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All you need to know about Pancreatic Cancer

The pancreas is a vital organ that helps in regulating blood sugar levels in our body by producing two important hormones glucagon and insulin. Insulin helps the cells to absorb glucose from food digested and glucagon provides nourishment to the body by raising glucose level when it is low. The pancreas is located behind the stomach and plays an important role during digestion by supplying enzymes required to digest fats, proteins and carbohydrates.

The formation of malignant cells in the tissues of the pancreas is called pancreatic cancer or pancreas cancer. This cancer is often diagnosed at a later stage due to the location of the organ, which makes it difficult to diagnose the disease earlier. Pancreatic cancer is hence also called a silent disease.

Pancreas cancer appears when the DNA of the pancreatic cells undergo alteration. The altered cells grow rapidly to form tumours which start to invade the healthy part of the pancreas, thus killing the healthy cells. These tumours if left untreated, can spread to nearby lymph nodes, blood vessels, tissues, organs, bones and eventually, the brain. Most often, cancer of the Pancreas is found in the cells that line the ducts of the pancreas. This type of pancreatic cancer is called pancreatic exocrine cancer or pancreatic adenocarcinoma. Sometimes cancer can be formed in hormone-producing cells or neuroendocrine cells of the pancreas. The tumours formed during this type of cancer are called pancreatic neuroendocrine tumours, islet cell tumours and pancreatic endocrine cancer.

The primary causes of Pancreatic cancer are still unknown. The growth & death rate of normal cells is moderate; however, in the case of cancer, the growth rate increases rapidly, which destroy healthy cells. Doctors and researchers have not found a definite cause for this issue, but studies show that inherited gene mutation could be one of the major reasons behind the cause.

Though there are no causes found for the development of pancreatic cancer, there are certain risk factors considered to develop pancreatic cancer.

Intake of food with high-fat content - The increased intake of high-fat content food increases cholesterol levels in the body, which damages the functionality of several organs in the body, including the pancreas.

Diabetes - When sugar levels in the blood are not under control, it disturbs the functionality of internal organs and causes severe damage to it.

Smoking - Smoking is the main cause of many cancerous diseases. Smoking increases the production of cancer cells by killing the healthy ones.

Lack of Exercise and Obesity - Regular exercise is a perfect way to stay healthy. Working out regularly for at least 30 mins a day keeps your immune system strong to fight against several deadly diseases. Obesity increases the production of hormones which leads to hormonal imbalance that can cause pancreatic cancer.

Excessive Alcohol Intake - Most often, people who abuse alcohol are prone to various kinds of diseases. Alcohol weakens the functionality of internal organs and pancreas is one of them.

Exposure to Toxic Chemicals - Avoid frequent exposure to toxic chemicals and pesticides by following the required safety measures.

Liver Damage - If you are suffering from prolonged kidney illness, you are more likely to get affected by pancreatic cancer. Liver and pancreas work together to help digest and purify food.

Family History - If you have a family history of your ancestors or immediate family suffering from pancreatic cancer, you are at a higher risk to get affected by pancreatic cancer too. This could be caused due to genetic mutation.

Since pancreatic cancer is often detected in its advanced stages, the treatment provided cannot eradicate the cancer cells. The treatment focuses on stopping the growth of cancer cells by preventing further damage caused and improves the quality of life. Some of the treatment options that ease the discomfort caused during pancreatic cancer are-

Surgery in the pancreatic head - An operation is performed to remove the tumour present in the pancreatic head. This procedure is called a Whipple procedure (pancreaticoduodenectomy). During the Whipple procedure, the head of the pancreas is disconnected from other adjoining organs such as gallbladder, stomach, bile duct and small intestine to remove the tumour. Once the tumour is removed, the doctor reconnects the organs. This procedure is complicated and requires extensive expertise to perform.

Surgery in the pancreatic body and tail - This procedure is called distal pancreatectomy. During this procedure left side of the pancreas is removed to eradicate the tumour. Sometimes the spleen is also removed during this surgery.

