What Is Pancreatic Cancer

Pancreatic cancer is a malignant growth in the glandular organ of the digestive system called pancreas.

  • Vomiting, jaundice and pain at the back of the stomach are the symptoms of pancreatic cancer.
  • CT scan helps diagnose cancer of the pancreas.
  • Pancreatic cancer is a potentially fatal disease.
  • Chronic inflammation of pancreas, diabetes and smoking increase the risk of developing pancreatic cancer.
  • Surgical removal of the pancreas may result in complete cure in the early stages.

Pancreas is located at the curve of the duodenum, which is the first portion of the small intestine. The pancreatic duct drains into the duodenum, a little beyond the junction of the stomach and the small intestine. It is a glandular organ secreting both digestive enzymes and hormones. Adenocarcinomas originating from glandular cells constitute 95% of pancreatic cancer. Cancerous tumors of the pancreas develop on the lining of the pancreatic duct. The part of the pancreas joining the duodenum is called its head and most of the adenocarcinomas usually develop in this area.

Pancreatic cancer is the fourth among the most common causes of death due to cancer in the US and its incidence is steadily rising. Over thirty-seven thousand people, mostly over the age of 50, are diagnosed with the disease every year. In addition to age, smoking is another factor which predisposes people to pancreatic cancer. Incidence of cancer in smokers is two to three times more than that in non-smoking people. However, caffeine or alcohol does not seem to be increasing the risk of cancer. People who have had diabetes for a long time, especially women, have a higher risk. Pancreatitis is the inflammation of pancreas; people with this condition are also more prone to pancreatic cancer.

Symptoms

Symptoms of pancreatic cancer vary depending on the location and size of the tumor. The bile duct joins the pancreatic duct before it drains into the duodenum. If a large tumor develops in the pancreatic duct near its head, it may obstruct the passage of bile from the liver into the small intestine. This may result in jaundice, characterized by the yellowing of the eyes and the skin. It is one of the first symptoms of pancreatic cancer. Itching also may be present along with jaundice due to the presence of bile salt deposits in the skin. If the cancer causes obstruction in the small intestine, or if it blocks the passage of food from the stomach into the intestine, it may result in vomiting. If the tumor is located in the body of the pancreas or near its tail end, it may not cause any symptoms unless it is obstructing the vein which leads out of the spleen. The lack of symptoms often delays the detection of the disease till it spreads to other areas.

Complications: When adenocarcinoma develops in the tail end of the pancreas or in the main body of the organ, it may grow very large before symptoms appear. In the meantime, the cancer would have metastasized to other tissues and organs in most of the cases. Lungs, liver and the nearby lymph nodes, are the usual sites of metastasis. Pain in the upper part of the abdomen radiating towards the back, and noticeable weight loss, may be the first symptoms which alert people and their doctors to the possibility pancreatic cancer. However, by this time, the cancer would have reached a stage when it is no longer curable.

The spleen is an organ which is involved in the production and destruction of blood cells and it is located near the tail end of the pancreas. When a large adenocarcinoma at the tail end of the pancreas causes obstruction to the vein leaving the spleen, it results in splenomegaly or spleen enlargement. The veins around the stomach and the esophagus also may swell up to form varices. These varices, especially those around the esophagus, may rupture resulting in bleeding.

Diagnosis

Pancreatic cancers, especially those developing in the body of the pancreas or in the tail portion, are usually diagnosed very late due to the absence of symptoms during the early stages. Blood tests or a physical examination may not show any abnormality. Ultrasound scanning, MRI scans, and an endoscopic test called retrograde cholangiopancreatography, may help in diagnosis. However, the most reliable and accurate test for cancer of the pancreas is the CT scan or computed tomography.

A biopsy of the pancreatic tissue may be conducted to confirm the presence of cancer. The tissue sample may be obtained by drawing it out with a needle under the guidance of a CT scan or an ultra sound scan. But there is some risk involved, as there is a high chance of the procedure causing the spread of cancer into surrounding areas. Sometimes, a biopsy of the liver is done in the same way to detect the presence of cancer cells which may have spread to the liver from the pancreas. Surgical exploration of the pancreas is also considered when other non invasive tests fail to give conclusive evidence of the disease or the absence of it.

Prognosis and Treatment

Surgical removal of the pancreas (Whipple procedure), usually including the part of the duodenum where the pancreatic duct joins the intestine, may cure the disease when it is detected before the cancer has spread to other areas. But pancreatic cancer is rarely discovered early for surgery to be effective. Consequently, less than 20% of pancreatic cancer cases qualify for surgery (Whipple procedure), and among those who have undergone surgery too, more than 80% people succumb to the disease within five years. Radiation treatment and chemotherapy are also tried with or without surgery, but they do not contribute significantly to prolonging life. When the cancer has progressed to an advanced stage the focus shifts to the management of symptoms.

NSAIDs such as acetaminophen or aspirin may relieve pain in some cases. But more often, stronger pain relieving medication may be necessary. Oral administration of morphine or codeine may be tried if the pain is severe. But a majority of people with pancreatic cancer may need nerve blocks directly injected into the nerves to get real relief from extreme pain. Oral supplementation of pancreatic enzymes may have to be given to aid digestion, and insulin injections may be necessary, if the patient develops diabetes.

 If there is obstruction to the flow of bile from the gall bladder into the small intestine due to the growth of a tumor near the head, a stent is inserted into the duct to drain the bile. If the tumor impedes the flow by blocking the duct again, a channel from the gall bladder to the intestine is created, bypassing the pancreatic duct. If the cancer causes intestinal obstruction, making a connection between stomach and the intestine at a point after the obstruction bypasses the affected part.

Since pancreatic cancer has very poor prognosis, especially when it is detected in an advanced stage, treatment options are few and the doctor may have to discuss palliative care options with the patient and family members. As a fatal outcome is almost certain, the patients and their families may be prepared for it in advance.

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Yasser Elnahas

MD, PHD, Professor Of CardioVascular Surgery
Dr. Yasser Elnahas, Is an associate Professor of Cardiovascular Surgery. Dr. Elnahas was trained as a fellow At Texas Heart Institute And Mayo Clinic Foundation.Dr. Elnahas is dedicated to educating the general public about different disease conditions and simplifying the medical knowledge in an easy to understand terminology.

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