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Pancreatic Cancer

cancer pancreas


Pancreatic cancer (cancer of the pancreas) mainly occurs in people aged over 60. Pancreatic cancer is relatively uncommon.

What is the pancreas?

The pancreas is in the upper abdomen and lies behind the stomach and intestines . The shape of the pancreas is like a tadpole, and so the pancreas has a head, a body and a tail.
The pancreas makes a fluid that contains enzymes (chemicals) that are needed to digest food.

Groups of special cells in pancreasemake the hormones insulin and glucagon to control the blood sugar level.

There are several types of pancreatic cancer, but more than 9 in 10 cases are ductal adenocarcinomas.

Ductal adenocarcinoma of the pancreas

This type of cancer develops from a cell which becomes cancerous in the pancreatic duct. This multiplies and a tumour then develops in and around the duct. As the tumour enlarges:

It can block the bile duct or the main pancreatic duct. This stops the drainage of bile and/or pancreatic fluid into the duodenum.
It invades deeper into the pancreas. In time it may pass through the wall of the pancreas and invade nearby organs such as various part of gut or liver.
Some cells may break off into the lymph channels or bloodstream. The cancer may then spread to nearby lymph nodes or spread to other areas of the body (metastasise).

Other types of pancreatic cancer

There are some rare types of cancer which arise from other types of cells within the pancreas. For example, cells in the pancreas that make insulin or glucagon can become cancerous (insulinomas and glucagonomas). These behave differently to ductal adenocarcinoma. For example, they may produce too much insulin or glucagon, which can cause various symptoms.

What causes pancreatic cancer (adenocarcinoma of the pancreas)?

A cancerous tumour starts from one abnormal cell. The exact reason why a cell becomes cancerous is unclear. It is thought that something damages or alters certain genes in the cell. This makes the cell abnormal and multiply out of control.

Many people develop cancer of the pancreas for no apparent reason. However, certain risk factors increase the chance that pancreatic cancer may develop. These include:

Ageing. It is more common in older people. Most cases are in people aged over 60.
Smoking.
Diet. Eating a diet high in fat and meat seems to increase the risk.
Obesity.
Chronic pancreatitis (persistent inflammation of the pancreas). Most cases of chronic pancreatitis are due to drinking a lot of alcohol.

 There are other less common causes.

Diabetes. Note: diabetes is common and the vast majority of people with diabetes do not develop pancreatic cancer.
Chemicals. Heavy exposure at work to certain pesticides, dyes and chemicals used in metal refining may increase the risk.
Genetic and hereditary factors
Most cases of pancreatic cancer do not run in families. However, some families have a higher incidence of pancreatic cancer than average

What are the symptoms of pancreatic cancer?

Symptoms of a blocked bile duct

It causes no symptoms at first. As the tumour grows it tends to block the bile duct. This stops the flow of bile into the duodenum which leads to:
Jaundice
Very dark coloured urine
Pale stools- stool  withoutnormal brown colour.
Generalised itch
Pain is often not a feature at first. Therefore a painless jaundice that becomes worse is often the first sign of pancreatic cancer. Nausea and vomiting are also fairly common symptoms.

Other symptoms

As the cancer grows in the pancreas, further symptoms that may develop include:
Pain in the upper abdomen. Pain can also pass through to the back.
You may feel generally unwell and lose weight.
You may not digest food very well,
Rarely, diabetes develops if nearly all the pancreas is damaged by the tumour.
Rarely, a tumour can trigger inflammation of the pancreas - acute pancreatitis. This can cause severe abdominal pain.
If the cancer spreads to other parts of the body, various other symptoms can develop.

How is pancreatic cancer diagnosed and assessed?

Initial assessment

There are many causes of jaundice and of the other symptoms listed above. For example, a blocked gallstone or hepatitis (liver inflammation). Typically, an ultrasound scan of the abdomen and various blood tests can usually give a good idea if the cause of jaundice .

