Pancreatic Cancer is cancer which starts in the organ behind the lower part of the stomach (pancreas – gland located deep in the abdomen, between the stomach and the spine). It begins when abnormal cells in the pancreas grow and divide out of control and form a tumor. It helps to makes enzymes for digestion and hormones which could control blood sugar levels.
Some organs are made up of cells, so does pancreas. Cells divide to form new cells as per the body’s requirement. Usually, old cells died and a new cell takes the place. But sometimes the process breaks. New cells form or old cells do not die, even if the body does not need them. The extra cell may form a mass of tissue which is known as a tumor.
Few tumors are mild which means they are unnatural but cannot penetrate other parts of the body. A destructive tumor is called cancer. The cells develop out of control and can expand to other tissues and organs.
Even if cancer expands to other areas of the body, it is still called pancreatic cancer if that is where it started. It often spreads to the liver, abdominal wall, lungs, bones and/or lymph nodes.
Types of Pancreatic Cancer
Pancreatic cancer is divided into two forms:
Exocrine tumors: It is the most common type of pancreatic cancer. Adenocarcinoma is the most basic type of exocrine tumor. These tumors normally start in the tubes of the pancreas, called ductal adenocarcinoma. If the tumor arises in the acini, it is called acinar adenocarcinoma.
A frequently common diagnosis is named intraductal papillary mucinous neoplasm (IPMN). An IPMN is a tumor which grows inside the pipes of the pancreas and makes a solid-fluid called mucin. IPMN is not cancerous in the beginning but if not treated early could become cancerous. Sometimes, an IPMN has already worsened and convert cancer by the time it is operated. Some rare types of exocrine pancreatic tumors are acinar cell carcinoma, adenosquamous carcinoma, colloid carcinoma, giant cell tumor, hepatoid carcinoma, mucinous cystic neoplasms, pancreatoblastoma, serous cystadenoma, signet ring cell carcinoma, solid and pseudopapillary tumors, squamous cell carcinoma, and undifferentiated carcinoma.
Endocrine tumors: These are also known as pancreatic neuroendocrine tumors (PNETs) or islet cell tumors. They are not similar to exocrine tumors. A pancreatic neuroendocrine tumor functions a few times only. Only a functioning tumor makes hormones. A functioning neuroendocrine tumor is defined based on the hormone made by cells. They include: Insulinoma, Gastrinoma, Glucagonoma, Somatostatinoma, VIPomas, PPomas
Risk Factors
- Age: risk of developing pancreatic cancer increases with age
- Gender: More females are affected rather than males
- Smoking & Drinking: access amount may be the cause of a pancreatic cancer in early age
- Obesity and diet: being overweight
- Diabetes
- Family history of pancreatic cancer
- Rare inherited condition
Symptoms
In the majority of cases, symptoms develop after the growth of pancreatic cancer.
Signs of Pancreatic Cancer may include:
- Jaundice (yellow eyes, Light-colored or greasy stools, Dark urine, itchy skin)
- Belly(abdomen) pain or back pain
- Weight loss and poor appetite (bloating)
- Nausea and vomiting
- Gallbladder or liver enlargement
- GI Bleeding
- Worsening of diabetes
These signs usually do not mean you have pancreatic cancer. But if you see one or more of them for more than two weeks, consult your doctor.
Diagnosis
Doctor may have you undergo the following tests if suspects pancreatic cancer
- Imaging tests: (creates pictures of your internal organs) these examinations assist your doctors to visualize your internal glands, including the pancreas. The methods used to diagnose pancreatic cancer are ultrasound, computerized tomography (CT) scans, magnetic resonance imaging (MRI) and, sometimes, positron emission tomography (PET) scans.
- Ultrasound: (Using a scope to create pictures of your pancreas) An endoscopic ultrasound (EUS) uses an ultrasound device to take pictures of your pancreas from inside your abdomen. The device is transferred through a thin, flexible tube (endoscope) down your esophagus and into your stomach to obtain the images.
