Pancreatic Cancer Symptoms, Risk Factors, Diagnosis and Treatment

Before answering the question of what is pancreatic cancer, it is necessary to explain the answer to the question of what pancreas is. The pancreas is a gland-shaped organ approximately 15 cm in size, considered a part of the digestive system, and located behind the stomach and liver in the body. Digestive enzymes secreted from the pancreas act on the duodenum, and the insulin hormone, which regulates sugar metabolism in the body, mixes directly with the blood. Pancreatic cancer is a malignant disease that develops due to excessive proliferation of cells that make up the pancreas.

What is Pancreatic Cancer?

Pancreatic cancer develops due to mutational changes in pancreatic DNA. These mutations cause pancreatic cells to grow uncontrollably, form masses, and cause normal cells to die or fail to function. If left untreated, they spread to neighboring organs. Pancreatic cancers usually arise from the cells lining the duct through which enzymes are secreted from the pancreas to the digestive tract. This type of cancer is called pancreatic adenocarcinoma or exocrine cancer of the pancreas. More rarely, tumors arising from hormone-producing or neuroendocrine cells of the pancreas may be observed. These types of tumors are called pancreatic neuroendocrine tumors or endocrine cancer of the pancreas.

It is not fully understood what causes pancreatic cancer, but some risk factors have been identified: Age is one of the most important. Because usually the disease affects people between the ages of 50 and 70. Some risk factors that may cause pancreatic cancer have been identified. These factors can be listed as follows.

• smoking
• Diabetes
• Chronic pancreatic inflammation (Pancreatitis)
• Family history of pancreatic cancer
• Obesity

In one in every 10 cases, pancreatic cancer is hereditary. Some genes can cause pancreatitis. This increases the risk of developing pancreatic cancer. If there are 2 or more close relatives with pancreatic cancer, if there is a hereditary disease such as Lynch or Peutz-Jeghers syndrome, or in some syndromes in which a general predisposition to cancer is observed, such as BRCA2 gene mutation, it is beneficial for these patients to be checked more frequently, as the risk of pancreatic cancer will increase.

What are the symptoms of Pancreatic Cancer?

In the early stages, a tumor in the pancreas usually does not cause any symptoms. This can make diagnosis difficult. Pancreatic tumors usually begin to show symptoms after spreading to surrounding organs.

• Abdominal pain radiating to the back

The first noticeable symptom of pancreatic cancer is pain in the back or stomach area.

• weight loss

Loss of appetite or sudden weight loss without following any diet may be a sign of pancreatic cancer.

• Jaundice

Jaundice, seen on the skin or in the white areas inside the eyes, may occur due to the pancreas blocking the bile duct.

• Darkening of urine color
• Itching

Apart from these, serious weakness/faintness, pale stool color, changes in bowel movements (diarrhea or constipation), fever and chills, indigestion and blockage in the vessels (thrombosis) problems may occur. It should not be overlooked that these symptoms may be caused by many different diseases and are not specific to cancer. However, if these symptoms begin suddenly and continue to increase, a doctor should be consulted.

What are the Stages of Pancreatic Cancer?

Cancer staging is a term used in cancer treatment to determine the spread of cancer. The treatment method for pancreatic cancer is decided by looking at the spread of the cancer. Pancreatic cancer has 4 stages.

Stage 0: There is no spread. At this stage, pancreatic cancer is limited to the uppermost layers of the pancreatic duct. At this stage, cancer cannot be detected with the naked eye or any imaging method.

Stage I: Local growth. At this stage, the cancer is limited to the pancreas. Stage IA when tumor size is up to 2 cm; When it is between 2 and 4 cm, it is defined as Stage IB.

Stage II: There is local spread. Tumor size is larger than 4cm. At this stage, it is either limited within the pancreas or growth outside the pancreas can be observed. Lymph nodes near the pancreas may be involved. But there is no distant propagation.

Stage III: Wider spread. The tumor has invaded nearby large vessels or nerves, but distant metastasis is not detected.

Stage IV: There is distant organ metastasis.

Pancreatic Cancer Diagnosis and Treatment

In patients presenting with the specified symptoms, the doctor may suspect pancreatic cancer and some tests are performed. Pancreatic cancer may be suspected if there is a palpable mass in the abdomen and signs of enlargement in the liver. Abdominal ultrasound, tomography, MRI or PET-CT examinations are required to confirm the diagnosis and perform staging. Since the pancreas, stomach and liver are behind it, it is difficult to fully visualize it with ultrasound. For this reason, a thin tube called EUS, or endoscopic ultrasonography, can be inserted through the mouth to examine the pancreas through the stomach. With another method called ERCP (endoscopic retrograde cholangiopancreatography), detailed imaging of the pancreas is performed by inserting a tube through the mouth and injecting a special dye into the bile and pancreatic ducts. MRCP (Magnetic resonance cholangiopancreatography) Detailed imaging of the pancreas under MRI is another method used in diagnosis. Definitive diagnosis is made by biopsy by taking a small sample from the suspicious mass accompanied by endoscopic imaging methods. In this biopsy material, the subtype is determined through pathological examinations and molecular analyses, and the treatment plan is planned by staging. Ca19-9, a cancer marker that can be measured in blood, is useful in the diagnosis and follow-up of pancreatic cancer treatment. However, it should be taken into consideration that this marker may be normal in some pancreatic cancers.

It is difficult to diagnose pancreatic cancer at an early stage. Because it rarely causes any symptoms in the early stages. That’s why cancer often goes undetected until it’s quite advanced. If the tumor is large or has spread to other areas in the body, the cancer will be more difficult to treat. Pancreatic cancer treatment is determined by the type and stage of the cancer. Age, general health status and organ function tests should also be taken into consideration in treatment planning. The three main forms of treatment for pancreatic cancer are surgery, systemic therapy and radiotherapy. Systemic treatment consists of chemotherapy, targeted therapies (smart molecules) and immunotherapies (treatment that acts on the immune system). Some stages of pancreatic cancer require only one form of treatment, while others may require combinations of multiple treatment modalities.

Since pancreatic cancer can usually be detected at an advanced stage, the chance of surgery is limited to some cases. If the cancer is located in the head of the pancreas, the pancreas can be removed using an extensive surgery called the Whipple procedure. In this technically difficult procedure, the head of the pancreas, part of the duodenum, gallbladder, part of the bile duct, and nearby lymph nodes may be removed. The remaining part of the pancreas and the stomach are then connected together. It is also possible to surgically remove tumors located in other parts of the pancreas. Patients whose entire pancreas has been removed must take insulin and other pancreatic enzymes externally throughout their lives. If pancreatic cancer has spread to large blood vessels adjacent to the pancreas, surgical treatment is usually not applied.

Technological developments in the medical world in recent years have increased the success rate in the treatment of pancreatic cancer. Satisfactory results can be achieved in the treatment of pancreatic cancer caught at an early stage. Many clinical trials are ongoing with many newly discovered or produced systemic treatment agents in this field.

If you have the symptoms mentioned or if there is a family history of pancreatic cancer, do not forget to have your check-ups. To learn more about pancreatic cancer or its treatment, you can make an appointment with our multidisciplinary expert staff.