Assessing the extent and spread

If you are confirmed to have pancreatic cancer, or it is strongly suspected from the initial tests, then further tests may be done to assess if it has spread. For example:
A CT scan (computerised tomography) is a commonly used test to assess pancreatic cancer. It is a specialised X-ray test that can give quite clear pictures of the inside of your body.

An MRI scan is sometimes done. MRI stands for magnetic resonance imaging. An MRI scan uses a strong magnetic field and radio waves to create computer pictures of tissues, organs and other structures inside your body.

An endoscopic ultrasound (EUS). An endoscope (gastroscope) is a thin, flexible, telescope. It is passed through the mouth, into the gut. The endoscope contains fibre optic channels which allow light to shine down so the doctor can see inside. Some endoscopes are fitted with a tiny ultrasound scanner at their tip, which can obtain pictures of structures behind the gut, such as the pancreas.

A chest X-ray.

A laparoscopy. This is a procedure to look inside your abdomen by using a laparoscope. A laparoscope is like a thin telescope with a light source. It is used to light up and magnify the structures inside the abdomen. A laparoscope is passed into the abdomen through a small incision (cut) in the skin.

This assessment is called staging of the cancer. The aim of staging is to find out

How much the tumour in the pancreas has grown, and whether it has grown partially or fully through the wall of the pancreas.
Whether the cancer has spread to local lymph nodes.
Whether the cancer has spread to other areas of the body (metastasised).

By finding out the stage of the cancer, it helps doctors to advise on the best treatment options. It also gives a reasonable indication of outlook (prognosis). See separate leaflet called Staging and grading cancer for details.

Biopsy

A biopsy is when a small sample of tissue is removed from a part of the body. The sample is then examined under the microscope to look for abnormal cells. Biopsy iis done via by passing a thin grabbing instrument down a side channel of the endoscope (gastroscope). Alternatively, sometimes a biopsy is done at the same time as having a scan. It can take two weeks for the result of a biopsy.

What are the treatment options for pancreatic cancer?

Treatment options that may be considered include surgery, chemotherapy and radiotherapy. The treatment advised for each case depends on various factors such as the stage of the cancer (how large the cancer is and whether it has spread), and your general health.

Surgery

If the cancer is at an early stage, then there is a modest chance that surgery can be curative. (An early stage means a small tumour which is confined within the pancreas .The reason why the chance of cure is only modest is because in a number of cases thought to be in an early stage, some cells have already spread to other parts of the body but are not yet detectable by scans or other staging tests. In time they grow into secondary tumours.

If the cancer is at a later stage then surgery is not an option to cure the disease. Some surgical techniques may still have a place to ease symptoms. For example, it may be possible to ease jaundice caused by a blocked bile duct. A bypass procedure may be used, or a stent may be inserted into the bile duct. (A stent is a small rigid tube made of plastic or metal which aims to keep a duct or channel open. It is usually inserted by instruments attached to an endoscope.)

Chemotherapy

Chemotherapy is a treatment of cancer by using anti-cancer medicines which kill cancer cells or stops them from multiplying. When chemotherapy is used in addition to surgery it is known as adjuvant chemotherapy. For example, following surgery you may be given a course of chemotherapy. This aims to kill any cancer cells which may have spread away from the primary tumour.

Radiotherapy

Radiotherapy is a treatment which uses high-energy beams of radiation to kill cancer cells, or stops cancer cells from multiplying. See separate leaflet called Radiotherapy for more details. Radiotherapy is not commonly used to treat pancreatic cancer.

What is the prognosis (outlook)?

If a pancreatic cancer is diagnosed and treated at an early stage then there is a modest chance of a cure with surgery. However, most pancreatic cancers are advanced before they cause symptoms and are diagnosed. A cure is unlikely in most cases. However, treatment may slow down the progression of the cancer.

The treatment of cancer is a developing area of medicine. New treatments continue to be developed and the information on outlook above is very general. The specialist who knows your case can give more accurate information about your particular outlook, and how well your type and stage of cancer is likely to respond to treatment.


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