Pancreatic cancera disease where abnormal cells split without control and spread to other nearby body tissue and/or organs is a type of malignancy that develops in the pancreasa long, flat organ that sits between the stomach and the spine that plays a key role in digestion and blood sugar regulation, a long, flat organ that lies between the stomach and the spine. It has two primary functions; endocrine function, which is responsible for secreting hormones (such as insulin) to control bloodthe red bodily fluid that transports oxygen and other nutrients around the body sugar levels, and exocrine function, which produce pancreatic enzymes that aid in digestion. This page will primarily focus on exocrine pancreatic cancers.
The pancreas has three main parts: the head, the body, and the tail. The head of the pancreas is attached to the duodenum (the first portion of the small intestinea section of the gastrointestinal tract that recieves food from the stomach and absorbs the nutrients from food, also called small bowel) via the pancreatic duct. Another tube, called the common bile duct, carries bile from the liver, passes through the pancreatic duct and empties into the duodenum. These cancers can develop anywhere in the pancreas, but usually develop in the head of the pancreas.
Pancreatic cancer is more common in males, and is often diagnosed over the age of 45. However, anyone can develop this disease.
Types of Pancreatic Cancer
There are two main types of pancreatic cancers, which are categorised by the type of cellsthe basic structural and functional unit of all living things the cancer originates from.
Exocrine Pancreatic Cancer
Exocrine pancreatic tumours are the most common subtype of this disease. It most often occurs as an adenocarcinomacancer arising from mucus-producing glands in organs, however, less common subtypes include adenosquamous carcinomacancer arising from tissues that line organs (a type of cancer affected squamous cells and gland-like cells), acinar cell carcinoma (a cancer arising from acinar cells in the epithelium that make enzymes), squamous cell carcinoma (cancer arising from squamous cells in the epithelium), undifferentiated carcinoma (carcinomas with patternless cancer growth) and pancreatoblastoma. Exocrine tumours usually begin in the lining of the pancreatic duct, and may not have as good of a prognosisto predict how a disease/condition may progress and what the outcome might be as other subtypes.
Solid Pseudopapillary Neoplasm (SPN) of the Pancreas
Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare subtype of exocrine pancreatic cancer that tends to develop in the tail of the pancreas. Unlike most pancreatic cancers, these tumours are more common in females, and tend to be diagnosed before the age of 40. SPN of the pancreas if often found incidentally when being treated for another condition, and often appear aymptomatic or with vague abdominal symptoms. These tumours are generally non-aggressive, unlikely to metastasise, and can have a good prognosis.
Endocrine Pancreatic Cancer
Endocrine cancers, or Neuroendocrine cancers, are a complex group of tumours that develop in the neuroendocrine system, which is responsible for regulating important bodily functions such as heart rate, blood pressure and metabolism. They most commonly develop in the gastro-intestinal tract, pancreas, and the lungs; however, they can develop anywhere in the body. These tumours develop from neuroendocrine cells, which are responsible for receiving signals from the nervous system and producing hormones and peptides (small proteins) in response.
Pancreatic neuroendocrine tumours (pNETs), or islet cell tumours, are rare carcinomas (cancers arising from bone and soft tissuetissue/the material that joins, holds up or surrounds inside body parts such as fat, muscle, ligaments and lining around joints lining the organs) that develop in the pancreas. The pancreas is responsible for producing a variety of hormones, such as insulin, gastrin, and glucagon. There are several types of pNETS, including:
Treatment
If pancreatic cancer is detected, it will be staged and graded based on size, metastasiswhen the cancer has spread to other parts of the body, also known as mets, and how the cancer cells look under the microscope. Stagingthe process of determining how big the cancer is, where it started and if it has spread to other areas and grading helps your doctors determine the best treatment for you.
Cancers can be staged using the TNM staging system:
- T (tumoura tissue mass that forms from groups of unhealthy cells) indicates the size and depth of the tumour.
- N (nodea small lump or mass of tissue in your body) indicates whether the cancer has spread to nearby lymph nodessmall bean-shaped structures that filters harmful substances from lymph fluid.
- M (metastasis) indicates whether the cancer has spread to other parts of the body.
This system can also be used in combination with a numerical value, from stage 0-IV:
- Stage 0: this stage describes cancer cells in the place of origin (or ‘in situ’) that have not spread to nearby tissuea group of cells that work together to perform a function.
- Stage I: cancer cells have begun to spread to nearby tissue. It is not deeply embedded into nearby tissue and had not spread to lymph nodes. This stage is also known as early-stage cancer.
- Stage II: cancer cells have grown deeper into nearby tissue. Lymph nodes may or may not be affected. This is also known as localisedaffecting only one area of body cancer.
- Stage III: the cancer has become larger and has grown deeper into nearby tissue. Lymph nodes are generally affected at this stage. This is also known as localised cancer.
- Stage IV: the cancer has spread to other tissues and organs in the body. This is also known as advancedat a late stage, far along or metastatic cancer.
