Pancreatic Cancer: Types, Risks, Symptoms, Diagnosis, Treatment & Complications

5 Key Points To Know

• Pancreatic cancer is a particularly aggressive and challenging type of cancer because it often goes unnoticed until it reaches an advanced stage.
• Pancreatic cancer has two main types: exocrine (adenocarcinoma) and endocrine tumors.
• Symptoms of pancreatic cancer include abdominal pain, jaundice, weight loss, and other digestive issues.
• A person with a family history of pancreatic cancer, as well as certain genetic conditions like Lynch syndrome, hereditary pancreatitis, or BRCA1 and BRCA2 mutations, has an increased risk of developing pancreatic cancer.
• There’s no good way to screen for pancreatic cancer.

Types of Pancreatic Cancer

There are two main types of pancreatic cancer based on the type of cells:

1. Exocrine Tumors: These tumors arise in the exocrine cells of the pancreas, which produce digestive enzymes and make up the majority of pancreatic cancers (about 95%). The most common type of exocrine pancreatic cancer is adenocarcinoma, which originates in the ducts of the pancreas.
2. Endocrine Tumors: These tumors are much less common and begin in the hormone-producing cells (islet cells) of the pancreas. They are called neuroendocrine tumors (NETs) and have different subtypes, including insulinomas, glucagonomas, gastrinomas, and others. They generally grow slower than exocrine tumors.

Risk Factors of Pancreatic Cancer

Pancreatic cancer is a complex disease, and its exact cause is often unknown. However, several risk factors have been identified that may increase the likelihood of developing pancreatic cancer. Here are some of the established risk factors:

1. Age: The risk of pancreatic cancer increases with age. It is most commonly diagnosed in individuals over the age of 65.
2. Tobacco Use: Smoking is one of the most significant risk factors for pancreatic cancer. Smokers are at a higher risk compared to non-smokers, and the risk increases with the duration and intensity of smoking.
3. Family History: A person with a family history of pancreatic cancer, as well as certain genetic conditions like Lynch syndrome, hereditary pancreatitis, or BRCA1 and BRCA2 mutations, has an increased risk of developing pancreatic cancer.
4. Chronic Pancreatitis: Long-term inflammation of the pancreas, known as chronic pancreatitis, is linked to an increased risk of pancreatic cancer. This risk is higher in individuals with hereditary pancreatitis.
5. Diet: A diet high in red meat, processed meat, and saturated fats, as well as low in fruits and vegetables, may contribute to an elevated risk. Conversely, a diet rich in fruits, vegetables, and whole grains may be protective.
6. Alcohol Consumption: Heavy and prolonged alcohol consumption has been associated with a slightly higher risk of pancreatic cancer.
7. Occupational Exposure: Some exposure to certain chemicals, such as pesticides, dyes, and chemicals used in metal refining, may be linked to an increased risk.

Symptoms of Pancreatic Cancer

Pancreatic cancer often does not cause noticeable symptoms in its early stages, which makes it challenging to diagnose until it has reached an advanced stage. When symptoms do appear, they are often vague and can be attributed to various other conditions. Common symptoms of pancreatic cancer include:

1. Abdominal Pain: Pain in the upper abdomen or middle of the back is a common symptom. This pain may become more severe as the tumor grows or spreads.
2. Jaundice: Jaundice is a yellowing of the skin and the whites of the eyes. It occurs when the cancer blocks the bile ducts, preventing bile from flowing normally. This can lead to dark urine and pale stools. Jaundice is common with the cancer of the head of the pancreas.
3. Unexplained Weight Loss: Significant and unexplained weight loss even if you’re eating normally can be a warning sign of pancreatic cancer
4. Digestive Problems: Pancreatic cancer can affect the pancreas’s ability to produce digestive enzymes, leading to problems like diarrhea, oily stools, and difficulty digesting fatty foods.
5. New-onset Diabetes: Sometimes, pancreatic cancer can cause new-onset diabetes or lead to changes in blood sugar levels in individuals with no diabetes.
6. Nausea and Vomiting: Nausea and vomiting may occur if the cancer blocks the digestive tract or affects the stomach.
7. Blood Clots: Some individuals with pancreatic cancer develop blood clots, which can cause symptoms such as swelling, pain, or redness in the affected limb.

