Introduction
Pancreatic cancer is a form of cancer that affects the pancreas, a large gland behind the stomach and small intestine. It is one of the most serious cancers and one of the most difficult to treat. Pancreatic cancer occurs when cells in the pancreas divide wildly, forming a mass or tumor. This type of cancer has no definitive cause and generally affects those aged over 65.
The outlook for pancreatic cancer is often very bleak as it typically has no early signs or symptoms. Identifying it at an early stage mean it may be possible to undergo curative treatments such as surgery or chemotherapy which could potentially lead to a full recovery. However, curing pancreatic cancer can be difficult as in many people it has already spread by the time they present with symptoms, at which point only palliative treatments are available.
Causes of Pancreatic Cancer
Pancreatic cancer is an aggressive and hard to treat cancer that affects the pancreas. There are many factors that can increase a person’s risk of developing the illness, including environmental, genetic, and lifestyle factors. Let us take a closer look at the various causes of pancreatic cancer and what steps can be taken to reduce this risk.
Genetics
Genetics plays an important role in the development of pancreatic cancer. About 10 percent of all cases are caused by an inherited condition, called an inherited gene mutation.
People who have inherited a gene mutation in a DNA repair gene, known as BRCA2 and PALB2, have a higher risk of developing cancer. In addition, certain syndromes that are known to increase the risk for certain types of cancer also affect the development of pancreatic cancer. These syndromes include familial atypical multiple mole melanoma syndrome (FAMMM), hereditary nonpolyposis colorectal cancer (HNPCC) and hereditary pancreatitis (HP).
People who have been diagnosed with one of these syndromes may be more likely to develop pancreatic cancer than those without the genetic mutation.
Environmental Factors
Environmental factors may play a role in the development of pancreatic cancer, and these risk factors should be considered. Evidence suggests that exposure to certain hazardous chemicals, such as asbestos and arsenic, may increase the risk of developing this type of cancer. It has also been suggested that smokers are at greater risk than non-smokers, although the exact link between smoking and pancreatic cancer is not clear.
Some studies have suggested that people with diabetes may have a higher-than-average risk of developing pancreatic cancer, although the evidence is not definitive. Other research indicates that people who suffer from chronic pancreatitis have an increased risk for developing this type of cancer. People with certain inherited genetic conditions such as familial adenomatous polyposis (FAP) may also be at greater risk for developing pancreatic cancer.
Frequent exposure to intense radiation may also increase an individual’s chances for this type of cancer; therefore individuals who work in fields where they are subjected to radiation should exercise caution and take steps to protect themselves from radiation exposure. Some studies have also proposed that diets high in red meat can increase a person’s chances of developing this type of cancer; however, further studies are necessary to confirm this link.
Symptoms of Pancreatic Cancer
Pancreatic cancer is a deadly and aggressive form of the disease that can be difficult to detect and diagnose in the early stages. Common symptoms of the disease include:
- Abdominal discomfort
- Weight loss
- Jaundice
- Dark urine
- Nausea
- Fatigue
- Itchy skin
It is important to be aware of these signs and seek medical attention as soon as possible.
Abdominal Pain
Abdominal pain is one of the most common symptoms of pancreatic cancer. Upper abdominal pain that radiates to the back and shoulder blades or steady pain in the upper abdomen are both indications that a person needs to be evaluated. It could be caused by gas, infection, or an obstruction of the intestine, but these symptoms should not be ignored and should be reported to a healthcare professional.
If pancreatic cancer is suspected, the doctor may order imaging tests such as an MRI or CT scan along with blood tests and imaging studies like an Endoscopic Ultrasound (EUS) to further diagnose or rule out the possibility of pancreatic cancer.
Weight Loss
Unexplained weight loss is often one of the earliest signs of pancreatic cancer. This type of weight loss isn’t related to changes in diet or lifestyle and should be taken seriously. Pancreatic cancer can cause significant nutrient malabsorption resulting in a decrease in body fat as well as muscle.
Unexplained weight loss alongside other symptoms may be a cause for concern and should be discussed with your doctor if it persists or worsens.
Jaundice
Jaundice, also known as icterus, is the yellow discoloration of the skin and whites of the eyes caused by high levels of a bile pigment called bilirubin in the bloodstream. As one of the most common symptoms of pancreatic cancer, jaundice develops when cancer blocks or narrows one or more ducts that carry bile from the gallbladder to the intestines. In rare cases, pancreatic cancer can block both common bile ducts and cause a build-up of bile in the system which impairs liver function.
Yellowing of the skin can appear on other parts of your body in addition to your face and neck. Other indications that you might have jaundice include:
- Dark urine
- Pale stools
- Itchy skin
- Fatigue
- Weight loss
- Pain between shoulder blades or in abdomen
- Nausea and loss of appetite
If you experience any signs or symptoms concerning for pancreatic cancer, such as jaundice, seek medical attention immediately so that an appropriate diagnosis can be made as soon as possible.
