal pain

Abdominal pain can occur when the pancreatic cancer irritates or invades surrounding nerves. Very rarely, it can be due to the cancer causing a bowel obstruction.

Nausea and vomiting

A blockage of the pancreatic or bile ducts can cause inflammation of the pancreas and put pressure on surrounding organs, which can lead to nausea and vomiting.

Loss of appetite and weight loss

Loss of appetite can be associated with nausea and vomiting. Weight loss can result from the cancer blocking the enzymes needed to digest food.

Unexpected onset of diabetes

Diabetes might develop if the cancer is disrupting the normal function of the pancreas. The pancreas produces insulin, a vital enzyme involved in sugar metabolism.

Methods for diagnosis

Scans

Scans used in the diagnosis of pancreatic cancer include:

Laboratory tests

CA19.9 is a protein associated with pancreatic cancer, but its presence does not necessarily mean you have pancreatic cancer and it is not elevated in all forms of pancreatic cancer. It is mainly used to track the progress of treatment rather than to diagnose a tumor.

Pancreatic cancer can affect the function of the liver and kidneys, so tests are performed to check their functionality.

Procedures

Procedures performed to diagnose pancreatic cancer include:

Types of treatment

Surgery

Surgery is used to remove a cancer that has not spread. If you have pancreatic cancer and are fit for major surgery, your doctor will perform a procedure called Whipple's resection. This is where a portion of the gall bladder, bile ducts and sometimes stomach are removed.

Another type of procedure, called a distal pancreatectomy, involves removing the cancer and surrounding tissue from the tail end of the pancreas. If the cancer cannot be removed, other forms of surgery can be used as a means of relieving symptoms. For example, stents can be inserted into the bile and pancreatic ducts to keep them open.

Additional therapy

Other therapies can be used in addition to surgical treatments to further improve treatment outcomes. They may be given before surgery (neoadjuvant therapy) and/or after surgery (adjuvant therapy). When given before surgery, they aim to reduce the size, and therefore stage, of the cancer. When given after surgery, they aim to help prevent the cancer returning. These non-surgical treatments include chemotherapy, radiotherapy, hormone therapy or a combination of these.

Occasionally, these therapies may be used if individuals are not suitable for surgical treatment. Often, in these situations, the aim of treatment is to control symptoms, and are not necessarily for cure. The treatment options and aims can differ, based upon the individual, the stage and type of cancer. Your doctor can help explain this information in more detail.

Chemotherapy

Chemotherapy works by damaging cancer cells and stopping their reproduction. Various medications can be used, which can be administered intravenously or orally. They are often given in cycles, with intervening rest periods, to help reduce toxic side effects.

Side effects occur because chemotherapy can also affect healthy cells. Your doctor will monitor your dosage carefully to achieve the best therapeutic effect.

Radiotherapy

Radiotherapy focuses X-rays on the area where the cancer is located. Radiotherapy can be used alone, or in addition to surgery and/or chemotherapy.

Hormone therapy

Hormone therapy is sometimes used to treat advanced pancreatic cancer, if the cancer cells are found to carry a particular hormone receptor. For example, some pancreatic cancers have estrogen receptors and tamoxifen is a medication that can be used to block that receptor, potentially slowing the growth of the tumor.

Other therapies

Some people diagnosed with cancer seek out complementary and alternative therapies. None of these therapies are proven to cure cancer, but some can help people feel better when used together with conventional medical treatment. It is important to discuss any additional treatments with your doctor before starting them.

Potential complications

Treatment side effects

Side effects of treatment for pancreatic cancer can include:

Advanced pancreatic cancer

Metastasis is when the cancer spreads to other parts of the body through the bloodstream and lymphatic system. The metastasized cancer damages the function of an affected organ or body part.

Bowel obstruction

If the pancreatic cancer grows and puts pressure on the small intestine, it can cause a bowel obstruction or blockage, which reduces the flow of food from the stomach to the intestines.

Prognosis

The outlook for pancreatic cancer depends on the type and stage of cancer, however the overall survival rates are usually low, as it is most often diagnosed at an advanced stage.

It is important to remember survival rates are only an indication, and are based upon the averages of previously treated patients. It is not an absolute prognosis for an individual. It is often difficult to accurately predict an individual's cure or survival rate. Constant advances in treatment are continually improving these statistics.

As pancreatic cancer progresses, the aim of treatment shifts from extending life to minimizing pain, with palliative care available for terminal patients.

Prevention

Maintaining a healthy weight, quitting smoking and avoiding alcohol overuse are the best means of reducing your risk of pancreatic cancer.

