Cancer of pancreas

What is cancer of pancreas or pancreatic cancer?

When cancer occurs in the pancreas or begins from pancreas it is known as cancer of pancreas. Pancreas is an organ in your abdomen that lies horizontally behind the lower part of your stomach. Your pancreas releases juices (enzymes) that help in digestion and hormones (especially insulin) that help manage your blood sugar.

Pancreatic cancer is usually an aggressive cancer. It spreads rapidly to nearby organs. It is seldom detected in its early stages. But for people with pancreatic cysts or a family history of pancreatic cancer, some screening steps might help detect a problem early. One sign of pancreatic cancer is diabetes, especially when it occurs with weight loss, jaundice or pain in the upper abdomen that spreads to the back.

Treatment may include surgery, chemotherapy, radiation therapy or a combination of these.

What are the symptoms of pancreatic cancer?

Usually in the initial stages, the pancreatic cancer remains silent and does not produce any symptoms. When the pancreatic cancer becomes large it produces following symptoms:

• Pain in the upper abdomen that radiates to your back
• Weight loss
• Loss of appetite
• Yellowing of your skin and the whites of your eyes (jaundice)
• Pain on eating food
• New-onset diabetes
• Blood clots
• Fatigue
• Vomiting

What are the causes of pancreatic cancer?

Factors that may increase your risk of pancreatic cancer include:

• Chronic inflammation of the pancreas (pancreatitis)
• Diabetes
• Family history of pancreatic cancer
• Smoking
• Obesity
• Older age, as most people are diagnosed after age 65

Can jaundice be due to pancreatic cancer?

Pancreatic cancer that blocks the liver's bile duct can cause jaundice. Signs include yellow skin and eyes, dark-colored urine, and pale-colored stools. Jaundice may occur without abdominal pain.

Your doctor may recommend that a plastic or metal tube (stent) be placed inside the bile duct to hold it open. This is done with the help of a procedure called endoscopic retrograde cholangiopancreatography (ERCP). During ERCP an endoscope is passed down your throat, through your stomach and into the upper part of your small intestine. A dye is then injected into the pancreatic and bile ducts through a small hollow tube (catheter) that's passed through the endoscope. Finally, images are taken of the ducts.

How is pancreatic cancer diagnosed?

If pancreatic cancer is suspected, following tests may be done:

• Imaging tests that create pictures of your internal organs. These tests help your doctors visualize your internal organs, including the pancreas. Techniques used to diagnose pancreatic cancer include ultrasound, computerized tomography (CT) scans, magnetic resonance imaging (MRI) and, sometimes, positron emission tomography (PET) scans.
• Using a specialendoscope to create ultrasound pictures of your pancreas. An endoscopic ultrasound (EUS) uses an ultrasound device to make images of your pancreas from inside your abdomen. The device is passed through a thin, flexible tube (endoscope) down your esophagus and into your stomach in order to obtain the images.
• Removing a tissue sample for testing (biopsy). A biopsy is a procedure to remove a small sample of tissue for examination under a microscope. Your doctor may obtain a sample of tissue from the pancreas by inserting a needle through your skin and into your pancreas (fine-needle aspiration). Or he or she may remove a sample during EUS, guiding special tools into the pancreas.
• Blood test. Your doctor may test your blood for specific proteins (tumor markers) shed by pancreatic cancer cells. One tumor marker test used in pancreatic cancer is called CA19-9. But the test isn't always reliable, and it isn't clear how best to use the CA19-9 test results. Some doctors measure your levels before, during and after treatment.

How is the stage of pancreatic cancer determined?

Once pancreatic cancer is diagnosed, we need to know the extent (stage) of the cancer. Using information from staging tests, your doctor assigns your pancreatic cancer a stage, which helps determine what treatments are most likely to benefit to you.

The stages of pancreatic cancer are indicated by Roman numerals ranging from 0 to IV. The lowest stages indicate that the cancer is confined to the pancreas. By stage IV, the cancer has spread to other parts of the body.