Diagnosis and Staging
Diagnosis and staging are the first step in treating pancreatic cancer. Through diagnosis, the doctor will be able to determine the type, size and location of the tumor. During staging, the doctor will assess if and how far the cancer has spread.
This process is important in order to be able to come up with a course of treatment that is tailored to the specific needs of the patient.
Imaging Tests
Imaging tests are used by doctors to diagnose and stage pancreatic cancer. These tests are usually non-invasive and provide a lot of information about the location, size and shape of the tumor, as well as how far the cancer may have spread.
Common imaging tests used include:
- X-rays which use electromagnetic radiation to create images of organs on film or digitally.
- CT scans which use X-ray technology but provide a more detailed picture of the inside of your body.
- MRIs which stands for Magnetic Resonance Imaging and uses radio waves to create three-dimensional images of your body’s soft tissue.
- PET scans (Positron Emission Tomography) which is an example of molecular imaging that uses special dye containing radioactive material to detect abnormal areas in your body’s cells where cancer may be present.
These imaging tests help physicians diagnose pancreatic cancer by determining if suspected cancers have invaded nearby areas or spread to other organs such as the liver or lungs. The results will also provide valuable information about lymph node involvement or determine whether distant metastasis has occurred. Based on these assessed parameters doctors can develop an effective treatment plan tailored specifically for each individual patient’s needs – helping give them their best chance at beating pancreatic cancer!
Biopsy
Biopsy is the term used for the removal of a sample of tissue (also known as the specimen) for the purpose of microscopic examination. This allows doctors to look for pancreatic cancer cells and confirm or rule out cancer as a diagnosis.
A biopsy can be done in several ways depending on where it is being performed and what method your doctor chooses. The most common type of biopsy is a needle biopsy, where a special thin needle is inserted directly into the suspected tumor or region and a sample of tissue is taken out through it. The procedure may be done either by itself or combined with other imaging techniques like ultrasound, CT scan or MRI to get greater accuracy.
Other types of biopsies that may be recommended for pancreatic cancer include:
- Fine needle aspiration (FNA)
- Endoscopic retrograde cholangiopancreatography (ERCP)
- Laparoscopy
- Open biopsy, among others.
Once the sample has been obtained, it will be sent to a lab for further testing and diagnosis.
Staging
The process of staging pancreatic cancer involves physicians using information obtained from diagnostic tests to ascertain the extent of the cancer and its spread to other areas in the body. Staging helps in determining the patient’s prognosis and selecting an appropriate course of treatment.
The most commonly used system for staging is the TNM system, developed by the American Joint Committee on Cancer (AJCC). The TNM staging system assigns numbers to T (tumor size and location), N (lymph node) and M (metastasis) categories. Each number indicates a higher degree of disease spread, with stage IV being the highest stage – indicating that cancer has metastasized beyond the pancreas.
Baseline evidence collected may include imaging studies such as x-rays, CT scans or MRI scans; endoscopic ultrasound; tissue sampling through a biopsy; blood tests; and analysis of ascites fluid from tumors within abdominal cavities, if any.
The staging process includes:
- Tumor staging: The size and location of primary tumor is evaluated which includes whether it has spread locally or directly invading neighboring organs like stomach, spleen or colon.
- Node classification: Lymph nodes by layers are examined if they contain any cancerous cells.
- Metastasis: Metastasis refers to whether there is distant growth in organs other than those near the primary tumor site like liver or lungs etc., This helps determine whether a patient would require chemotherapy or radiation therapy along with surgery.
Treatment Options
Pancreatic cancer is a life-threatening disease but there are treatments available for it that can help extend life. Treatment for pancreatic cancer can include chemotherapy, radiation therapy, surgery, and targeted therapy. Each of these treatments has its own pros and cons and need to be evaluated carefully to determine the best course of action.
Let’s explore the different treatment options available for pancreatic cancer:
Surgery
Surgery is the main form of potentially curative pancreatic cancer treatment. Depending on the location and size of the cancer, and whether or not it has spread, some people may be eligible to have surgery to try to remove the cancer. Additionally, surgery can help relieve symptoms when they are caused by a pancreatic tumor, such as jaundice due to a blocked bile duct.
Types of pancreatic cancer surgery include:
- Whipple procedure (or pancreatectomy): This is an extensive operation that may be recommended for tumors located in the head of the pancreas. In this procedure, a surgeon removes part or all of the pancreas, depending on how far the cancer has spread; part of the small intestine, gallbladder, and possibly part of the stomach are also removed during this operation.