References

  1. SEER stat fact sheets: pancreas cancer. Surveillance epidemiology and end results program (SEER). Accessed 14 July 2014 from link here
  2. Relevance of nitrosamines to human cancer. Accessed 14 July 2014 from link here
  3. Cancer survival and prevalence in Australia: period estimates from 1982 to 2010 (full publication; 28 Aug 2012 edition) (AIHW) - DownloadAsset.aspx. Accessed 14 July 2014 from link here
  4. Endoscope-assisted brachytherapy for pancreatic cancer: From tumor killing to pain relief and drainage. Accessed 14 July 2014 from link here
  5. Gastrointestinal Neuroendocrine Tumors: Pancreatic Neuroendocrine Tumors | Memorial Sloan Kettering Cancer Center. Accessed 14 July 2014 from link here
  6. Pancreatic cancer. Accessed 14 July 2014 from link here
  7. Pancreatic cancer survival by stage. Accessed 14 July 2014 from link here
  8. Radiotherapy for pancreatic cancer?: Cancer Research UK?: CancerHelp UK. Accessed 14 July 2014 from link here
  9. Risk Factors For Pancreas Cancer. Accessed 14 July 2014 from link here
  10. Signs and symptoms - Pancreatic Cancer UK. Accessed 14 July 2014 from link here
  11. What are pancreatic tumors. Accessed 14 July 2014 from link here
  12. What is pancreatic cancer? Accessed 14 July 2014 from link here

10 Most frequently asked questions (FAQs)

What is pancreatic cancer?
The pancreas is an organ located behind the stomach that produces digestive enzymes. When pancreatic cells grow and divide abnormally, they can form a tumor and turn cancerous.
What types of pancreatic cancer are there?
Pancreatic cancers can be exocrine or endocrine. Exocrine cancers (cancers of the exocrine pancreas) are the most common type of pancreatic cancer. They occur in the exocrine glands that produce pancreatic juices, which are released into the intestine. Endocrine tumors (also known as neuroendocrine tumors) are uncommon and are referred to as functional if they secrete hormones, non-functional if they do not.
What causes pancreatic cancer?
The exact reasons for the cell damage that cause pancreatic cells to become cancerous are not known.
How is pancreatic cancer diagnosed?
Pancreatic cancer is ultimately diagnosed by a pathologist who examines a biopsy. Prior to that, diagnostic tests include blood tests, CT, MRI and PET scans, endoscopy, laparoscopy and by a tissue biopsy sent to pathology.
How is pancreatic cancer treated?
Surgery, chemotherapy, radiotherapy and hormonal therapy are the treatment options for pancreatic cancer.
When is surgery for pancreatic cancer possible?
Surgery for pancreatic cancer is possible only when the tumor has not spread to major nerves, blood vessels or other organs. It is not recommended for stage III and IV cancers.
What surgeries are performed for pancreatic cancer?
If the cancer is in the head of the pancreas, the Whipple operation is performed. This is where a portion of the gall bladder, bile ducts and sometimes stomach are removed. If the cancer is in the tail end of the pancreas, a procedure called a distal pancreatectomy is performed to remove this section. If the cancer can't be removed, surgery is used to relieve symptoms, such as by placing tubes (stents) in the bile ducts to keep them open.
Can pancreas transplants help people with pancreatic cancer?
Unfortunately, replacing the pancreas would not clear pancreatic cancer, because most cases of pancreatic cancer are diagnosed after they have already spread. The cancer would also likely return, because to have an organ transplant, people have to take immunosuppressant medication.
What are the symptoms of pancreatic cancer?
Symptoms of pancreatic cancer include nausea, vomiting, abdominal pain, weight loss and paler stool color.
Can pancreatic cancer be cured?
Unfortunately, pancreatic cancer usually has a poor prognosis and is often terminal, so remission is difficult to achieve.

Related topics

Colorectal cancer

Colorectal cancer is the name for cancers that arise in the large intestine or rectum. Also known as colon cancer or colorectal cancer, bowel cancer can interfere with bowel function and spread to other parts of the body, such as the liver and lungs.

Esophageal cancer

Oesophageal cancer is the name for cancers that arise in the tissues of the oesophagus, the tube that connects the throat to the stomach. Abnormal cells can form a tumour, leading to problems with swallowing food, and can spread through the body.

Bladder cancer

Bladder cancer is the name for cancers that arise in the tissues of the bladder, the organ that stores urine before it is expelled from the body during urination. Abnormal cells can form a tumour, affect urination and spread throughout the body.

Breast cancer

Breast cancer is the name for cancers that develop in breast tissue. Abnormal cells can form a tumour (lump) in the breast and spread throughout the body. Breast cancer is the most common form of cancer among women, but can also develop in men.

About this article

Title: Pancreatic cancer

Author: Jonathan Meddings BMedLabSc (Hons)

First Published: 20 Oct 2014

Last reviewed: 17 Jan 2022

Category: Information on Pancreatic cancer

Average rating: 4.0 out of 5 (1554 votes)

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