The pancreatic cancer has following stages:

• Stage 0: No spread. Pancreatic cancer is limited to a single layer of cells in the pancreas. The pancreatic cancer is not visible on imaging tests or even to the naked eye.
• Stage I: Local growth. Pancreatic cancer is limited to the pancreas, but has grown to less than 2 centimeters across (stage IA) or greater than 2 centimeters (stage IB).
• Stage II: Local spread. Pancreatic cancer has grown outside the pancreas, or has spread to nearby lymph nodes.
• Stage III: Wider spread. The tumor has expanded into nearby major blood vessels or nerves but has not metastasized.
• Stage IV: Confirmed spread. Pancreatic cancer has spread to distant organs.

What is the treatment of pancreatic cancer?

Treatment for pancreatic cancer depends on the stage and location of the cancer as well as on your overall health and personal preferences. For most people, the first goal of pancreatic cancer treatment is to eliminate the cancer, when possible. When that isn't an option, the focus may be on improving your quality of life and preventing the cancer from growing or causing more harm.

Treatment may include:

• surgery,
• radiation,
• chemotherapy or a
• combination of these.
• When pancreatic cancer is advanced and these treatments aren't likely to offer a benefit, your doctor will offer symptom relief (palliative care) that makes you as comfortable as possible.

What surgery is done for pancreatic cancer?

• The main surgery done for pancreatic cancer is known as “Whipple’sSurgery”. It is usually done if the cancer is located at the pancreatic head.The Whipple procedure is technically difficult operation to remove the head of the pancreas, the first part of the small intestine (duodenum), the gallbladder and part of the bile duct. In some situations, part of the stomach and nearby lymph nodes may be removed as well. Your surgeon reconnects the remaining parts of your pancreas, stomach and intestines to allow you to digest food.
• Surgery for tumors in the pancreatic body and tailis called distal pancreatectomy. Your surgeon may also remove your spleen.
• Surgery to remove the entire pancreas. In some people, the entire pancreas may need to be removed. This is called total pancreatectomy. You can live relatively normally without a pancreas but do need lifelong insulin and enzyme replacement.

Each of these surgeries carries the risk of bleeding and infection. After surgery some people experience nausea and vomiting if the stomach has difficulty emptying (delayed gastric emptying). Expect a long recovery after any of these procedures. You'll spend several days in the hospital and then recover for several weeks at home.

What is the role of radiation therapy in the treatment of pancreatic cancer?

Radiation therapy uses high-energy beams, such as those made from X-rays and protons, to destroy cancer cells. You may receive radiation treatments before or after cancer surgery, often in combination with chemotherapy. Or your doctor may recommend a combination of radiation and chemotherapy treatments when your cancer can't be treated surgically.

Radiation therapy usually comes from a machine that moves around you, directing radiation to specific points on your body (external beam radiation). In specialized medical centers, radiation therapy may be delivered during surgery (intraoperative radiation).

Radiation therapy traditionally uses X-rays to treat cancer. Some medical centers offer proton beam radiation therapy, which may be a treatment option for some people with advanced pancreatic cancer.

What is the role of chemotherapy in treatment of pancreatic cancer?

Chemotherapy uses drugs to help kill cancer cells. These drugs can be injected into a vein or taken orally. You may receive one chemotherapy drug or a combination of them.

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. At specialized medical centers, this combination may be used before surgery to help shrink the tumor. Sometimes it is used after surgery to reduce the risk that pancreatic cancer may recur.

In people with advanced pancreatic cancer, chemotherapy is often used to control cancer growth and prolong survival.

What is palliative care?

Palliative care is specialized medical care that focuses on providing relief from pain and other symptoms of a serious illness. Palliative care specialists work with you, your family and your other doctors to provide an extra layer of support that complements your ongoing care. Palliative care can be used while undergoing aggressive treatments, such as surgery, chemotherapy and radiation therapy.

When palliative care is used along with other appropriate treatments — even soon after the diagnosis — people with cancer may feel better and live longer.

Palliative care is provided by teams of doctors, nurses and other specially trained professionals. These teams aim to improve the quality of life for people with cancer and their families. Palliative care is not the same as hospice care or end-of-life care.