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Pancreatic cancer

Pancreatic cancer is caused by uncontrolled growth of pancreatic cells. 
The pancreas produces the hormone insulin that controls glycemia.

This organ secretes some enzymes that also play an important role in the digestion of food in the gastrointestinal tract.

  • If the mass is formed in the channels that carry the pancreatic juice, it is called exocrine pancreatic cancer , in 95% of the cases, it is an adenocarcinoma .
  • When the cancer develops in cells that produce insulin, it is called endocrine cancer or carcinoma of the pancreas and islet cells.

At the time of diagnosis, 65-70% of patients present metastases to:

  1. Liver ,
  2. Lungs ,
  3. Bones ,
  4. Peritoneum.

Pancreatic cancer is the fifth leading cause of cancer death.

Rarely does this tumor form in children or young people. 
The incidence in Europe is about 10 cases per 100,000 inhabitants.


Classification of pancreatic cancer

Exocrine Cancer (Non-Endocrine)
These tumors account for more than 95% of all pancreatic cancers. 
Adenocarcinoma forms in glandular cells. 
This tumor can become large enough to:

  • Invading the nerves (if it affects the visceral nerves in the back of the peritoneum causes  pain in the spine ),
  • Compress the arteries (upper mesenteric, common hepatic and splenic) and veins (portal vein).

It often spreads (metastasized) in the liver or lymph nodes. 
In this case, the tumor may be considered non-operable.

Endocrine cancer
This neoplasm is much less frequent than non-endocrine cancer.

Endocrine tumors can produce active hormones and cause very serious symptoms. 
There are several types:

  1. Insulinoma produces large amounts of insulin that can cause hypoglycemia (low blood sugar).
  2. Glucagonoma is a very rare cancer. Usually, when the doctor diagnoses this tumor, the patient already has liver metastases. 
    May cause:

    1. A  major rash ,
    2. Estomatitis ,
    3. Diarrhea,
    4. Diabetes.

 

Benign tumor and precancerous alteration in the pancreas

Not all pancreatic masses are cancer. 
One tumor may be benign (noncancerous), while another could become cancer over time (precancerous change).

  • Serous cystic neoplasm (NCS) or  serous cystadenoma is a tumor that forms cysts filled with aqueous fluid. This cyst is usually benign and does not need treatment.
  • Cystic mucinous neoplasm (NCM) or  mucinous cystadenoma is a tumor composed of a cyst filled with a gelatinous substance called mucin. This cyst is benign but can become a cancer over time.
  • Intraductal papillary mucinous neoplasm (NPMI) is a benign tumor that grows in the pancreatic ducts and can become a cancer over time. In addition, it may grow to cause an obstruction of the Wirsung (pancreatic) duct.

 

Causes of Pancreatic Cancer

We do not know the exact cause of pancreatic cancer, but we have identified several risk factors that predispose people to get sick. 
Risk factors include:

  1. Genetics and heredity
  2. Age (mainly affects the elderly)
  3. Ulcers
  4. Obesity
  5. Type II diabetes
  6. Smoke
  7.  Chronic pancreatitis


Symptoms of Pancreatic Cancer

Symptoms vary depending on the affected region of the gland:

  • The head,
  • The body,
  • The tail.

Early diagnosis of these symptoms is difficult because they only appear in the advanced stage of the disease. 
Therefore, sometimes this cancer is defined as a silent disease.

Tumors of the body and tail usually cause symptoms only when they are at an advanced stage. 
At this level, the tumor invades adjacent organs and blood vessels. In addition, through the lymphatic and blood vessels it spreads to distant organs. 
The pancreatic head cancer causes symptoms by blocking the gastrointestinal tract and biliary tract. For this reason, it can be identified earlier than other tumors.

