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Pancreatic Cancer

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Overview of pancreatic cancer

Pancreas cancer is considered as ‘orphan’ cancer because of its relative low incidence.1 Owing to the high fatality rates, pancreatic cancer incidence rates are almost equal to mortality rates. Worldwide, over 200,000 people die annually of pancreatic cancer. The highest incidence and mortality rates of pancreatic cancer are found in developed countries. In USA, and Europe pancreatic cancer is the 4th and 6th leading cause of cancer death, respectively.

Pancreatic cancer is diagnosed late in the natural history of the disease, given the few early indicators of illness, and the lack of screening tests for this disease. While rates have been stabilizing over the past two decades in many countries, where they are already high, and they continue to increase in countries where the rates were relatively low four decades ago, such as Japan.2

Signs and Symptoms of pancreatic cancer

Some of signs and symptoms of pancreatic cancer are as follows.3

Causes and Risk Factors of pancreatic cancer

Some of the causes and risk factors for the development of pancreatic cancer are enumerated below.

  • Tobacco smoking. This risk factor is likely to explain some of the international variations and gender differences
  • Chronic pancreatitis and diabetes mellitus
  • Obesity
  • Glucose intolerance and hyperinsulinemia
  • Physical inactivity
  • Aspirin use
  • Occupational exposure to certain pesticides
  • Dietary factors such as carbohydrate or sugar intake
  • In USA, the highest rates of pancreatic cancer incidence and mortality are observed among Blacks, who have some of the highest rates in the world.
  • Environmental factors
  • Although familial pancreatic cancer is well documented, the genes responsible for this condition have not been identified and are unlikely to explain more than 5–10% of all pancreatic cancer cases.

Diagnosis of pancreatic cancer

In case pancreatic cancer is suspected, one or more of the following tests may be advised to confirm the diagnosis.4

  • Computed tomography (CT) scan: In this, the computer puts a series of X-rays together to create pictures of the pancreas and other organs and blood vessels in the abdomen.
  • Ultrasonography: The ultrasound procedure may use an external or internal device, or both types:
  • Transabdominal ultrasound: The ultrasound device is placed on the abdomen and slowly moved around.
  • Endoscopic ultrasound (EUS) : An endoscope is passed through the patient’s mouth and stomach, down into the first part of the small intestine. At the tip of the endoscope is an ultrasound device.
  • Endoscopic retrograde cholangiopancreatography (ERCP): An endoscope is passed into the first part of the small intestine. A smaller tube (catheter) is passed through the endoscope into the bile ducts and pancreatic ducts and dye is injected through this. Then, X-ray pictures are taken, which can show whether the ducts are narrowed or blocked by a tumor or other condition.
  • Percutaneous transhepatic cholangiography (PTC): A dye is injected through a thin needle inserted through the skin into the liver. Unless there is a blockage, the dye should move freely through the bile ducts. The dye makes the bile ducts show up on X-ray pictures.
  • Biopsy: In some cases, a piece of tissue is removed and examined.

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Treatment of pancreatic cancer

Treatment for pancreatic cancer depends on the stage and location of the cancer as well as the person’s age, overall health and personal preferences. The primary goal of treatment is to eliminate the cancer. When that is not possible, the focus may be on preventing the pancreatic cancer from growing or causing more harms. When pancreatic cancer is advanced and treatments are not likely to offer a benefit, symptomatic treatment is given to make the person as comfortable as possible.

Surgery

Only a small portion of pancreatic cancers has a good chance of being removed completely with surgery. Once the cancer has spread beyond the pancreas to other organs, lymph nodes or blood vessels, surgery is usually no longer an option. The different surgeries that may be recommended are:

  • Surgery for tumors in the pancreatic head: If the cancer is located in the head of the pancreas, an operation called a Whipple procedure is done (pancreatoduodenectomy), where the head of the pancreas, as well as a portion of small intestine (duodenum), gallbladder and part of the bile duct are removed. Part of the stomach may also be removed. Then, the remaining parts of the pancreas, stomach and intestines are reconnected to allow digestion of food.
  • Surgery for tumors in the pancreatic tail and body: Surgery to remove the tail of the pancreas or the tail and a small portion of the body is called distal pancreatectomy. The spleen also may be removed. Surgery carries a risk of bleeding and infection.

Radiation Therapy

Radiation therapy uses high-energy beams to destroy cancer cells. Radiation treatment is given before or after cancer surgery, often in combination with chemotherapy. Radiation therapy can also be used during surgery (intraoperative radiation). Radiation could be given in two ways:

  • External beam radiation: When the radiation machine is placed outside the body
  • Brachytherapy: When the machine is placed inside the body near the cancer

Combination of radiation and chemotherapy treatments can also be given when the cancer cannot be treated surgically.

Chemotherapy

Chemotherapy uses drugs to help kill cancer cells. In chemotherapy, drug(s) can be injected into a vein or taken orally. A chemotherapy drug or a combination of drugs can be given.

Chemotherapy can also be combined with radiation therapy (chemoradiation). Chemoradiation is typically used to treat cancer that has spread beyond the pancreas, but only to nearby organs and not to distant regions of the body. This combination may also be used after surgery to reduce the risk that pancreatic cancer may recur.

In patients with advanced pancreatic cancer, chemotherapy may be combined with targeted drug therapy.

Targeted Drug Therapy

Targeted drug therapy is an emerging area of cancer treatment. Targeted drugs attack specific abnormalities within cancer cells. The targeted drug erlotinib blocks chemicals that signal cancer cells to grow and divide. Erlotinib is usually combined with chemotherapy for use in people with advanced pancreatic cancer.

Many other targeted drug treatments are under investigation in clinical trials. One such drug being studied is cetuximab, which targets the same signals as erlotinib but goes about it a different way.

Prevention of pancreatic cancer

Treatment has not improved substantially over the past few decades and has little effect on prolonging survival time. Therefore, prevention could play an important role in reducing pancreatic cancer mortality. Although there are no proven ways to prevent pancreatic cancer, the following steps may reduce the risk:

  • Quit smoking
  • Maintain a healthy weight
  • Exercise regularly
  • Eat a healthy diet

References

1. Lowenfels AB, Maisonneuve P. Epidemiology and risk factors for pancreatic cancer. Best Pract Res Clin Gastroenterol. 2006;20(2):197–209.

2. Michaud DS. Epidemiology of pancreatic cancer. Minerva Chir. 2004;59(2):99–111.

3. Verma M. Pancreatic cancer epidemiology. Technol Cancer Res Treat. 2005;4(3).

4. National Cancer Institutes. National Institutes of Health. What you need to know about Cancer of the Pancreas. Available at: http://www.cancer.gov/cancertopics/wyntk/pancreas/page6 Accessed on 08-06-08

Written by: healthplus24.com team

Date last updated: February 02, 2015