What is Pancreatic Cancer?
Cancer is a class of diseases characterized by out-of-control cell growth, and pancreatic cancer occurs when this uncontrolled cell growth begins in the pancreas. Rather than developing into healthy, normal pancreas tissue, these abnormal cells continue dividing and form lumps or masses of tissue called tumors. Tumors then interfere with the main functions of the pancreas. If a tumor stays in one spot and demonstrates limited growth, it is generally considered to be benign.
More dangerous, or malignant, tumors form when the cancer cells migrate to other parts of the body through the blood or lymph systems. When a tumor successfully spreads to other parts of the body and grows, invading and destroying other healthy tissues, it is said to have metastasized. This process itself is calledmetastasis, and the result is a more serious condition that is very difficult to treat.
The most common
cancer that arises in the pancreas is the adenocarcinoma, which carries the
worst prognosis. The main risk factors are smoking, excessive alcohol
consumption, obesity and diabetes mellitus. There is also a strong relation to
chronic pancreatitis and a family history of cancer. Hence this cancer can be
guarded against by lifestyle modifications, such as cessation of smoking,
change in drinking habits, regular exercise and a healthy lifestyle.
What Are The Symptoms Of Pancreatic Cancer?
Cancer symptoms are quite varied and depend on where the cancer is located, where it has spread, and how big the tumor is. Pancreatic cancer is often called a "silent" disease because it rarely shows early symptoms and presents non-specific later symptoms. Tumors of the pancreas cancers are usually too small to cause symptoms. However, when the cancer grows, symptoms include:
- Pain in the upper abdomen from the tumor pushing against nerves
- A painless yellowing of the skin and eyes and darkening of the urine called jaundice, created when the cancer interferes with the bile duct and the liver.
- Loss of appetite, nausea, and vomiting
- Significant weight loss and weakness
- Acholic stool (pale or grey stool) and steatorrhea (excess fat in stool)
These symptoms of pancreatic cancer have numerous other causes, making it difficult to diagnose the disease before it is in an advanced stage.
What Are The Stages Of Pancreatic Cancer?
After a diagnosis is made, doctors find out how far the cancer has spread to determine the stage of the cancer. The stage determines which choices will be available for treatment and informs prognoses. The standard pancreatic cancer staging method is called the TNM (Tumor - Node - Metastasis) system. T indicates the size and direct extent of the primary tumor, N indicates the degree to which the cancer has spread to nearby lymph nodes, and M indicates whether the cancer has metastasized to other organs in the body. A small tumor that has not spread to lymph nodes or distant organs may be staged as (T1, N0, M0), for example.
Group staging, from 0 to IV, for pancreatic cancer follows from TNM categories. Stage 0 is written as (Tis, N0, M0) where Tis stands for carcinoma in situ. This is when the tumor is confined to the top layers of pancreatic duct cells and has not invaded deeper tissues nor spread outside of the pancreas. Stage IV is written as (Any T, Any N, M1) and describes cancer that has spread to distant sites throughout the body.
Physicians also use a simpler staging system that classifies tumors based on the likelihood that they can be surgically removed. Resectable cancers are isolated to the pancreas and can be entirely removed. Locally advanced (unresectable) tumors have not spread to distant organs but cannot be completely removed surgically. Metastatic tumors have spread to distant organs, and surgery would only be used to relieve pain or unblock ducts
Diagnosis
Diagnosis is
done by imaging, such as CT scan, MRI, CT guided fine needle biopsy (FNAC) and
a blood test to detect a specific
protein called CA 19.9, the level of which is elevated in pancreatic cancer. It
is not always possible to do preoperative biopsy or FNAC successfully, and it
frequently happens that the surgeon decides to operate on clinical and radiological
suspicion alone. During the operation, a frozen section biopsy is used to
confirm the disease.
Treatment
Upon diagnosis,
the fate of the affected person hinges on whether the cancer is limited to the
pancreas and, if so, whether it can be surgically removed. Like most other
solid cancers, surgery is the keystone to the treatment of this cancer. If the
cancer has spread to other distant organs such as the liver, it is in the incurable
stage and the average survival of these patients is 6 to 9 months from diagnosis.
Anticancer chemotherapy drugs can be used to ameliorate the painful symptoms,
but it does not increase survival at this stage. If the cancerous tumour is not
limited to the pancreas but has extended to involve surrounding vital
structures, then it is inoperable, which means it cannot be surgically removed.
These patients are treated with a combination of chemotherapy and radiotherapy,
which can give an extended survival of
42 to 60 weeks.
If the tumour is
limited to the pancreas and is operable, then surgery carries the best chance
of cure. The operation varies according to where the tumour is located. If it
is in the head of the pancreas, then the surgery is called a Whipple procedure (pancreaticoduodenectomy).
This is a long and complicated surgery carrying significant chance of
post-operative complications and even death, up to 5 per cent.
If successful,
it carries a 5 year survival rate of 20 per cent, which means that 20 per cent
of patients are likely to live more than 5 years. The average survival of these
patients is 19 months. If the tumour is in the mid-part or body of pancreas, it
is rarely operable, but sometimes a total pancreatectomy or removal of whole pancreas
can be done. For cancers in the tail of the pancreas, a distal pancreatectomy
operation with removal of the spleen is done.
Of all the
patients diagnosed with pancreatic cancer, 80 per cent are inoperable at
diagnosis. Surgery is also not a guarantee of cure. Thus it is apparent that
treatment options for this disease are limited, even when detected relatively
early. Research is ongoing to find better options. As of now, it appears that prevention
is better than cure, and therein lies the importance of a healthy lifestyle.
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