Symptoms of pancreatic head tumor

Weight loss 92%
Jaundice 82%
Anorexia 72%
Dark urine 64%
Nausea 45%
Vomiting 37%
Tiredness 35%
Itchy 24%
Fever 11%
Vomiting with blood 8%

 

Symptoms of Tumor of the Body or Tail of the Pancreas

Weight loss 100%
Pain 87%
Tiredness 43%
Nausea 43%
Vomiting 37%
Constipation 27%
Vomiting with blood 17%
Mane 17%
Fever 7%
Jaundice 7%
Diarrhea 3%

 

Description of symptoms

  • The jaundice is a major symptom where the white of the eye (sclera) and the patient ‘s skin turn yellow. 
    This can be a cancer symptom that affects the head of the pancreas (about 60% of tumors occur in the head of the pancreas).
  • When the cancer spreads, it totally or partially blocks the bile duct. This slows the movement of bile and causes high bilirubin in the blood, resulting in yellowing of the eyes and skin.
  • Among the other symptoms are diarrhea and poor digestion .
  • Another sign is the strong belly pain that radiates slowly to the spine . 
    This happens when the tumor affects the nerves. 
    The pain increases mainly 3-4 hours after a meal or sometimes when the person is lying down. 
    Abdominal pain is typical of cancer in the tail or body of the pancreas.
  • The loss of appetite is another symptom of pancreatic cancer, although it is common in other diseases and infections . 
    It usually indicates that there may be a problem in the stomach, so it is best to talk to a doctor.
  • When pancreatic cancer affects the head of the gland, serious unintentional weight loss can occur . 
    Along with abdominal pain, this is one of the first symptoms in women and men.
  • Another symptom is the color change in stool and urine. 
    When the tumor blocks the bile duct, the stools become clear , especially of clay color. 
    The stool also emits a strange and strong smell. 
    The urine becomes much darker .
  • The patient may suddenly develop diabetes . 
    This is because the pancreas loses its ability to produce insulin.
  • Rarely, there may also be an increase in blood levels of lipase .
  • It can cause itchy skin , although this is a rare symptom. When it occurs along with stomach pain and jaundice, it is necessary to talk to a doctor immediately.

An insulinoma is a tumor of the pancreas that causes an increase in insulin production. 
The consequence is hypoglycemia. 
Among the symptoms of insulinoma are:


Stage IV of pancreatic cancer

It is the most lethal form of cancer. Pancreatic cancer has a poor prognosis and is the fourth leading cause of death. 
The one-year survival rate is 25% and only 6% in 5 years in case of metastasis. 
Instead, the 5-year survival rate for localized cancer is 20 percent.


Treatment Options for Stage IV Pancreatic Cancer

Chemotherapy and intravenous injections are given to relieve pain and prolong the patients’ survival period. 
Patients can undergo palliative surgeries and the doctor tries to relieve the symptoms of jaundice, pain, nausea and vomiting caused by obstruction of the bile ducts.

Palliative surgery includes:

  • Biliary Bypass : If the tumor blocks the bile duct and bile collects in the gallbladder, the doctor inflicts the gallbladder or bile duct and binds them to the small intestine. This creates a new path for the flow of bile juices around the blocked area.
  • Endoscopic stent placement : Through the catheter, the stent is inserted to drain the bile out of the body or small intestine.
  • Gastric bypass : If the tumor blocks the flow of food to the gastric level, the doctor connects the stomach to the small intestine to allow the patient to return to normal eating.


Diagnosis of pancreatic cancer

The doctor should see the patient and control the abdomen, if in doubt prescribe exams.

Generally, blood tests in patients with pancreatic cancer show:

Hiperbilirrubinemia total Up to 10-15 mg / dl
Increase
  • Alkaline phosphatase
  • GGT,
  • Azotemia,
  • Creatininemia *
Decrease Prothrombin time

* Hyperazotemia and hypercreatininemia indicate renal damage caused by chronic jaundice. 
About 25% of pancreatic cancer patients have diabetes at diagnosis; in addition, about 40% have glucose intolerance.

Tumor markers
The major tumor marker is CA19-9. 
It has high blood values ​​in 75-85% of patients with pancreatic carcinoma. 
It is necessary to exclude other disorders that cause biliary obstruction and may increase the value of CA19-9:

  1. Diseases of the liver,
  2. A benign pathology of the pancreas.

Values ​​of CA19-9 greater than 100 U / ml (normal values ​​= 30 U / ml) are quite specific for tumor of pancreatic cancer. 
Some patients have values ​​of 19’000 – 20’000 at diagnosis, in this case they are very specific to the tumor.