Cancers can also be graded based on the rate of growth and how likely they are to spread:
- Gradea description of how abnormal cancer cells and tissue look under a microscope when compared to healthy cells I: cancer cells present as slightly abnormal and are usually slow growing. This is also known as a low-grade tumour.
- Grade II: cancer cells present as abnormal and grow faster than grade-I tumours. This is also known as an intermediate-grade tumour.
- Grade III: cancer cells present as very abnormal and grow quickly. This is also known as a high-grade tumour.
Once your tumour has been staged and graded, your doctor may recommend genetic testinga procedure that analyses DNA to identify changes in genes, chromosomes and proteins, which can be used to analyse tumour DNA to help determine which treatment has the greatest chance of success, which analyses your tumour DNA and can help determine which treatment has the greatest chance of success. They will then discuss the most appropriate treatment option for you.
Treatment is dependent on several factors, including location, stage of disease and overall health.
Treatment options for exocrine pancreatic cancer may include:
- Surgerytreatment involving removal of cancerous tissue and/or tumours and a margin of healthy tissue around it to reduce recurrence, potentially including:
- Pancreaticoduodenectomyremoval of part of the pancreas (generally the head), the first part of the small intestine (duodenum), part of the stomach, the gallbladder, and part of the common bile duct; also known as a Whipple procedure, also known as a Whipple procedureremoval of part of the pancreas (generally the head), the first part of the small intestine (duodenum), part of the stomach, the gallbladder, and part of the common bile duct; also known as a pancreaticoduodenectomy.
- Distal pancreatectomyremoval of the ‘tail’ of the pancreas.
- Total pancreatectomycomplete removal of the pancreas.
- Chemotherapya cancer treatment that uses drugs to kill or slow the growth of cancer cells, while minimising damage to healthy cells.
- Radiation therapya treatment that uses controlled doses of radiation to damage or kill cancer cells.
- Ablation therapya minimally invasive procedure that uses extremely high or low temperatures to destroy (ablate) abnormal tissue and/or cancer cells.
- Embolisationa treatment that aims to reduce blood flow to the cancer and ultimately reduce cancer growth.
- Targeted therapymedication that targets specific molecular features of cancer cells.
- Clinical trialsresearch studies performed to test new treatments, tests or procedures and evaluate their effectiveness on various diseases.
- Palliative carea variety of practices and exercises used to provide pain relief and improve quality of life without curing the disease.
Risk factors
While the cause of pancreatic cancer remains unknown, the following factors may increase your riskthe possibility that something bad will happen of developing the disease:
- Being a tobacco smoker (or having a history of it).
- Obesity.
- Having a diet high in red and processed meat.
- Excessive alcohol consumption.
- Having certain conditions, including:
- Long-term diabetes.
- Long-term pancreatitisinflammation of the pancreas.
- Having a specific cyst in the pancreatic ducts, known as intraductal papillary mucinous neoplasms (IPMNs).
- Having a family history of pancreatic cancer.
- Genetic mutations, including BRCA1 and BRCA2.
Not everyone with these risk factors will develop the disease, and some people who have the disease may have none of these risk factors. See your general practitioner (GP) if you are concerned.
Symptoms
Exocrine pancreatic cancers have different symptoms to endocrine pancreatic cancers.
Symptoms of exocrine pancreatic cancers may include:
- Jaundiceyellowing of the skin and the whites of the eyes.
- Changes in bathroom habits, such as dark urine and pale-coloured and greasy stools.
- Itchy skin.
- Abdominal and/or back pain.
- Unexplained weight loss/loss of appetite.
- Nauseato feel sick or likely to vomit and vomiting.
- Fatiguea state of extreme tiredness or exhaustion, can be physical or mental.
- Enlargement of the gallbladder.
- Blood clots in the leg.
- New, onset diabetes/changes in blood sugar levels.
- Indigestion.
Not everyone with the symptoms above will have cancer, but see your GP if you are concerned.
Diagnosis
If your doctor suspects you have an pancreatic cance, they may order the following tests to confirm the diagnosisthe process of identifying a disease based on signs and symptoms, patient history and medical test results and refer you to a specialist for treatment:
- Physical examinationan examination of your current symptoms, affected area(s) and overall medical history.
- Imagingtests that create detailed images of areas inside the body tests, potentially including:
- CT (computed tomography) scana type of medical imaging that uses x-rays and computer technology to create detailed images of the body.
- MRI (magnetic resonance imaging)a type of medical imaging that uses radiowaves, a strong magnet and computer technology to create detailed images of the body.
- PET (positron emission tomography) scana type of medical imaging that uses radioactive tracers to create detailed images of the body.
- Ultrasounda type of medical imaging that uses soundwaves to create detailed images of the body .
- Blood teststesting done to measure the levels of certain substances in the blood.
- Biopsyremoval of a section of tissue to analyse for cancer cells.
