Pancreatic cancer is a malignant neoplasm that develops from glandular tissue or ducts. Pancreatic cancer affects the organ and very quickly invades nearby tissues. The symptoms of pancreatic cancer are often invisible until the final stages occur. The first signs of pancreatic disease begin to appear when the formation increases in volume and begins to spread in the body, metastasizing to the lymph nodes, liver, bones, lungs and other organs and systems.
The Scientific and Practical Surgery Center has ultra-modern equipment to combat cancer. Diagnosis and treatment are carried out by highly qualified specialists who have modern methods of treatment, who have undergone practical and theoretical training in advanced cancer treatment technologies in recognized global cancer centers.
Causes of pancreatic cancer, key risk factors
This is a small organ that is located in the abdominal cavity below the liver and behind the lower half of the stomach. There are two types of cells in the gland: exocrine cells produce enzymes that help the body digest food, and endocrine cells produce hormones, including insulin, that help control blood glucose.
Tumors form when damaged or mutated cells grow uncontrollably, divide and damage gland tissue and surrounding organs. Most malignant processes develop in exocrine cells. The exact cause and mechanism of how pancreatic cancer develops is unknown, but several risk factors are associated with the disease. These include:
- long history of smoking and drinking alcoholic beverages;
- obesity, especially with a BMI exceeding 30;
- having a close relative with pancreatic problems;
- diabetes (mainly type 2Source: The relationship between diabetes mellitus and pancreatic cancer. Kashintsev A.A., Kokhanenko N.Yu. Siberian Journal of Oncology, 2013. pp. 36-39);
- chronic pancreatitis, especially in males Source: Chronic pancreatitis and pancreatic cancer. Lazebnik L.B., Vinokurova L.V., Yashina N.I., Bystrovskaya E.V., Bordin D.S., Dubtsova E.A., Orlova Yu.N. Experimental and clinical gastroenterology, 2012. p. 3-9.
The risk of developing signs of pancreatic cancer increases dramatically as you age. According to international statistics, 97.5% of all new diagnoses occur in people 45 years of age and older. Approximately 89% of all new diagnoses occur in people 55 years of age and older. 66.5% of all new cases are in people over 65 years of age.
Pancreatic cancer: possible symptoms and warning signs
Sometimes the first symptoms of pancreatic cancer are atypical, mild and vague, similar to many other problems. Pain (usually in the abdomen or back), weight loss, jaundice (yellowish discoloration of the skin and/or eyes) with or without itching, loss of appetite, nausea, bowel changes, pancreatitis and sudden onset diabetes are symptoms that may indicate pancreatic cancer. glands. If a patient experiences one or more of these symptoms, it is strongly recommended to immediately consult a doctor and undergo a diagnosis.
Neuroendocrine tumors are rarely diagnosed, accounting for about 7% of all organ cancers. They can cause the pancreas to overproduce hormones. High levels of these hormones in the blood lead to symptoms such as weight loss, nausea, vomiting, muscle weakness and skin rashes. The very first signs of pancreatic cancer:
Bloating (ascites) is an abnormal accumulation of fluid in the abdominal cavity. Excess fluid causes swelling and bloating.
Pain syndrome, mainly in the upper abdomen or middle back, can be caused by the pressure of the tumor on the nerves or organs near the pancreas as the tumor grows into them. Pain may also occur if a tumor blocks the digestive tract.
Poor appetite, indigestion and nausea are common symptoms of pancreatic cancer. Some or all of these symptoms may occur when the tumor presses on the stomach or the beginning of the small intestine. In this case, food may remain in the stomach and cause some digestive problems, including nausea and vomiting. Symptoms of indigestion may also occur due to a blockage of the pancreatic duct through which enzymes flow, or due to changes in the activity of the organ.
Jaundice is a yellowing of the skin and eyes caused by excess bilirubin (a component of bile) in the blood. A tumor in the head of the pancreas can cause a narrowing of the bile duct and block the flow of bile from the gallbladder into the small intestine. A blocked bile duct causes bilirubin to accumulate. People with jaundice may also experience itchy skin, abnormally dark urine, and light-colored or clay-colored stools.
