Pancreatic Cancer

Pancreatic cancer is the cancer of tissues of your pancreas that usually spreads rapidly.  Pancreas, a large organ (nearly 6 inches long) that is situated behind the lower part of stomach, secretes enzymes that help in digestion and hormones that regulate blood sugar level.

The prognosis of pancreatic cancer is poor despite the early detection of the cancer.  The signs and symptoms of pancreatic cancer mostly appear after the cancer is quite advanced. Hence it is rarely diagnosed in the early stage rendering surgical removal impossible and is leading cause of cancer death.

The appearance of signs and symptoms of pancreatic cancer often occur after the disease has advanced. These include:

• Pain in the upper abdomen that often radiates to your back
• Jaundice (yellowish discoloration of skin and white portion of your eye)
• Reduced body weight
• Anorexia (Loss of appetite)

When to see a Doctor?

You should seek medical advice if you have had inexplicable weight loss, abdominal pain, jaundice or other symptoms that worry you.

The cause of pancreatic cancer has not been clearly understood. Pancreatic cancer develops when the pancreatic cells undergo mutation in their DNA. The mutation results in uncontrolled and abnormal proliferation forming tumor. 

The most common form of pancreatic cancer is pancreatic exocrine cancer or adenocarcinoma which begins in the cells lining the ducts of pancreas. Pancreatic endocrine cancer or islet cell cancer is seldom seen and begins in cells producing hormone. 

To make a diagnosis of pancreatic cancer your doctor may recommend tests and procedures to examine your signs and symptoms that have been troubling you. 

If you are diagnosed with pancreatic cancer, your doctor may refer you to an oncologist (a doctor who treats cancer) or a radiation oncologist (an oncologist who uses radiation for treatment of cancer) or gastroenterologist (a doctor who specializes in digestive condition).

If your doctors suspects pancreatic cancer, the diagnosis can be done by following tests:

• Imaging Tests: Different imaging tests like ultrasound, Computerized Tomography (CT) scan and Magnetic Resonance Imaging (MRI) are used for investigation of pancreatic cancer.
• Endoscopic Ultrasound (EUS): An endoscope fitted with ultrasound device is passed into your stomach and duodenum to obtain the images of pancreas. The doctor may collect sample of pancreatic tissue (biopsy) during this procedure to diagnose whether the cells are cancerous.
• Endoscopic Retrograde Cholangiopancreatography (ERCP): During ERCP, an endoscope fitted with catheter is guided into the duodenum through the mouth and the dye is injected into the pancreatic and bile ducts. Then, X-rays of the ducts are taken. 
• Biopsy: It involves removal of tissues from pancreas for examination under microscope. The biopsy sample can be obtained by fine-needle aspiration (inserting needle into your pancreas through the skin) or by using endoscopic ultrasound.

After the confirmation of pancreatic cancer, the doctor will determine the stage of cancer. The stages of cancer can be determined by:

• Laparoscopy: A laparoscope (lighted tube with video camera on its end) is passed into abdomen through incision. The camera transmits video enabling doctor to explore your pancreas and surrounding tissue and helps in determining whether the cancer has spread within your abdomen.
• Imaging tests: Different tests like CT scan and MRI are used to determine the extent of cancer.
• Blood Test: It is done to detect specific proteins or tumor marker for instance, CA19-9 shed by the pancreatic tumor cells. However this test is not always reliable.

Stages of pancreatic cancer: 

• Stage I: Cancer is limited to the pancreas only. 
• Stage II: Cancer has spread to neighboring tissues and organs and may have spread to the lymph nodes. 
• Stage III: Cancer has spread to the major blood vessels nearby the pancreas and may have spread to the lymph nodes. 
• Stage IV: Cancer has spread to distant sites, such as the liver, lungs and the peritoneum (lining that surrounds your abdominal organs).

How to prepare yourself for the visit?

Getting prepared for the visit can optimize the therapy and help make the visit more fruitful.

List out all the symptoms.

Write down your key medical information. 

Write down the names of all your medications, vitamins or supplements. 

Make a list of the questions to ask your doctor. Some typical question can be:

• Do I have pancreatic cancer? If yes, what's the stage of cancer?
• Are there any further tests that need to be performed?
• Can it be cured? What are the available treatment options?
• What are the probable side effects of each treatment? Which one could be the best for me?
• Can any treatment help me live longer?
• What would you advice my family members?
• Can anything help me feel better?

