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All you need to know about Pancreatic Cancer

(Symptoms, Prevention and Treatment)

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1.What is 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.

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2.Symptoms of Pancreatic Cancer

Pancreatic cancer symptoms are very faint even at the advanced stages and are not evident in the early stages. This delays the early diagnosis of the disease. Some of the symptoms noticed in the later stages are-

  • Sudden loss of weight
  • Lower back and abdominal pain
  • Blood clots
  • The whites of eye and skin turn yellow which shows the impression of jaundice
  • Reduced appetite
  • Depression
  • Sudden rise in blood sugar levels (Diabetes)
  • Weakness & tiredness
  • Excessive hunger or thirst
  • Dark urine
  • Swelling, redness and leg pain
  • Nausea and vomiting
  • Diarrhoea
  • Light-coloured or greasy stools

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3.Causes of Pancreatic Cancer

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.

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4.Types of Pancreatic Cancer

There are two types of pancreatic cancers. These are -

Pancreatic adenocarcinoma - This type of pancreatic cancer affects the exocrine cells present in the pancreas. Exocrine cells are abundantly found in the pancreas, which helps in producing pancreatic enzymes like proteases, lipase and amylase and helps in the formation of pancreatic ducts. This is the most common pancreatic cancer, which is seen 95% of pancreatic cancer patients.

Pancreatic Neuroendocrine Tumours (NETs) - This type of pancreas cancer is very rare, and grows in the endocrine cells of the pancreas. Endocrine cells play a vital role in making hormones are responsible for regulating blood sugar, among other vital activities.

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5.Pancreatic Cancer Risk Factors

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.

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6.Pancreatic Cancer Diagnosis

Diagnosis of Pancreatic Cancer

Life expectancy is higher when pancreatic cancer is diagnosed earlier. However, the chances of early diagnosis are very rare. Once your doctor suspects the presence of pancreatic cancer, he/she would recommend you to undergo one or more of the following tests to diagnose the issue.

CT & MRI Scan - During this test, a cross-sectional picture of your internal organs are captured to find details about the tumour present inside. This is done with the help of ultrasound scan, X-rays and magnetic beams. A positron emission tomography (PET) scan is recommended occasionally to diagnose the issue further.

Endoscopic Ultrasound - This test is done by passing a fine tube into the throat (esophagus) which reaches your abdomen and records pictures of the pancreas internally. This procedure is followed with the help of ultrasound images shown through the camera attached to the flexible tube.

Biopsy - A small piece of tissue is collected from the pancreas to know more about the cancer. This is done by passing fine needles through the skin to reach the pancreas with the help of ultrasound images. Once the sample tissue is obtained, it is further studied under a microscope for further details such as the stage of cancer and the severity of the infection.

Blood test - Pancreatic cancer is very rarely diagnosed through a blood test. However, doctors look for the presence of a particular protein - CA19-9 in the blood, which confirms the presence of cancer. The level of this protein is measured to evaluate the treatment process.

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7.Pancreatic Cancer Treatment

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.

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8.Steps to Prevent Pancreatic Cancer

The causes of pancreatic cancer are unknown; however, it can be prevented by following a few essential tips. Certain risk factors such as age, heredity and gender cannot be prevented. Here are a few tips to prevent pancreatic cancer-

Quit smoking - Smoking is the main cause for several types of cancer and pancreatic cancer is one of them

Maintain a healthy weight - Exercise regularly and eat healthy to maintain a healthy weight. Being obese raises the risk of hormonal changes which causes several life-threatening diseases.

Limit Alcohol Intake - Excessive consumption of alcohol damages the internal organs severely. Alcohol abuse causes several types of cancer and pancreatic cancer is one of them.

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9.Stages of Pancreatic Cancer

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.

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10.Road to Recovery and Aftercare

As mentioned above, pancreatic cancer is one of the deadliest cancers as it is very difficult to cure. Cancer can be cured to a certain extent, with a five-year life extension when diagnosed at an early stage. The possibilities get complicated at a later stage leading to slimmer chances of survival. Life after surgeries and pancreatic cancer treatment is not easy as it is never back to normal. Certain lifestyle changes have to be implemented to extend the rate of survival. Here are a few tips to follow on the road to recovery-

Collaborate on pain relief - Work closely with the oncologist to control postoperative pain. Doctors will suggest strong painkillers in the beginning and will gradually decrease the dosage to bring the pain under control. Certain painkillers cause severe chest burn and acidity problems. Reach out to an expert for an alternative.

Plan lighter meals - As a part of Whipple surgery the infected part of several internal organs connected to the pancreas are removed. This causes discomfort while eating. It is wise to eat small amounts many times a day rather than three larger meals. This way, the stomach will be less pressurized, and digestion becomes easier.

Monitor blood sugar - Keep a regular tab on the blood sugar levels after the Whipple surgery as conditions may worsen. Surgeons remove part of the pancreas, the organ responsible for insulin production during the surgery. This leads to an imbalance in blood sugar levels with some patients developing diabetes for the first time after a Whipple surgery.

Watch for cramps, gas, and bloating - Due to insufficient of pancreatic enzymes, there is a regular occurrence of cramps, gas and bloating. This problem affects about half of all Whipple patients. People with this condition typically need to take oral pancreatic enzyme supplements to promote digestion. Most pancreatic-cancer patients also take prescription antacids, plus multivitamins with iron to replace lost nutrients.

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11.Pancreatic Cancer FAQs: All your concerns addressed

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.

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