The pancreas is a glandular organ of the vertebrate’s digestive system and endocrine system. Pancreatic cancer develops when the cells of the pancreas, begin to multiply uncontrollably forming a mass. These cancerous cells invade other parts of the body.
Cancers developing within the pancreas are two types:
- Endocrine pancreatic cancer – It is the part that makes insulin and other hormones which are known as “islet cell” or “pancreatic neuroendocrine tumors.”
- Exocrine pancreatic cancer – It is the part that makes enzymes.
The pancreatic cancer risk factors are:
- Age: Increasing age above 60 puts an individual at greater risk.
- Hereditary genetic syndromes: Though rarely, there are familial or hereditary genetic syndromes arising from genetic mutations which can run in any family and put individuals at risk, like BRCA-2 and, to a lesser extent, BRCA-1 gene mutations. Familial syndromes are though unusual, but a doctor should be aware know of any family history.
- Race and ethnicity: Some races are more prone to pancreatic cancer. Like African-Americans are at greater risk.
- Tobacco use,
- A sedentary lifestyle,
- A history of diabetes,
- Chronic pancreatic inflammation (pancreatitis),
- A fatty (or Western) diet.
- Certain chronic infections such as hepatitis B and H. pylori.
- Certain drugs sitagliptin and metformin.
- Some types of pancreatic cysts.
Since the pancreas is deeply penetrated gland lying deep in the belly in front of the spine, cancer often grows silently before it is detected. Early symptoms are generally absent. Symptoms are identified once the tumor is developed into larger one and starts pressing other organs.
Frequent sites of metastasis for pancreatic cancer are liver, lymph nodes, and the lining of the abdomen.
General signs and symptoms of pancreatic cancer are produced by the result of blockage of the duct that travels through pancreas from the liver. Symptoms of exocrine pancreatic cancer are:
- dark colored urine,
- Skin becomes itchy,
- light-colored stools,
- pain in back or abdomen,
- poor or loss of appetite,
- weight loss,
- nausea and vomiting
- blood clots, and
- Enlargement of the gallbladder.
The signs and symptoms of endocrine pancreatic cancers are different as they are related to excess hormone production consecutively leading to a variety of symptoms which are:
- Insulinomas: This is Insulin-producing tumors which lower blood glucose level
- Glucagonomas: This is glucagon-producing tumors that can increase glucose levels and it causes symptoms of similar to that of diabetes.
- Gastrinomas: This is gastrin-producing tumors which trigger the stomach to produce acid in large quantities leading to ulcers and anemia.
- Somatostatinomas: This is somatostatin-producing tumors which will result overregulation of other hormones and it produces symptoms of diabetes, diarrhea, jaundice, and other problems.
- VIPomas: In this type, the tumors produce a substance known as vasoactive intestinal peptide (VIP) that causes severe watery diarrhea and digestive problems
- PPomas: In this type, the tumors produce pancreatic polypeptide (PP) that will affect both endocrine and exocrine function leading to abdominal pain and enlarged livers.
- Carcinoid tumors: In this type, the tumors make serotonin, 5-HTP, and causes the carcinoid syndrome.
Most screening tests employed for pancreatic cancer treatment include: doing of CT scans, ultrasounds, magnetic resonance cholangio-pancreatography (MRCP), endoscopic retrograde cholangiopancreatography (ERCP), or endoscopic ultrasounds.
For complaints of nonspecific symptoms, physical examination including blood tests, X-rays, and ultrasound is being done. In an MRI if a pancreatic mass is seen, this raises the suspicion of pancreatic cancer then a biopsy is performed to yield a diagnosis.
In addition to the various radiologic tests, a suspicion of pancreatic cancer might arise from the elevated “tumor marker,” which is a blood test that can be abnormally high in people with pancreatic cancer. But although the CA 19-9 test is cancer-related, it is not specifically indicative of pancreatic cancer.
Liver cancer can be prevented by adopting following healthy ways to life:
- By not smoking,
- Keeping a healthy weight,
- Increased consumption of fruits, vegetables, and whole grains,
- Decreased consumption of red and processed meat,
- Consumption of citrus fruits and curcumin reduced risk of pancreatic cancer.
Once pancreatic cancer is being diagnosed, it is then the stage of this cancer is determined.
There are 4 stages of pancreatic cancer with stage 1 being the earliest stage (stage 0 is not counted) and stage IV being the most advanced (metastatic disease).
According to the National Cancer Institute following are the stages of pancreatic cancer:
Stage 0: Cancer is present only in the lining of the pancreatic ducts. Stage 0 also is known as carcinoma in situ.
- Stage I: Cancer has developed and is in the pancreas only.
- Stage IA: The tumor has become 2 centimeters or smaller.
- Stage IB: The tumor has become larger than 2 centimeters.
Stage II: Cancer has spread or advanced to nearby tissue and organs.
- Stage IIA: Cancer has spread to nearby tissues and organs but not to nearby lymph nodes.
- Stage IIB: Cancer has spread to nearby lymph nodes and to other nearby tissue and organs.
Stage III: Cancer has progressed to the major blood vessels near pancreas and to nearby lymph nodes.
Stage IV: Cancer has spread to distant organs, like liver, lung, and peritoneal cavity. This stage is known as end-stage pancreatic cancer.
Patients with stage I and stage II cancers have local or “resectable” cancer and it can be completely removed with an operation. Patients with stage III cancers have “locally advanced, unresectable” disease which can be treated by treatments like radiations or chemotherapy preferably.
Some common side effects of pancreatic cancer treatment vary according to the type of treatment.
For radiation treatment side effects are fatigue, nausea, and diarrhea. Chemotherapy side effects include fatigue, loss of appetite, change in taste, hair loss and lowering of the immune system with risk for infections.
Other side effects include nausea, vomiting, diarrhea, and constipation.
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