Pancreatic cancer arises when the pancreatic cells start dividing and growing uncontrollably. The mutation in cellular genetic makeup causes uncontrollable growth. Although pancreatic cancer is rare cancer, it has a high mortality rate. As reported in the Indian journal of surgery in 2015, pancreatic cancer survival rates are among the lowest for any cancer, with a 98% mortality-to-incidence ratio.
What is the origin of pancreatic cancer?
The pancreas sits behind the stomach with a broad-tapered body, a narrow pointed tail, and a wider head. This fish-shaped organ releases enzymes and hormones, which help in digestion and manage blood sugar levels. Cells of the exocrine and endocrine glands of the pancreas can have cancerous growths. Based on the origin, pancreatic cancer comes under two broad categories:
- Exocrine pancreatic cancer:
The uncontrolled growth of exocrine cells (cells that line the exocrine gland and ducts of the pancreas) may develop various exocrine pancreatic cancers. They are the most common pancreatic cancer and include the following types:
- Adenocarcinoma or ductal carcinoma: The origin of cancer is the lining of the ducts in the pancreas. It is the most common type of pancreatic cancer, accounting for 90% of diagnosed pancreatic cancer.
- Squamous cell carcinoma: This tumor has the worst prognosis of all pancreatic cancer and is a rare variety.
- Colloid carcinoma: Colloid carcinoma accounts for 1-3% of exocrine pancreatic cancers, is easier to treat, and has a better prognosis.
- Adenosquamous carcinoma: This tumor accounts for 1-4% of exocrine pancreatic cancer. Adenosquamous carcinoma is a more aggressive type of cancer with a poorer prognosis. It shows symptoms of both squamous cell carcinoma and adenocarcinoma.
- Neuroendocrine pancreatic tumors (NETs):
NETs, or islet cell tumors, or neuroendocrine cancer, make up less than 5% of pancreatic cancers. It develops from cells of the endocrine glands, which secrete insulin and glucagon hormones to regulate blood sugar levels. The following are types of pancreatic NETs:
- Gastrinoma: A tumor of gastrin-producing cells that disturbs food digestion.
- Glucagonoma: The tumor arises among glucagon-producing cells and shows constant high blood glucose levels.
- Insulinoma: This cancer involves the insulin hormone-producing cells, which affect blood glucose levels.
What are the signs and symptoms of pancreatic cancers?
Symptoms of pancreatic tumors depend on the type of cancer you have. In the early stages, a person may not have any prominent symptoms except fluctuation in hormonal levels. While in later stages, the patient may exhibit severe symptoms. The following are some signs and symptoms seen in progressive stages:
- Pain in the upper part of the abdomen that spreads to the back.
- Decrease in appetite
- Signs of jaundice, including yellowing of the skin and eye sclera
- Change in color of feces, mostly light-colored
- Dark-colored urine
- Higher blood sugar levels lead to the development of new or worsening diabetes.
- Itchy skin
- Nausea and vomiting
- Malaise
- Unexpected weight loss
How to diagnose pancreatic cancer?
The early detection of pancreatic cancer is challenging because it usually doesn’t show any symptoms until it has spread to other organs or has become conspicuous. The healthcare providers may suggest the following diagnostic tests:
- Medical history: The healthcare provider may ask about your medical and family history. A brief explanation of your symptoms is also crucial to diagnose the condition.
- Blood tests: It helps detect pancreatic tumor markers in the blood.
- Endoscopic ultrasound (EUS): A doctor may insert a thin, flexible tube into the digestive tract to detect pancreatic cancer. EUS is more accurate than abdominal ultrasound in diagnosing pancreatic cancer.
- Computed tomography (CT) scan: Multiphase CT-scan or pancreatic protocol CT scans are specific CT scans designed to detect pancreatic cancer. It also shows if cancer has spread to nearby organs, lymph nodes, or distant organs.
- Magnetic resonance imaging: MRI gives a detailed image of the pancreas, bile ducts, and blood vessels.
- Cholangiopancreatography: It can detect blockage, narrowing, or dilatation of the pancreatic and bile ducts due to cancerous growth.
- Positron emission tomography (PET) scan: Doctors can detect the metastasis of exocrine pancreatic cancer by this radioactive imaging.
- Biopsy: The doctors can perform an endoscopic or surgical biopsy of abnormal pancreas areas to confirm pancreatic cancer.
What are the treatment modalities of pancreatic cancer?
Certain factors, such as age, overall general health, size and location of the mass, metastasis, and cancer stage, play a crucial role in determining the most effective treatment for pancreatic cancer. The following are the treatment options for pancreatic cancer:
- Surgery: In pancreatectomy, the surgeon removes the cancerous part of the pancreas, the whole pancreas, and sometimes nearby lymph nodes. The surgeons may recommend a Whipple procedure if the head of the pancreas contains a cancerous growth. The healthcare providers remove the head of the pancreas, the gallbladder, a portion of the bile duct, and the duodenum in the Whipple procedure.
- Radiotherapy: A doctor uses a high-speed radiation dose to destroy cancer cells.
- Chemotherapy: The healthcare providers administer cycles of chemotherapy drugs to kill the cancer cells.
Sometimes, the doctors may administer chemotherapy and radiation therapy before surgery to shrink the tumor mass.
- Immunotherapy: The doctors give immune-boosting drugs to help your body fight against cancer.
- Palliative care: The healthcare providers may give supportive care to reduce the side effects of cancer treatment. It includes diabetes management, pain control, jaundice treatment, opening up the blocked intestine, and other apparent symptoms.
If detected and treated in the early stage, pancreatic cancer has a better prognosis. Contact your healthcare provider if you have symptoms like jaundice or pain shooting in the back.
Dr. Neeraj Goel, Clinical Lead & Senior Consultant – Gastrointestinal, Minimal Access, HPB and Bariatric Surgery, Dharamshila Narayana Superspeciality Hospital, Delhi