Surgery to remove the entire pancreas - This procedure is called total pancreatectomy where the entire pancreas is removed to eradicate the tumour. Life expectancy after the removal of the entire pancreas can be extended with the help of insulin and enzyme replacement.

Surgery for tumours affecting nearby blood vessels -This surgery is performed at the most advanced stage of cancer by well-experienced surgeons. This procedure involves the removal of the tumour and blood vessels nearby to stop the infection from spreading.

Usually, surgeries for pancreatic cancer involves various complications such as bleeding and infection. There may be a constant feeling of nausea after the surgery due to the body's difficulty in emptying the stomach.

Chemotherapy - It is a targeted drug therapy to kill cancer cells. In this treatment, the drugs are given orally or injected into the veins through an IV, The chemotherapy drugs vary from patient to patient as the combination of drugs may differ depending on the severity of the disease. In case of advanced stages where the cancer has spread beyond the pancreas, chemotherapy combined with radiation therapy is performed called chemoradiation. Chemoradiation therapy is used before the surgery to reduce the size of the tumour and after surgery to avoid recurrence of pancreatic cancer.

Radiation Therapy - Radiation therapy is often combined with chemotherapy to treat pancreatic cancer. This treatment is conducted with the help of high-energy beams made from X-rays and protons. The combined therapy is recommended by doctors when surgeries fail to cure the disease. In this treatment, a series of rays from a moving machine point are directed towards the body at particular points. Radiation therapy is a treatment method which is frequently used to cure cancer at its advanced stage.

Clinical Trials - Clinical trials allow the oncologist to try new treatment methods to cure the disease. Clinical trials do not guarantee a cure and can cause immediate side effects. These trials are done with approval from patients and are monitored closely to avoid any mishappenings. Clinical trials are not done on all pancreatic patients.

Palliative Care - Palliative or supportive care is the last hope for many cancer patients in advanced stages where medical treatments fail to work. This treatment targets to relieve pain and discomfort caused due to illness. The treatment helps in strengthening your emotions and mental health during the recovery process. When palliative care is combined with other treatment methods, there are signs of faster recovery.

If Pancreatic cancer is left untreated, it will lead to complications such as -

Weight loss - The tumours present in the pancreas grow rapidly when not treated on time. These tumours compress the walls of the stomach. This results in loss of appetite. The feeling of nausea and vomiting are also the reasons behind the loss of appetite. When the intake of food is reduced, it leads to massive weight loss. Once diagnosed, doctors usually prescribe pancreatic enzyme supplements to help the digestion process.

Jaundice - Pancreatic cancer causes jaundice as it obstructs the liver's bile duct. Doctors suggest surgery in which a plastic or metal tube is placed inside the bile duct to keep it open. This surgery is called Endoscopic Retrograde Cholangiopancreatography (ERCP).

Pain - Pancreatic cancers are difficult to cure when diagnosed at an advanced stage. The tumours found in the advanced stages cause severe pain as they compress nearby organs, tissues and blood vessels. Doctor prescribe certain painkillers that can help cope up with this pain. When the pain is unbearable, doctors inject alcohol into the nerves to control abdominal pain. This procedure interrupts the communication between the nerves and the brain through nerve signals.

Bowel obstruction - Pancreatic cancer causes difficulty in bowel movements due to the obstruction caused by the growth of the tumor. This complication can be rectified by surgery to keep your small intestine open.

Once pancreatic cancer is diagnosed by an oncologist after several diagnoses, the treatment is provided based on the stage of cancer. Cancer gets challenging to cure when it is at its advanced stages. There are four stages of pancreatic cancer-

Stage 1 - The tumour is restricted only to the pancreas. There are no symptoms shown at this stage; however, if the cancer is diagnosed at this stage, it can be treated very easily.

