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Pancreatic cancer Causes, Symptoms and Treatment

The pancreas is a digestive gland about 15 cm long, lodged deep in the abdomen, behind the stomach and enclosed in the duodenum which is the first part of the small intestine.

– It intervenes in the digestion by secreting pancreatic enzymes. This is its so-called exocrine function.

– It plays a vital role in regulating the level of glucose in the blood by secreting hormones such as insulinand glucagon. This is its endocrine function.

The pancreatic cancer is due to the formation of a malignant tumor, that is to say, the abnormal proliferation of succeptible cancer cells to spread elsewhere in the body. More than 95% of pancreatic tumors affect the exocrine function region of the pancreas, that is, the pancreatic enzyme that is needed for digestion. These are usually adenocarcinomas . This sheet is devoted exclusively to this type of tumor.

This file does not deal with other forms of pancreatic cancer, which are less common, neuroendocrine tumors (2 to 3% of pancreatic tumors), cystadenocarcinoma (1% of pancreatic cancers), and others more rare such as pancreatoblastomas, malignant oncocytomas, acinar tumors, and various types of carcinomas.

Evolution and prevalence

Pancreatic cancer accounts for about 2% of new cancer cases detected each year in Canada. In France, the number of new cases of pancreatic cancer is estimated at about 9,000 every year. It concerns both men and women, and for the most part people aged 50 or over.

Symptoms of pancreatic cancer

Because of their deep position in the abdomen, pancreatic tumors can remain for a long time without causing symptoms. It is therefore difficult to detect pancreatic cancer at an early stage. On the other hand, the symptoms caused by pancreatic cancer are not specific and may correspond too many other digestive diseases.

  • Persistent abdominal pain in the upper abdomen that can spread to the back;
  • Jaundice (jaundice)  : complexion and yellow eyes, discolored stools and dark urine in case of compression of the bile ducts by the tumor located in the pancreas,
  • Feeling of bloating, feeling full stomach even after eating a little;
  • Nausea, vomiting;
  • Unexplained weight loss
  • Loss of appetite;

Extreme and generalized fatigue.

These signs are therefore not typical and may correspond too many more commonplace digestive disorders. It is therefore essential, in view of the persistence of these signs, to consult a doctor to determine the cause, especially for people at risk.

Risk factors

  • People with relatives of people with pancreatic cancer
  • Those who have a parent who has suffered from chronic hereditary pancreatitis ( inflammation of the pancreas), hereditary colorectal cancer or hereditary breast cancer, Peutz-Jeghers syndrome or multiple familial nevus syndrome ;
  • People with diabetes, but it are not known if in this case, cancer is a cause or consequence of diabetes.
  • Smoking. Smokers are 2 to 3 times more likely than non-smokers;
  • Obesity, high calorie diet, low in fiber and antioxidants
  • The role of alcohol is discussed. It promotes the occurrence of chronic pancreatitis, which in turn increases the risk of developing pancreatic cancer
  • Exposure to aromatic hydrocarbons, organophosphorus insecticides, petrochemical industry, metallurgy, sawmills

Prevention

It is not known how it would be possible to prevent pancreatic cancer. However, the risk of developing it by avoiding smoking, maintaining a healthy diet and regular physical activity can be reduced.

Diagnostic means of pancreatic cancer

Because of its deep location, pancreatic tumors are difficult to spot early and further tests are essential.

The diagnosis is based on the abdominal CT, supplemented if necessary by an ultrasound, an endoscopy of the bile ducts or pancreas.

Biological tests look for tumor markers in the blood (tumor markers are proteins produced by cancer cells that can be assayed in the blood)

Complementary treatments and approaches to pancreatic cancer

The treatments chosen vary according to the stage of the tumor, its location, its aggressiveness and its extension to the ganglia, neighboring organs or at a distance (metastases)

The surgery is for non-metastatic tumors, limited to the pancreas or at least not having invaded large vessels. It is not feasible when the tumor is spread to neighboring organs, which would expose to too much risk during the operation. When surgery is not possible, the medical team may use chemotherapy or radiation therapy.