One of the manifestations of pancreatic cancer is intestinal symptoms and stool changes. Many patients with pancreatic cancer experience diarrhea, constipation, or both. Diarrhea – loose, watery, greasy stool with an unpleasant odor, can be caused by insufficient pancreatic enzymes in the intestines. This leads to malabsorption as undigested food quickly passes through the digestive tract. Constipation is also a common problem, especially in patients taking painkillers. These medications slow down the passage of food through the intestines. If the digestive system works too slowly, stools may become dry, hard, and difficult.
Acute weight loss (also known as cancer cachexia) is a complex problem that affects how the body uses calories and protein. Cancer cachexia can cause the body to burn more calories than usual, break down muscle, and reduce appetite. The person may also notice a change in appetite or desire to eat certain foods.
Cancer causes changes in the blood that can increase the chance of clots (blood clots) forming. Blood clots may go undetected and cause no symptoms. However, they are often associated with swelling, pain, and tenderness in the affected area.
Symptoms of the disease
Signs of the disease predominantly appear already at a late stage of development, when the malignant formation blocks the lumens of the glandular ducts, puts pressure on neighboring organs and causes extensive intoxication of the body with decay products.
The first symptom is often pain. It appears due to cancer of the nerve endings. The intensity of pain can range from mild discomfort to acute attacks. Strengthening is observed in a lying position, after drinking alcohol, spicy or fatty foods. Depending on where the main source of pain is located, you can understand which part of the gland is susceptible to the pathological process:
- girdling pain – the entire organ;
- on the left in the upper abdomen - tail;
- in the right hypochondrium - the head.
In addition to pain, patients with pancreatic cancer often develop thrombosis, accompanied by tissue swelling, redness of the skin, and local fever.
Another sign of this type of oncology is obstructive jaundice. It manifests itself in the form of yellowed mucous membranes, eye sclera, skin, enlarged abdomen, discolored feces and too dark urine.
Intoxication of the body at stage 4 of pancreatic cancer causes an increase in body temperature, sudden weight loss, deterioration of mood and appetite, apathy, lethargy, and fatigue.
Types of pancreatic cancer
Experts identify several forms of pancreatic cancer. Exocrine cells, which make up the majority of pancreatic cells, are found in the glands and ducts of the organ. About 90% of all pancreatic cancers form in exocrine cells and are considered pancreatic adenocarcinomas. Adenocarcinomas are tumors that form in mucus-secreting glands.
About 5% of all pancreatic cancers form in endocrine cells and are considered neuroendocrine tumors (NETs). They are also called islet cell cancer because the endocrine cells are often found in clusters called islets.
Stages of pancreatic cancer
After a diagnosis of pancreatic cancer is made, doctors will try to find out the stage. It describes how serious cancer is and how best to treat it. Doctors also use cancer stage when talking about survival statistics.
The earliest stage of pancreatic cancer is stage 0 (carcinoma in situ), followed by stages I (1) to IV. Typically, the lower the number, the less the cancer has spread. A higher number, such as stage IV, means the cancer is in the most advanced stage.
The most commonly used system for pancreatic cancer is the TNM system, which is based on 3 key pieces of information:
Tumor size (T): How big the tumor is and whether it has grown outside the pancreas into nearby blood vessels.
Spread to nearby lymph nodes (N): Whether the cancer has spread to nearby lymph nodes. If yes, how many lymph nodes are affected by cancer.
Spread (metastasis) to distant sites (M): Whether the cancer has spread to distant lymph nodes or distant organs, such as the liver, peritoneum (the lining of the abdomen), lungs, or bones.
Tumor architecture describes how cancer cells look like normal tissue under a microscope.
Level 1 (G1) means the cancer is very similar to normal pancreatic tissue.
Grade 3 (G3) means the cancer appears very abnormal.
Level 2 (G2) is somewhere in the middle.
Low-grade (G1) cancers tend to grow and spread more slowly than high-grade (G3) cancers. In most cases, grade 3 pancreatic cancer has a poor prognosis compared to grade 1 or 2 pancreatic cancer.
Possibility of resection. For patients, an important factor is the size of the resection – whether the entire tumor will be removed:
R0 : The cancer is considered completely removed. (There are no visible or microscopic signs indicating that cancer remains)
R1 : All visible cancer was removed, but laboratory tests of the removed tissue indicate that some small areas of cancer likely remain.
R2 : Some visible tumors could not be removed.