Stage 2 - At this stage, pancreatic cancer has started to spread to nearby lymph nodes. The infection has not reached the blood vessels and tissues at this stage. The symptoms are not evident at this stage either and are very rarely diagnosed, which makes it challenging to treat. In some rare cases, few faint symptoms are shown such as-

• Change in urine colour
• Sudden weight loss
• Tiredness
• Reduced appetite
• Jaundice - the skin and white of eyes turn yellow
• Pain and swelling in the upper abdomen

Once the presence of cancer is diagnosed, it is treated by a combination of the following treatment methods to eradicate tumour or to prevent its invasion to healthy parts of the body.

• Chemotherapy
• Radiation
• Surgery
• Targeted drug therapies

The survival rate of Stage 2 pancreatic cancer patients is around 30% which gives them around 5 years of extended life.

Stage 3 - At this stage, cancer has started spreading to nearby blood vessels, lymph nodes and tissues. The infection is still restricted to other organs. The symptoms at this stage are still faint and very difficult to find; hence pancreatic cancer is called silent cancer. Some of the symptoms shown at this stage are-

• Reduced Appetite
• Sudden loss of weight
• Tiredness
• Constant and sharp back pain
• Depression
• Swelling, tenderness and pain in the upper abdomen

At this stage, cancer gets difficult to cure. Once diagnosed at this stage, the treatment can prevent the disease from spreading to healthy parts of the body. The treatment options at this stage are-

• A Whipple procedure (Surgery to remove the infected part of the pancreas)
• Anti-cancer drugs
• Radiation therapy

The cancer is more likely to recur in spite of rigorous treatment. Only 3 to 12 percent of patients get a five-year extended life. This is due to the rapid growth of cells that spreads beyond the infected area to smaller undetectable places even during the process of eradication.

Stage 4 - It is the last and final stage of pancreatic cancer. The cancer is very severe at this stage where symptoms are very evident, and the treatment gets very difficult. At this stage, the cancer has metastasized to nearby organs and gradually moves to bones and brain. Some of the evident symptoms noticed at this stage are-

• Severe back pain
• Depression
• Sudden loss of weight
• Yellowing of skin and white of eyes (jaundice)
• Loss of appetite
• Tiredness
• Pain and swelling in the upper abdomen

At this stage, pancreatic cancer cannot be cured. Unfortunately, most pancreatic cancer patients are diagnosed at the last stage of cancer where there is no cure. Doctors work towards easing discomfort and pain. Few treatments are provided to stop the growth of cancer cells which are -

• Chemotherapy
• Gastric bypass surgery
• Bile duct bypass surgery
• Bile duct stent
• Palliative pain treatments

The five- year extended survival rate at this stage is confined to only 3 percent.

Q.  Can pancreatic cancer be prevented?

1. Unfortunately, most pancreatic cancer cannot be prevented, but you can reduce your risk by maintaining a healthy weight, stopping smoking and limiting your alcohol intake. Other risk factors include chronic pancreatitis and family history. Occasionally, precancerous lesions can be identified and, if removed early, can prevent pancreatic cancer from developing.

Q.  Is pancreatic cancer a genetic disease?

1. Pancreatic cancer can be genetic, but the vast majority of pancreatic cancer is irregular. Many genes play a role in the growth of pancreatic cancer. The four major driver genes include KRAS, P53, P16 and SMAD4. If you have a strong family history of pancreatic cancer, you should contact a genetic counselling and screening program. Familial pancreatic cancer is defined as having two or more first-degree relatives with pancreatic cancer.

Q.  What are the chances of a pancreatic cyst becoming cancerous?

1. Pancreatic cysts are very common, and the majority are not cancerous. But some may be, and others may be precancerous. There are several different types of pancreatic cysts ranging from benign to malignant, which are declared after a series of diagnosis.

Q.  Can I live without a pancreas?

1. Yes, you can live without a pancreas, but you will be diabetic, which means you will have to take insulin regularly. You will also need to take enzyme pills to help with the digestion of food.