- Distal pancreatectomy: This operation is needed for cancers located in the body and tail of the pancreas, and only involves removing part of the pancreas and spleen; it is less complex than a Whipple procedure but may be recommended if there are no signs that the tumor has spread beyond nearby lymph nodes in your abdomen.
- Partial or total Pancreatectomy with Enucleation: Depending on where in your pancreas you have a tumor (head vs body/tail) – usually used for smaller tumors – you may just need part or all of one lobe safely removed while leaving healthy tissue around it intact (enucleation). A lobectomy or multiple sections of your pancreas may need to be removed sometimes as well in order to remove ‘cleanly’ all parts involved with a tumor. Chapter 12 from UpToDate states that smaller tumors (2cm) present lower rate recurrences after later evaluation.
The goals for surgery are twofold: firstly attempted removal (or enucleation) but also providing tissue samples for biopsy so that more definitive prognosis above his/her stage can then be provided/confirmed for optimal adjuvant therapy plans depending on diagnosis obtained from pathology after biopsy from patient’s treatment center primary surgical facility where hospitalized at during treatment surgey delivery process & recovery following curative affects sizing up treatment plan duration going forward postoperatively…
Chemotherapy
Chemotherapy uses drugs to kill cancer cells. The drugs can be taken orally or they may be injected directly into the bloodstream. Chemotherapy drugs can also be used in combination with other treatments, such as radiation therapy and surgery.
Depending on the stage of pancreatic cancer and a person’s overall health, chemotherapy may be used alone or in combination with other treatments.
- In the early stages of pancreatic cancer (stage 0 to stage 2), chemotherapy is often used to help shrink tumors before or after surgery is performed.
- In advanced stages (stage 3 or 4), chemotherapy cannot usually cure pancreatic cancer but it might help slow its growth and lessen symptoms such as abdominal pain, weight loss and jaundice caused by blockage of the common bile duct.
Chemotherapy drugs work by binding to molecules on the surface of cancer cells, changing their function and preventing them from multiplying. These drugs can also damage DNA inside cells, which inhibits cell division.
Radiation Therapy
Radiation therapy is a type of cancer treatment that uses high doses of radiation to kill cancer cells or keep them from growing and dividing. It can be used in combination with surgery and/or chemotherapy to treat pancreatic cancer. While radiation itself has not been shown to cure pancreatic cancer, it may play an important part in your treatment plan depending on the specific circumstances of your diagnosis.
In the case of pancreatic cancer, radiation therapy may be used:
- Before surgery to shrink a tumor and make it easier for the surgeon to remove.
- After surgery – known as adjuvant therapy – to kill any remaining cancer cells and reduce the likelihood of recurrence.
- On rare occasions, radiation may be used as a primary treatment if surgery isn’t an option due to age or medical condition.
Radiation works by damaging the DNA of rapidly dividing cells including cancer cells. This stops them from replicating and allows healthy tissue nearby to heal faster while limiting risks associated with traditional surgery such as infection or scarring. With new advances in technology, radiation can now be targeted more precisely as well as delivered safely over a longer period of time using smaller doses so that side effects are minimized.
When considering whether or not to pursue radiation therapy for a pancreatic tumor, your doctor will look at various factors such as the size, stage and location of the tumor, in addition to your age and overall health. Based on this assessment they can develop an appropriate plan before proceeding with any treatments.
Prognosis
When it comes to pancreatic cancer, prognosis is complex. The outlook for a pancreatic cancer diagnosis can be difficult to predict as the disease is usually diagnosed when it is advanced and the exact type of cancer can vary greatly. Factors like stage of cancer, location, overall health and genetic makeup all contribute to the prognosis of pancreatic cancer.
Let’s get into the details of prognosis for pancreatic cancer:
Survival Rates
Pancreatic cancer is one of the most aggressive forms of cancer and the outlook for prognosis and survival varies depending on several factors such as stage, grade, and type. Generally, about seven in 100 people (7%) with pancreatic cancer that has not spread will survive their disease for five years or more after diagnosis.
For those cancers that are found at an early stage (stage 1 or 2), treatments that involve surgery to remove most of the pancreas may provide a greater chance of long-term survival – approximately 20% at five years or more. More advanced stages (stage 3 or 4) have poorer survival rates even following the most effective treatments, with fewer than 5% still alive after five years.
The median survival rate for all types and stages of pancreatic cancer is approximately one year from diagnosis. The overall five-year survival rate is only 10%. While this may seem low compared to some other forms of cancer, there have been recent updates to treatments which can increase prognosis and improve outcomes when diagnosed early on in the disease process.