Instrumental exams

  • The first proposed examination is ultrasonography showing a dilatation of the bile duct or pancreas. This examination does not allow visualizing the pancreas and, therefore, the tumor mass.
  • The endoscopic ultrasound is performed with an endoscope that is inserted into the throat to the intestine. So the probe can see better inside the abdomen. It is the most suitable test for solid tumors, but does not allow visualizing the tail of the pancreas.
  • The computed tomography  of the abdomen and chest with contrast medium is an examination to see the tumor size and interference with neighboring structures. Mass is hypovascularized in exocrine tumors, while endocrine tumors are well vascularized.
  • The physician prescribes ERCP (endoscopic retrograde cholangiopancreatography)  in order to:
    • Evaluate if there is an obstruction of the bile ducts,
    • Remove the cells for cytological examination,
    • Place a stent and keep the bile ducts open if the tumor compresses these organs.

The diagnosis of glucagonoma is based on:

  1. In cutaneous biopsy of erythema ,
  2. In the values ​​of glucagon in the blood.


Treatment of pancreatic cancer

The treatment depends on the location and stage of the tumor. 
Treatment options are determined depending on the person’s age, health status and personal preferences. 
Options include surgery, chemotherapy, and radiation therapy. 
Surgery is recommended to remove part of the pancreas or the entire organ only if the tumor is localized. 
More than 80% of these tumors are not operable at diagnosis.

This will be performed to remove tumors in the head of the pancreas (pancreatoduodenectomy), in the tail and in the body (distal pancreatectomy). 
The average duration of hospitalization after surgery is 11 days.

However if the cancer spreads to other organs, blood vessels or lymph, surgery can only be done to reduce the symptoms. 
In this case, it is possible to choose chemotherapy or radiotherapy.

The tumor does not respond well to chemotherapy . 
However, based on a scientific study conducted by Oettle et al., Gemcitabine can increase survival in three years from 19.5% to 36.5% after surgery. 
In addition, five-year survival increased according to these data (from 9% to 21%).

Quitting smoking , maintaining a healthy body weight, exercising regularly and following a healthy diet are some ways to prevent this disease.

Treatment for Insulinoma
The doctor usually advises surgery to remove the tumor. 
There are some medications that can be taken:

  1. Pending the intervention,
  2. If the surgery was not conclusive,
  3. If the patient is not operable.

The most suitable medicine is diazoxide, which reduces insulin secretion.

 


Diet and food

The only possible natural remedy is to follow the dietary guidelines for cancer. 
Among natural cures, according to blood type diet theory , pancreatic cancer can be caused by certain foods. 
Depending on the blood type, there are harmful foods and other beneficial or neutral foods. 
For example, for people in group B, the cause may be a diet that includes:

  1. Tomato,
  2. Caquis.

 


What is the life expectancy? The prognosis

Staging and Survival Statistics for Pancreatic Cancer

  • Stage 1 : During the first phase a very small tumor forms that occupies only a limited area of ​​the pancreas. 
    It is possible to surgically remove the tumor; therefore, this stage has a high survival rate. 
    Based on scientific studies, surgery in the first stage increases life expectancy. 
    The survival rate increases significantly if the patient undergoes surgery at this stage. 
    After the operation, almost 10-25% of people survive for up to five years.
  • Stage 2 : during this phase, pancreatic neoplasm is operable because the growing tumor has not spread to distant organs. 
    Cancer cells can spread around the lymph nodes. 
    Removal of the tumor and lymph nodes is still an available option. 
    According to studies available in the American Cancer Society, less than 5-7% of people diagnosed with pancreatic cancer live for five years.
  • Stage 3 : During the third stage, the disease spreads to the lymph nodes and blood vessels. 
    This is called locally advanced cancer that can still be removed along with the surrounding lymph nodes, but only if it has not spread to the large blood vessels.
  • Stage 4 : Phase 4 is that terminal and can be reached quickly. 
    Cancer spreads throughout the body and bones through the bloodstream. 
    The last stage of the cancer is inoperable and the doctor tries to minimize the pain. 
    Mortality in stage 4 pancreatic cancer is very high. 
    The life expectancy of the diagnosis is around 3-6 months, but the survival can only be two days. 
    Negative prognostic factors (indicating reduced survival) include:

    • Brain metastases,
    • Metastases in the lymph nodes ,
    • Tumor size greater than 3cm,
    • Low differentiated cells (with characteristics not similar to specific pancreatic cells),
    • After tumor removal surgery, if the remaining margins still have positive cells in the analysis.

Generally the survival rate of pancreatic cancer is very low; on average, only 4% of patients survive at least 5 years. 
These survival rates are based on large groups of people and can not be used to predict what will happen to a particular patient.

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