Q.  How is pancreatic cancer treated?

1. The treatment of pancreatic cancer depends on several factors, including the stage of the disease (how far it has advanced). The main treatment options include:

• Surgery
• Chemotherapy
• Radiation

Q.  Pancreatic cancer surgery

1. Depending on your diagnosis, your doctor may recommend Whipple surgery, which involves removing the head, or a right-hand portion, of the pancreas, as well as parts of the small intestine, gallbladder, bile duct, and sometimes a portion of the stomach. Other types of surgery for pancreatic cancer include distal pancreatectomy (removal of the "tail" of the pancreas, as well as the spleen) and total pancreatectomy (removal of the entire pancreas and spleen). If cancer has spread too far to be removed, your doctor may suggest palliative interventions, which cannot cure the disease but instead helps relieve symptoms.

Q.  Chemotherapy for pancreatic cancer

1. Pancreatic cancer can also be treated with chemotherapy - using drugs that kill cancerous cells. Chemotherapy can be given before and after surgery, or when surgery isn't possible. It is sometimes used in conjunction with radiation - using high-energy x-rays that kill cancer cells. Likewise, you may receive radiation before and after surgery, with or without chemotherapy, or to ease symptoms in advanced stages of the disease. Our health care team can recommend the treatment that's right for you.

Q.  What are the signs and symptoms of pancreatic cancer?

1. Pancreatic cancer doesn’t show any signs or symptoms during the early stages. However, by the time you start noticing the symptoms, the tumours have already grown quite large and cancer has infected the tissues surrounding the pancreas. You have to note that if you have one or more than one of these signs, it doesn’t mean you have pancreatic cancer; it can be caused due to some other condition, but it’s always best to go to the doctor for confirmation.
   These are some of the signs that you have to look out-

• Jaundice or jaundice related symptoms
• Consistent belly or backache
• Sudden weight loss and poor appetite
• Nausea and vomiting
• Liver or Gallbladder inflammation
• Diabetes
• Blood clots

Q.  Is there a cure for pancreatic cancer?

1. There is no absolute cure for cancer, but surgery is a way to treat this illness. But, by the time it’s diagnosed cancer has already reached advanced stages and surgery is not advisable. If cancer has spread to the surrounding tissues and major organs then surgical removal of tumours is not suggested. Many factors determine pancreatic cancer treatment; it includes your age, overall health, and personal preferences. It’s quite difficult to treat pancreatic cancer, at least through surgery.

Q.  How long can chemotherapy prolong your life?

1. For most cancers, where the palliative chemotherapy is used, the extended lifespan falls between three to twelve months. The better your response to the treatment, the longer you’re expected to live. The Median Duration of Response will tell you how long cancer will take to respond to standard chemo treatments before it starts growing again.

Q.  Is there a cure for stage 1 pancreatic cancer?

1. If your cancer is detected during the early stages, then it can be treated with surgery. Surgical extraction of tumours can increase your chances of a cure. However, it’s very difficult to detect pancreatic cancer during the early stages. There is a reason this cancer is called the silent killer, and that’s because it spreads undetected. By the time the patient is diagnosed or the symptoms start showing it’s too late for surgery. Since the warning signs (in the early stages) resemble other illnesses people don’t take it seriously.

Q.  How much sleep is required for a chemo patient?

1. A patient going through chemotherapy will require seven to nine hours of sleep. During the chemo treatment, a patient will feel sleepy, at least more than normal, this is because the body needs to repair itself. However, sometimes a patient is unable to sleep due to side effects from the chemo treatment. If the patient has trouble falling asleep they can follow these tips-

• Maintaining a routine
• Avoiding oversleeping
• Keeping the sleeping area quiet and cool
• Eat your last meal two hours before bedtime
• Don’t have any caffeine after lunch
• Don’t drink any alcohol before bedtime

Q.  Can stage 4 pancreatic cancer go undiagnosed?

1. Every cancer case is different, but cancer is usually diagnosed by stages 2 or 3. Stage 4 is advanced cancer and it’s pretty hard for it to go undiagnosed. Some patients may have symptoms in stage 2, while some may show signs in stage 4. It’s very rare that patients reach stage 4 and have insignificant or no cancer symptoms at all.