Treatment Outcomes
The prognosis for pancreatic cancer is often poor due to the cancer’s tendency to spread rapidly. The five-year survival rate for patients with localized pancreatic cancer (confined only to the pancreas) is about 11 percent. If the cancer has metastasized (spread) outside of the pancreas, the five-year survival rate drops dramatically to just three percent.
However, when treatment begins early and the tumor size is small, it can improve chances for a cure or longer life expectancy. In some cases, surgical removal of all visible cancer followed by postoperative chemotherapy and/or radiation therapy can lead to long-term survival and perhaps even a cure. Treatment outcomes depend on many factors like age, overall health, specific type of pancreatic cancer and stage at diagnosis.
Therefore, it is essential that patients are monitored regularly by their doctor even after they have completed treatment in order to watch for recurrence or changes in their health.
Prevention
Pancreatic cancer is one of the most aggressive and deadliest forms of cancer. Due to its rapid advancement, prevention is key for avoiding this deadly disease. Scientists have identified factors that increase the risk of pancreatic cancer and understanding the risk factors can help people take preventive measures to reduce the risk of developing this disease.
Healthy Diet
Eating a healthy diet may lower your risk of developing pancreatic cancer. It is important to maintain a balanced diet to increase the chances of healthier cells developing and growing in the body, thereby reducing the risk of cancerous cells forming.
A few dietary habits that have been associated with a decreased risk of pancreatic cancer include:
- Consuming plenty of fruits and vegetables: Eating produce provides the body with essential nutrients and helps prevent unhealthy weight gain or obesity, both believed to be associated with an increased risk for pancreatic cancer.
- Focusing on plant-based sources of protein: Eating vegetable proteins such as beans, seeds, nuts, and grain may reduce the risk of pancreatic cancer by providing energy and helping maintain a healthy weight. They may also provide antioxidants which help protect our bodies from free radical damage linked with an increased risk for developing this type of cancer.
- Including healthy fats: Though it is important to limit intake of saturated fats as they tend to increase inflammation in the body and can lead to increased risks for certain types of cancer, it is wise to include healthy sources such as avocados, olive oil, flaxseed oil, fish oil, nuts seeds etc., as these are generally rich in Omega 3 fatty acids which are known for their anti-inflammatory properties.
- Limiting alcohol consumption: Keeping alcohol intakes within moderation (1-2 drinks daily) can help reduce potential risks for all kinds diseases including cancers related to genetic mutation or cell growth irregularities.
Regular Exercise
Regular exercise has been identified as a crucial factor in the prevention of pancreatic cancer. Exercise helps to reduce the risk of certain diseases, such as type 2 diabetes, which is linked to an increased risk of developing pancreatic cancer. Additionally, regular exercise helps to lower unhealthy levels of triglycerides and cholesterol, which can help reduce the risk of pancreatic cancer. Furthermore, studies have found that performing regular aerobic and strength-training exercises can decrease inflammation in the pancreas.
Exercising regularly not only increases energy levels but can also help with weight management. Being overweight and obese increases the risk for a number of diseases including pancreatic cancer; therefore exercise is an important step towards reducing the chance of developing this disease due to obesity or excessive weight gain.
So incorporating physical activity into your daily routine is key for preventing pancreatic cancer through maintaining a healthy body weight and controlling cholesterol levels within normal ranges. Here are some recommended activities:
- Aerobic activities such as swimming, running, jogging and biking.
- Strength-training exercises to help build muscle mass which improves burning calories even when at rest.
Avoid Smoking and Alcohol
Smoking and drinking alcohol are important modifiable risk factors in the development of pancreatic cancer. It is estimated that between 15% and 25% of pancreatic cancer cases in the United States are associated with smoking. The risk increases with the amount smoked, and smokers are at a higher risk for developing pancreatic adenocarcinoma compared to nonsmokers. Heavy alcohol use has also been linked to an increased risk for pancreatic cancer. It is also associated with poorer prognosis and increased mortality from any cause other than pancreatic cancer.
Therefore, it is essential to avoid smoking or limit smoking along with abstaining from heavy alcohol use in order to protect against developing this form of cancer. Not only should those at higher risk for developing this type of cancer strive to refrain from smoking or drinking, but all individuals should be advised about these risks as part of prevention strategies against pancreas carcinoma.
Conclusion
The outlook for individuals diagnosed with pancreatic cancer depends on the extent of the cancer when it is diagnosed, how far it has spread, and which treatments are available. These factors vary greatly by individual, and no single answer applies to everyone.
In general, however, prognosis for pancreatic cancer is poor because it is often discovered at an advanced stage. Surgery may be an option for some people, but chemotherapy and radiation therapy are generally used to treat advanced cases. While these treatments may help to prolong life and improve symptoms while they last, they usually cannot cure the disease. Therefore, regular check-ups are essential in order to detect any signs of recurrence early on and make sure that appropriate follow-up care is received.