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Pancreatic Cancer

pancreatic cancer

The pancreas is in the upper abdomen and lies behind the stomach and intestines (guts). It makes a fluid that contains enzymes (chemicals) that are needed to digest food. The enzymes are made in the pancreatic cells and are passed into tiny ducts (tubes). These ducts join together like branches of a tree to form the main pancreatic duct. This drains the enzyme-rich fluid into the duodenum (the part of the gut just after the stomach). The enzymes are in an inactive form in the pancreas. They are 'activated' in the duodenum to digest food.

Groups of special cells called 'Islets of Langerhans' are scattered throughout the pancreas. These cells make the hormones insulin and glucagon. The hormones are passed directly into the bloodstream to control the blood sugar level.

What is pancreatic cancer?

Pancreatic cancer is relatively uncommon. 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.
  • In time it may pass through the wall of the pancreas and invade nearby organs such as the duodenum, stomach 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).

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.

Certain risk factors increase the chance that pancreatic cancer may develop. These include:

  1. Ageing.
  2. Smoking.
  3. Eating a diet high in fat and meat seems to increase the risk.
  4. Obesity.
  5. Chronic pancreatitis (persistent inflammation of the pancreas).
  6. Diabetes.
  7. Chemicals. Heavy exposure at work to certain pesticides, dyes and chemicals used in metal refining may increase the risk.
  8. Genetic and hereditary factors
What are the symptoms of pancreatic cancer?

Symptoms of a blocked bile duct

  • Jaundice
  • Dark urine.
  • Pale faeces - as the faeces contain no bile which causes their normal brown colour.
  • Generalised itch caused by the bile in the bloodstream.
Other symptoms
  • Pain in the upper abdomen. Pain can also pass through to the back.
  • You may feel generally unwell and lose weight.
  • Smelly pale feces and weight loss.
  • Rarely, diabetes develops if nearly all the pancreas is damaged by the tumour.
  • Rarely, a tumour can trigger inflammation of the pancreas - acute pancreatitis.
How is pancreatic cancer diagnosed and assessed?

Initial assessment

Typically, these include an ultrasound scan of the abdomen and various blood tests. These initial tests can usually give a good idea if the cause of jaundice is a blockage from the head of the pancreas.

Assessing the extent and spread

A CT scan (computerised tomography) is a commonly used test to assess pancreatic cancer.

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 oesophagus and stomach and on into the duodenum. 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.

This assessment is called staging of the cancer. The aim of staging is to find out:
  1. How much the tumour in the pancreas has grown, and whether it has grown partially or fully through the wall of the pancreas.
  2. Whether the cancer has spread to local lymph nodes.
  3. Whether the cancer has spread to other areas of the body (metastasised).
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.

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 and has not spread to the lymph nodes or other areas of the body).

If the tumour is in the head of the pancreas then an operation to remove the head of the pancreas may be an option. This is a long and involved operation, as the surrounding structures such as the duodenum, stomach, bile duct, etc, need to be rearranged once the head of the pancreas is removed.

If the tumour is in the body or tail of the pancreas then removal of the affected section of the pancreas is sometimes an option.

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.

Chemotherapy

Chemotherapy is a treatment of cancer by using anti-cancer medicines which kill cancer cells or stops them from multiplying. See separate leaflet called Chemotherapy with cytotoxic medicines for more details. When chemotherapy is used in addition to surgery it is known as adjuvant chemotherapy.

Radiotherapy

Radiotherapy is a treatment which uses high-energy beams of radiation which are focused on cancerous tissue. This kills cancer cells, or stops cancer cells from multiplying.

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. As a rule, the smaller the tumour, and the earlier the tumour is diagnosed, the better the outlook.

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.


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