Pancreatic cancer arises when cells in the pancreas, a glandular organ behind the stomach, begin to multiply out of control and form a mass. These cancerous cells have the ability to invade other parts of the body. There are a number of types of pancreatic cancer. The most common, pancreatic adenocarcinoma, accounts for about 85% of cases, and the term "pancreatic cancer" is sometimes used to refer only to that type. These adenocarcinomas start within the part of the pancreas which make digestive enzymes. Several other types of cancer, which collectively represent the majority of the non-adenocarcinomas, can also arise from these cells. One to two in every hundred cases of pancreatic cancer are neuroendocrine tumors, which arise from the hormone-producing cells of the pancreas. These are generally less aggressive than pancreatic adenocarcinoma. However, when the cancer grows, symptoms include:
- Pain in the upper abdomen from the tumor pushing against nerves.
- Loss of appetite, nausea, and vomiting.
- Significant weight loss and weakness.
- Sudden onset of glucose tolerance disorder, such as diabetes.
- Black or bloody stool, indicating bleeding from the digestive tract.
- Enlarged liver and gallbladder.
Types of Pancreatic Cancer
There are several types of Pancreatic Cancer, depending on whether the cancer begins in the exocrine or endocrine component. :-
Exocrine Tumors : Pancreatic cancer can result from a mutation in either the exocrine or endocrine function of the pancreas. Exocrine tumors are far more common, accounting for 95% of all cases. Adenocarcinoma is an exocrine tumor and is the most common kind of pancreatic cancer (80-90%). Adenocarcinoma arises from abnormal cells lining the pancreatic duct. These cells may form glands, or a collection of cells surrounding an empty space. Unless otherwise specified, nearly all accounts of pancreatic cancer refer to adenocarcinoma.
Endocrine Tumors: These are also called islet cell tumors or pancreatic neuroendocrine tumors (PNETs). They are much less common than exocrine tumors, making up about 1% of pancreatic cancers. A pancreatic neuroendocrine tumor can be functioning, meaning it makes hormones, or nonfunctioning, meaning it doesn’t make hormones.
Diagnosis of Pancreatic Cancers
Ultrasound: An ultrasound scan uses high-frequency sound waves to produce an image of the inside of your body.
Computerised Tomography (CT) Scan:A computerised tomography (CT) scan is able to produce a detailed image of the inside of your body using a series of X-ray images.
Magnetic Resonance Imaging (MRI) Scan: A magnetic resonance imaging (MRI) scan also produces an image of the inside of your body, but uses strong magnetic and radio waves instead of X-ray images.
Endoluminal Ultrasonography (EUS) :If a small shadow is seen on a CT or MRI scan but it is not obvious what this is, another test can be performed called endoluminal ultrasonography (EUS).
Endoscopic Retrograde Cholangiopancreatography (ERCP): Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure used to insert a plastic tube or stent into the bile duct if someone has jaundice.
Laparoscopy: A laparoscopy is a surgical procedure that allows the surgeon to access the inside of the abdomen (tummy) and the pelvis.
Biopsy: A Biopsy involves taking a small sample of cancerous cells from a suspected tumour. These cells can then be tested in a laboratory to see if they are cancerous (malignant) or non-cancerous (benign).
Treatment of Pancreatic Cancer at Super Speciality Hospitals in India
Surgery: Surgery may be used to remove all or part of the pancreas. If a cancer has not metastasized, it is possible to completely cure a patient by surgically removing the cancer from the body. There are three main surgical procedures that are used when it seems possible to remove all of the cancer:
Whipple Procedure:The Pancreas head, and sometimes the entire organ, is removed along with a portion of the stomach, duodenum, lymph nodes, and other tissue. The procedure is complex and risky with complications such as leaking, infections, bleeding, and stomach problems.
Distal Pancreatectomy:A Distal Pancreatectomy is where the bottom half of the pancreas is removed by a surgical procedure. The most frequent reason for performing a distal pancreatectomy is the presence of a tumor in the body or tail of the pancreas.
Central Pancreatectomy::In a Central Pancreatectomy, a tumor in the neck or body of the pancreas is removed while preserving the healthy head and tail of the pancreas.
Total Pancreatectomy: In a Total Pancreatectomy, the entire pancreas is removed. Similar to a Whipple procedure, a portion of the stomach, duodenum, gallbladder, and local lymph nodes are also removed. The spleen may be removed as well. This procedure is used when malignant cells have invaded most of the pancreatic tissue.
Laparoscopy: The minimally invasive surgical techniques of laparoscopy are normally used directly before a scheduled pancreatic resection to determine if a more invasive operation is the best course of action. Since metastases can sometimes be missed on CT, MRI or other imaging studies, laparoscopy is a reliable way to check for metastasis to other organs. If metastases are found and the surgeon decides an operation is not the best course of action, then the patient will have a shorter recovery time compared to that of a major surgery and will be in better shape to receive alternate forms of treatment.
Chemotherapy:Chemotherapy uses drugs to help kill cancer cells. Chemotherapy can be injected into a vein or taken orally. Chemotherapy can also be combined with radiation therapy (chemoradiation). Chemoradiation is typically used to treat cancer that has spread beyond the pancreas, but only to nearby organs and not to distant regions of the body. This combination may also be used after surgery to reduce the risk of recurrence of pancreatic cancer.
Radiation therapy: It destroys cancer by focusing high-energy rays on the cancer cells. This causes damage to the molecules that make up the cancer cells and leads them to commit suicide. Unlike chemotherapy which is a systemic treatment, radiation therapy is a local treatment meant to destroy only tumor cells. During the treatment, a beam of radiation is directed through the abdomen to the cancerous area. The radiation is similar to that used for diagnostic X-rays, only in a higher dose.
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