What is irreversible electroporation (“nanoknife”)?
Irreversible electroporation is a technology that has only recently begun to be used in the treatment of pancreatic diseases. It is indicated for inoperable tumors that have invaded large blood vessels.
The essence of irreversible electroporation is the use of electric current to destroy malignant cells. The method is very effective in treating cancer in Israel.
Irreversible electroporation uses an electric current. Many years ago, researchers used it to transfect cells. Scientists simply passed a current through the cell, thereby piercing the cell membrane to create a small hole, and injected DNA into the cell . The holes eventually healed. This procedure is called reversible electroporation.
Irreversible electroporation is used in the treatment of pancreatic diseases. This uses a powerful electric current that does not produce heat. It causes irreversible damage to the membranes of malignant cells. After the cell is saturated with water through the resulting hole, it dissolves and dies.
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Diagnosis of pancreatic cancer
Often in the initial stages there are almost no symptoms Source: Difficulties in diagnosing pancreatic cancer. Evdokimova S.Yu. E-Scio, 2021. This may make diagnosis difficult. In addition to examination and standard tests, it is necessary:
An ultrasound scan is a painless procedure that uses high-frequency sound waves to create images of the body's organs. However, this type of scan can often miss the early stages of pancreatic cancer because the ultrasound waves do not always penetrate deep into body tissue well.
Computed tomography (CT) scans provide detailed images of internal organs using a series of X-rays. The doctor can use the results of the CT scan to check for abnormalities and estimate the size of the tumor.
Magnetic resonance imaging (MRI) also provides images of the gland, but uses strong magnetic and radio waves instead of X-rays. An MRI allows the doctor to check for signs of metastases.
A positron emission tomography (PET) scan can help show where the cancer is and whether it has spread throughout the body.
Endoscopic retrograde cholangiopancreatography is a procedure used to insert a plastic tube or stent into the bile duct for jaundice.
Laparoscopy is a surgical procedure that allows the surgeon to gain access to the inside of the abdomen and pelvis. During the procedure, a small incision is made in the abdomen and a laparoscope (a thin, flexible microscope) is inserted. This will allow the surgeon to look into the abdomen and make sure that the tumor has not spread before recommending its removal.
A biopsy involves taking a sample from a suspected tumor, which can then be tested to determine whether it is cancerous.
Pancreatic cancer: treatment
The treatment regimen is drawn up taking into account the stages, size of the lesion and age, general condition and personal preferences of the patients. The first goal will be to completely remove the tumor and any other cancer cells in your body. If this is not possible, the focus will be on preventing tumor growth while improving overall health. Source: Diagnosis and Treatment of Pancreatic Cancer. Patyutko Yu. I., Sagaidak I. V. Bulletin of the Russian Cancer Research Center named after. N. N. Blokhin RAMS No. 2, 2006. p. 36-37.
There are three main methods of treatment:
- operation;
- chemotherapy;
- radiation therapy.
Some types of cancer in this location require only one form of treatment, while others may require two or a combination of all three.
Typically, surgery is the only way to completely cure pancreatic cancer. However, because the condition usually progresses by the time it is diagnosed, surgery is only suitable for about 15-20% of people.
This is not a suitable option if the tumor is localized around important blood vessels or has spread to other parts of the body.
Although surgery may not be an appropriate way to remove the tumor, doctors may suggest it to relieve symptoms. This type of surgery will not cure the cancer, but it will delay complicationsSource: Pancreatic Cancer: Indications for Surgery. Keck T. Medical Council, 2010. p. 65-68.
Chemotherapy is a type of cancer treatment that uses anti-cancer drugs that either kill cancer cells or stop them from multiplying. Chemotherapy treatment is often used along with surgery and radiation therapy to ensure that as much of the cancer as possible is treated.
Chemotherapy may be prescribed:
- before surgery - try to shrink the cancer;
- after surgery - to reduce the risk of cancer recurrence;
- when surgery is not possible, try to shrink the cancer, slow its growth and relieve symptoms.
Some chemotherapy drugs can be taken by mouth, but some must be given intravenously.
Radiation therapy is a form of cancer treatment that uses high-energy beams of radiation to shrink tumors and relieve pain.
Pancreatic tumor treatment:
Surgical methods:
Pancreaticoduodenal resection – removal of the head and body of the pancreas, duodenum 12, part of the common bile duct and stomach.