What your doctor wants to know?

A clear talk with your doctor can optimize the therapy and improve the outcomes. Prepare yourself to answer some essential questions from your doctor. Your doctor might ask you typical questions like: 

• When did you first begin experiencing symptoms?
• How severe are the symptoms?
• Have your symptoms appeared continually or occasionally?
• Does anything improve or worsen your symptoms?

Treatment choice for pancreatic cancer is guided by the stage and location of cancer, your age and health conditions. The aim of the treatment is to completely eradicate the cancer whenever possible. 

If it is not possible, the treatment is aimed to prevent the pancreatic cancer from growing or causing more damage. For advanced cancer, where treatment will show no benefit, treatment is intended to relieve symptoms and improve the quality of life. 

• Surgery: Surgery is opted when pancreatic cancer is confined to pancreas. It could be either pancreatoduodenectomy (Whipple procedure) or distal pancreatectomy. In Whipple procedure, the head of your pancreas along with duodenum (portion of small intestine), gallbladder and part of bile duct are removed. Whipple surgery is associated with higher risk of bleeding and infection and it takes longer time for recovery. Distal pancreatectomy involves removal of tail and small portion of body of pancreas. When performed by experienced surgeon, surgery is associated with fewer complications.

• Radiation therapy: Use of high energy beams such as X-rays, destroys the cancer cell. Radiation therapy may be given before or after surgery. When surgery cannot be performed, combination of radiation and chemotherapy is given. 
• Chemotherapy: In chemotherapy drugs are given to kill cancer cells. Chemotherapy can be given intravenously or orally mostly in combination. Chemoradiation (chemotherapy combined with radiation) is used when the pancreatic cancer has spread to the neighboring organs. Chemoradiation may be given after surgery to avoid the recurrence of the cancer. 
• Targeted therapy: Targeted therapy uses drugs that attack particular abnormalities within cancer cells. The targeted drug erlotinib blocks chemicals that help in growth and division of cancer cells. Erlotinib along with other chemotherapy is used to treat advanced pancreatic cancer. 
• Clinical trials: In clinical trials new forms of treatment such as, new drugs, gene therapy or new approach to surgery or radiation are studied.

If those new methods are proved to be safer or efficacious, they could replace the conventional treatment standards. However, clinical trials do not assure a cure and could have serious side effects. 

There's no certain way to prevent pancreatic cancer. However risk associated with cancer can be reduced by following tips:

• Stop Smoking: You can use nicotine replacement therapy if it's difficult for you to quit
• Choose Healthy Diet: A diet enriched with fruits, vegetables and whole grains reduces the risk of cancer.
• Maintain a healthy weight: An overweight or obese is at higher risk of developing cancer. Aim to lose weight slowly by combining regular exercises and healthy diet. Exercise regularly to maintain the healthy weight. 

Complementary or alternative remedies have not been found to treat pancreatic cancer effectively but may help with to cope up the distress. 

Different alternative therapies such as art therapy, music therapy, and relaxation exercises may help to relieve the stress and anxiety you experience. Talking about your feelings to specialist help you develop strategies required to cope with the changes due to cancer.

Following tips may help to cope with pancreatic cancer:

• Learn enough about your cancer which helps make you a good decision about your care. 
• Join support groups and find someone whom you are comfortable with to discuss your feeling.
• Consider hospice care which provides comfort and support to terminally ill people and their loved ones.

There are several risks and complications associated with pancreatic cancer.

Risks

• Race: African-Americans have high risk of cancer
• Overweight/obese
• Pancreatitis (chronic inflammation of pancreas)
• Diabetes
• Family history of pancreatic cancer
• Smoking
• Family history of genetic syndrome (for instance BRCA 2 gene mutation)
• Lynch syndrome: An inherited condition that increases your risk of various types of cancer

Complications

• Jaundice: Due to blockage of liver's bile duct. Your doctor may recommend placing a stent inside the bile duct to open it. 
• Pain: A growing tumor can cause severe pain due to compression of nerves in abdomen. Medication can relieve pain. Radiation therapy may provide relief since it stops tumor growth. Your doctor may inject alcohol into the nerve (celiac plexus block) to control pain
• Bowel obstruction: Pancreatic cancer can spread into the duodenum or compress it thereby causing blockade of flow of ingested food. A bypass surgery which attaches stomach to intestine containing no cancer or placing a stent may be recommended. 
• Weight Loss