- Biopsy: (Removing a tissue sample for testing) It is a method to extract a tiny sample of tissue for a test under a microscope. Your doctor may collect a sample of tissue from the pancreas by injecting a needle through your skin and into your pancreas (fine-needle aspiration). Or by removing a sample during EUS, guiding special tools into the pancreas.
- Blood test: The doctor test the blood for specific proteins (tumor markers) shed by pancreatic cancer cells. The market test used in one tumor marker in pancreatic cancer is called CA19-9. There is no guarantee of the test and it is not clear how best to use the CA19-9 test results. Some doctors rank your levels throughout the treatment.
If pancreatic cancer confirms after the diagnosis, then the Doctor determines the extent (stage) of cancer. Doctor assigns a stage of pancreatic cancer after the stage tests. It helps to decide the most likely treatments.
Treatments
Your pancreatic cancer treatment by Dr. Swapnil Sharma may include one or more of the following therapies:
Surgery
- Whipple procedure: A surgical method in which the head of the pancreas, the gallbladder, part of the stomach, part of the small intestine, and the bile duct are removed. Enough of the pancreas is left to produce digestive juices and insulin.
- Total pancreatectomy: This surgery removes the whole pancreas, part of the stomach, part of the small intestine, the common bile duct, the gallbladder, the spleen, and nearby lymph nodes.
- Distal pancreatectomy: Operation to remove pancreas body and the tail. The spleen may also be removed if cancer has spread to the spleen.
If cancer has grown and cannot be removed, the following types of palliative surgery may be done to relieve symptoms and improve quality of life:
- Biliary bypass: If cancer is obstructing the bile duct and bile is building up in the gallbladder, a biliary bypass may be done. During this operation, the doctor will cut the gallbladder or bile duct in the area before the blockage and sew it to the small intestine to create a new pathway around the blocked area.
- Endoscopic stent placement: If the tumor blocks the bile duct, an operation may be done to put in a stent (a thin tube) to drain bile that has built up in the area. The surgeon may place the stent through a catheter that drains the bile into a bag on the outside of the body or the stent may go around the blocked area and drain the bile into the small intestine.
- Gastric bypass: If the tumor blocks the flow of food from the stomach, the stomach may be sewn directly to the small intestine so the patient can continue to eat normally.
Chemotherapy Systemic Chemotherapy :
drugs are used to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body. Regional Chemotherapy : drugs are placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas. Combination chemotherapy : Uses more than one anticancer drug. The way the chemotherapy is given depends on the type and stage of the cancer being treated.Targeted therapy
It is type of treatment that uses drugs or different machines to identify and attack specific cancer cells without harming normal cells.
Radiation therapy
It uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy:
- External radiation therapy: A machine outside the body send a radiation toward cancer.
- Internal radiation therapy: radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near cancer.
Both depends on the type and stage of the cancer being treated. Healing from Surgery Most people who have pancreatic cancer surgery heal without any problems. These people go home within 2-to-4 days. A fewer number of patients may have a slower recovery and need to wait for a little more. A surgeon will give you guidance on how to take care of yourself, including your surgery, bathing, driving, and sexual activity. There will be information about yourself:
- Diet
- Exercise
- Pain medicine
- Bowel movements
After Treatment, you will be given a Daily Goals Checklist. Use that checklist to understand how you are doing every day.
Follow up appointments
After you’ve completed your treatments for Pancreatic cancer, follow-up care is very essential. Routine checkups can help find any changes in your health, and if cancer comes back (or “recurs”), it must be treated as soon as possible.
If your treatment has finished, follow-up is required every 3−6 months for the first couple of years and then every 6−12 months for the following 3 years.
Your doctor may check your CEA level before you begin treatment and again after treatment to understand if it has come down.
Doctors recommend CT scans of the chest, abdomen, and pelvis for 3 years in people who are at high risk for recurrence.
Why Choose Dr. Swapnil Sharma
Dr. Swapnil Sharma, is pancreatic surgeon, practicing in Mumbai who is doing all types of pancreatic surgery while concentrating on your quality of life. He also offers minimally invasive laparoscopic surgeries depending upon patient's condition and stage of disease hat provide successful treatment with less impact on patients.