The choice of treatment is discussed in a multidisciplinary consultation involving gastroenterologist, surgeon, oncologist, radiotherapist…. etc. The final decision is made in agreement with the sick person.

Surgery

The type of intervention differs depending on the location of the tumor, head, body or tail of the pancreas. It removes the part of the pancreas concerned by the tumor, as well as depending on the case, a part of the small intestine, stomach, gallbladder or spleen.

These are heavy interventions requiring that the person’s health be otherwise good.

  • Whipple’s operation: this is the surgical procedure performed in the case of a tumor in the right end of the pancreas, linked to the small intestine, called the “head”. It consists of removing the head of the pancreas as well as the gallbladder, part of the stomach and small intestine and the lymph nodes located nearby. This is a major surgery that involves a reconstruction of the digestive tract;
  • Distal pancreatectomy: If the tumor is located elsewhere than in the head of the pancreas, it is sometimes possible to remove the affected part. If necessary, the surgeon also ablates the spleen;
  • Total pancreatectomy: This very rare procedure involves removing the entire pancreas, as well as part of the stomach and small intestine, spleen, gall bladder and lymph nodes.

Sometimes a tumor that was thought to be completely removable (based on various medical examinations done before surgery) cannot be removed. The surgeon can confirm this only at the beginning of surgery.

When the tumor grows, it can compress the nearby organs:

Sometimes the tumor compresses the ducts through which the bile passes. In case of compression of these bile ducts, the surgeon can derive the bile ducts in the small intestine or put in place prostheses to restore their diameter.
– When the tumor compresses the duodenum, it can prevent the passage of the food bolus from the stomach to the intestine, it is possible to derive the stomach directly to the small intestine.

The convalescence following surgery is often difficult, especially if there was a reconstruction of the digestive tract. The person who is operated on may have to spend several days in the intensive care unit. It is first fed by intravenous or by a probe directly connected to the intestine. Subsequently, the power supply must be adapted.

The digestive system needs several days to resume normal operation. Thereafter, the prescription of pancreatic enzymes may be indicated, as well as that of insulin in case of occurrence of diabetes. Indeed, when it removes the entire pancreas, the surgeon eliminates the tumor, but also the cells that make the insulin.

Chemotherapy

Chemotherapy is an intravenous or oral treatment intended to destroy cancer cells. It also does not spare certain healthy cells with side effects, nausea, vomiting, and fatigue, loss of appetite, hair loss and increased risk of infection.

In the case of pancreatic cancer, the medical team may use chemotherapy after surgery to remove cancer cells that may have persisted, or to prevent recurrence. Chemotherapy can also be used to limit the progression of the disease or to reduce the symptoms if a tumor cannot be removed.

Radiotherapy

Radiation therapy is rarely used in the treatment of pancreatic cancer. It consists of sending radiation to a specific area of ​​the body to destroy the cancer cells that have formed there. Radiation therapy for a pancreatic tumor can cause diarrhea, indigestion or nausea. The side effects of radiotherapy fade after treatment when healthy cells have regenerated. It can help reduce abdominal pain.

    Pancreatic cancer monitoring

Tumor monitoring after surgery is done on CT and tumor markers

Pancreatic enzyme and insulin therapy may be required depending on the type of surgery that has been performed.

The treatment of pain and dietary approach

 Whatever the treatment chosen, the wide choice of painkillers (analgesics) can cope with pain related to the tumor or its treatments.

Management of feeding problems is given the greatest attention before and after treatment to promote healing and postoperative recovery.

Complementary approaches 

Notice. Check out our Cancer fact sheet for all of the complementary approaches that have been studied in people with cancer, such as acupuncture, visualization, massage therapy and yoga. These approaches may be appropriate when used in addition to, but not substituting for, medical treatments.

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