Diagnosis of Pancreatic Cancer

Diagnosing pancreatic cancer often involves a series of tests and imaging tests or biopsy to confirm its presence and determine its stage. Here are some common diagnostic methods:

1. Blood Tests: Blood tests are often used in the diagnosis and management of pancreatic cancer, although they are not typically definitive on their own. One of the commonly measured blood markers is carbohydrate antigen 19-9 (CA 19-9). However, it’s important to note that not everyone with pancreatic cancer will have elevated CA 19-9 levels, and elevated CA 19-9 levels can occur in individuals without cancer. This marker is often used more for monitoring the progression of the disease or to assess treatment effectiveness rather than for initial diagnosis.

2. Imaging Tests: Imaging tests play a crucial role in diagnosing pancreatic cancer by providing detailed images of the pancreas and surrounding areas. Some common imaging techniques used for this purpose include:

• Computed Tomography (CT) scan: This imaging test uses X-rays to create detailed cross-sectional images of the abdomen. It’s often the initial test used to detect pancreatic tumors, determine their size, and assess whether the cancer has spread to nearby structures or distant organs.
• Magnetic Resonance Imaging (MRI) scan: MRI uses powerful magnets and radio waves to generate detailed images of the pancreas and surrounding areas. It can provide additional information about the tumor’s location, size, and involvement of nearby blood vessels.
• Endoscopic Ultrasound (EUS): This combines endoscopy with ultrasound imaging to obtain detailed images of the pancreas and nearby structures. EUS allows for a close look at the pancreas and helps in guiding biopsies for tissue samples.
• Positron Emission Tomography (PET) scan: PET scans involve the injection of a small amount of radioactive material that is absorbed by organs and tissues. A PET scan combined with a CT scan (PET-CT) can help determine the extent of cancer spread by highlighting areas with increased metabolic activity, which might indicate cancerous growth.
• Magnetic Resonance Cholangiopancreatography (MRCP): This specialized MRI technique focuses specifically on the pancreatic and bile ducts. It helps evaluate any blockages or abnormalities within these ducts.

3. Biopsy and Pathology: Biopsies for pancreatic cancer diagnosis involve different methods like Fine Needle Aspiration (FNA), Core Needle Biopsy, Endoscopic Ultrasound-Guided Fine Needle Aspiration (EUS-FNA), or in some cases, surgical biopsy. These procedures use needles to extract tissue samples from the pancreas, guided by imaging techniques or endoscopy. The collected tissue is then analyzed by a pathologist to confirm the presence of cancerous cells, determine the cancer type and stage, and guide appropriate treatment decisions.

Treatment of Pancreatic Cancer

The treatment of pancreatic cancer depends on several factors, including the stage of the cancer, the patient’s overall health, and the location of the tumor. Treatment plans are often individualized, and a multidisciplinary team of healthcare professionals, including oncologists, surgeons, and radiologists, collaborates to determine the most appropriate approach. Treatment options for pancreatic cancer may include:

1. Surgery: Surgical removal of the tumor is the most effective treatment for pancreatic cancer when the disease is confined to the pancreas and has not spread to other organs. Surgical options may include:

• Whipple Procedure (Pancreaticoduodenectomy): This extensive surgery removes the head of the pancreas, the duodenum, a portion of the stomach, the gallbladder, and nearby lymph nodes.
• Distal Pancreatectomy: In this procedure, the tail and body of the pancreas are removed.
• Total Pancreatectomy: This operation involves the removal of the entire pancreas, the gallbladder, and parts of the stomach, duodenum, spleen, and nearby lymph nodes.
• Palliative surgery: Often, cancer that has extensively spread beyond the pancreas or into major blood vessels cannot be completely removed. Palliative surgeries aim to alleviate symptoms associated with pancreatic cancer when complete removal isn’t possible. A prevalent symptom of pancreatic cancer is the blockage of the bile duct, causing bile to leak into nearby organs, resulting in pain and digestive issues.
• Stent placement: During endoscopic retrograde cholangiopancreatography (ECRP), metal tubes (stents) are inserted using an endoscope to keep the bile duct open, providing relief.
• Bypass surgeries: These surgeries redirect the flow of bile directly from the bile duct to the intestine, bypassing the pancreas. Although they offer longer-lasting relief, bypass operations involve longer recovery periods compared to stent placements.