Tail pancreatic resection is the removal of the distal part of the pancreas along with the spleen and lymph nodes.
Palliative surgery is performed when the tumor is unresectable, its purpose is to make the person’s life easier.
Chemotherapy is the introduction into the patient’s body of chemotherapy drugs that destroy cancer cells.
Radiation therapy (radiotherapy ) is the irradiation of cancer cells with a small dose of x-rays, during which they are destroyed.
Pancreatic cancer: prognosis for life
To develop treatment, doctors use a simpler staging system that divides cancers into groups based on whether they can be removed by surgery:
- operable cancer;
- border operability;
- inoperable (locally advanced or metastatic).
Operable cancer . When the lesion is located only in the pancreas (or has spread not far beyond), the treating surgeon considers that the entire tumor can be removed, this is called resectable. (Usually includes most TNM stage IA, IB, and IIA cancers.)
Borderline . This term is used to describe certain types of cancer that may have just reached nearby blood vessels, but which doctors believe can be completely removed by surgery.
Inoperable . These cancers cannot be completely removed by surgery. If the cancer has spread to distant organs, it is called metastatic (stage IV). These cancers cannot be completely removed. Surgery is still an option, but the goal will be to prevent or relieve symptoms rather than try to cure the cancer.
Tumor markers are substances that can sometimes be found in the blood due to cancer. CA 19-9 is a tumor marker that may be useful in therapy. Decreased CA 19-9 levels after surgery (compared to preoperative levels) and low CA 19-9 levels after pancreatic surgery often predict a better prognosis.
Which patients can undergo minimally invasive pancreatic surgery?
Most patients are candidates for minimally invasive pancreatectomy. This operation is contraindicated only for 2 categories of patients :
- those who have undergone several surgical operations in the past ;
- those who have complex tumors that have grown into large blood vessels.
Before consenting to surgical treatment, it is advisable for the patient to consult with a surgeon who performs both minimally invasive and open surgeries. Such a specialist will be able to individually select the most suitable method of tumor removal.
Prevention
The basis of prevention is maintaining a healthy lifestyle and eliminating all possible risk factors.
Article sources:
- Pancreas cancer. Foltz E.E. Bulletin of medical Internet conferences No. 3, 2021. p. 146-151
- Diagnosis and treatment of pancreatic cancer. Patyutko Yu. I., Sagaidak I. V. Bulletin of the Russian Cancer Research Center named after. N. N. Blokhin RAMS No. 2, 2006. p. 36-37
- Difficulties in diagnosing pancreatic cancer. Evdokimova S.Yu. E-Scio, 2019
- Pancreatic cancer: indications for surgery. Keck T. Medical Council, 2010. p. 65-68
- Chronic pancreatitis and pancreatic cancer. Lazebnik L.B., Vinokurova L.V., Yashina N.I., Bystrovskaya E.V., Bordin D.S., Dubtsova E.A., Orlova Yu.N. Experimental and clinical gastroenterology, 2012. p. 3-9
- Genetic aspects of pancreatic cancer. Grigorieva I.N., Efimova O.V., Suvorova T.S., Tov N.L. Experimental and clinical gastroenterology, 2014. p. 70-76
- Diagnosis and surgical treatment of pancreatic cancer. Norbert Hüser, Volker Assfalg, Daniel Hartmann, Daniel Reim, Alexander Novotny, Edouard Matevossian, Helmut Friess. Experimental and clinical gastroenterology, 2011. p. 102-111
- Results of surgical treatment of pancreatic cancer. Mikhailov I.V., Bondarenko V.M., Kudryashov V.A., Prigozhaya T.I., Podgorny N.N., Shimanovsky G.M., Starinchik V.I., Novak S.V., Atamanenko A. .V., Dovidovich S.V., Kravchenko O.V., Nesterovich T.N., Achinovich S.L. Problems of health and ecology, 2014. p. 46-51
- The relationship between diabetes mellitus and pancreatic cancer. Kashintsev A.A., Kokhanenko N.Yu. Siberian Journal of Oncology, 2013. p. 36-39
The information in this article is provided for reference purposes and does not replace advice from a qualified professional. Don't self-medicate! At the first signs of illness, you should consult a doctor.