2. Chemotherapy: Chemotherapy uses drugs to kill cancer cells or slow their growth. It may be administered before surgery (neoadjuvant chemotherapy) to shrink the tumor or after surgery (adjuvant chemotherapy) to target any remaining cancer cells. In advanced cases, chemotherapy may be used as the primary treatment to control the cancer’s growth and manage symptoms.

3. Radiation Therapy: Radiation therapy uses high-energy rays to target and destroy cancer cells. It may be combined with surgery or chemotherapy to enhance the treatment’s effectiveness. In some cases, stereotactic body radiation therapy (SBRT) may deliver precise radiation to the tumor.

4. Targeted Therapy: Targeted therapies are drugs that target specific molecules or pathways involved in the growth and spread of cancer cells. They are often used in combination with chemotherapy. Examples of targeted therapies for pancreatic cancer include drugs that target the epidermal growth factor receptor (EGFR) or vascular endothelial growth factor (VEGF).

5. Immunotherapy: Drugs stimulate the body’s immune system to recognize and attack cancer cells. While immunotherapy has shown promise in some cancers, its effectiveness in pancreatic cancer is still being studied.

6. Palliative Care: Palliative care is critical to pancreatic cancer treatment, especially in advanced cases. It focuses on managing symptoms, improving quality of life, and providing emotional support to patients and their families. Palliative care can be integrated with other treatments and is not limited to end-of-life care.

Complications of Pancreatic Cancer

Often diagnosed at an advanced stage, pancreatic cancer can be a very aggressive and challenging illness that can cause several issues. These side effects may be brought on by the tumor or cancer management procedures. Some of the common complications of pancreatic cancer are as follows:

1. Pancreatitis: Pancreatic cancer has the potential to inflame the organ, which can result in severe stomach discomfort, nausea, and vomiting.
2. Bowel Obstruction: Pancreatic cancer may occasionally obstruct the intestines, resulting in symptoms such as excruciating stomach pain, constipation, and vomiting.
3. Ascites: Fluid formation in the abdominal cavity is known as ascites. It can happen as a result of liver malfunction or as a result of cancer spreading to the peritoneum, the lining of the abdomen.
4. Thrombosis: Deep vein thrombosis (DVT) or pulmonary embolism (PE) can develop due to blood clots, a risk factor for pancreatic cancer.
5. Metastasis: Pancreatic cancer frequently metastasizes to the liver, lungs, and peritoneum, among other organs. Such consequences as liver failure or pleural effusion (fluid buildup around the lungs) are particular to the damaged organ and may result from this.

Questions for your doctor

1. What stage is my pancreatic cancer, and what does that mean for my prognosis and treatment options?
2. What treatment options are available for my pancreatic cancer, and which do you recommend for my case?
3. What are the potential side effects of the recommended treatments, and how can they be managed?
4. How will my daily life be affected during treatment?
5. Can I continue working and performing regular activities?
6. What are the chances of the cancer returning after treatment, and what follow-up care will I need?
7. How can I manage the pain and discomfort associated with pancreatic cancer or its treatment?
8. Are there dietary or lifestyle changes that can help improve my overall well-being during treatment?
9. What are the signs of complications or disease progression should I watch out for?

References

1. https://gi.org/topics/gastrointestinal-cancers/
2. https://www.hopkinsmedicine.org/health/conditions-and-diseases/pancreatic-cancer/pancreatic-cancer-types#:~:text=When%20you%20read%20about%20classic,adenocarcinoma%2C%20and%20neuroendocrine%20pancreatic%20cancer.
3. https://www.mdanderson.org/cancer-types/pancreatic-cancer/pancreatic-cancer-diagnosis.html