Pancreatic Cancer: Causes, Treatment and Prevention Strategies

Pancreatic cancer is a serious condition that begins in the tissues of the pancreas, an organ located in the lower part of the stomach, which produces digestive enzymes and hormones such as insulin, playing a vital role in digestion and blood sugar regulation. When cancer develops in this organ, it can have profound effects on the body's overall health and function. Despite being a relatively rare type of cancer, its aggressive nature and high mortality rate make it extremely important for those affected by it to know about the disorder and the way forward. To help, in this article, we delve into the symptoms, risk factors, and available treatment options for pancreatic cancer. Let’s start by understanding its signs and symptoms. 

Pancreatic Cancer Signs and Symptoms

Pancreatic cancer often goes unnoticed until it is in an advanced stage because its early signs and symptoms can be subtle or nonspecific. When symptoms appear, they may include:

• Jaundice: Yellowing of the skin and eyes, dark urine, light-coloured stools, and itchy skin. Jaundice occurs when a tumour blocks the bile duct, preventing bile from being properly excreted.
• Abdominal pain: Persistent pain in the upper abdomen that may radiate to the back. This pain is often worse when lying down or after eating.
• Unintended weight loss: Significant and unexplained weight loss, which may be accompanied by a loss of appetite and changes in eating habits.
• Nausea and vomiting: Persistent nausea, vomiting, and digestive problems such as indigestion or difficulty swallowing food.
• Changes in stool: Oily, greasy stools (steatorrhea) that float and are difficult to flush, indicating that the body is not absorbing fats properly.
• Fatigue: Extreme tiredness and weakness that do not improve with rest.
• Back pain: Persistent pain in the middle or lower back, often accompanying abdominal pain.
• Blood clots: Formation of blood clots in the legs (deep vein thrombosis) or lungs (pulmonary embolism), which can cause pain, swelling, redness, and difficulty breathing.
• Loss of appetite: Decreased interest in food and difficulty eating normal portions, often leading to weight loss and malnutrition.
• Itchy skin: Persistent itching, which can be associated with jaundice and bile accumulation.
• Depression and mood changes: Unexplained mood changes, including depression and anxiety, which can sometimes precede the diagnosis of pancreatic cancer.

Types of Pancreatic Cancer

Pancreatic cancer can be broadly categorised into two main types based on the cells in which the cancer originates: exocrine tumours and endocrine tumours. Each type has distinct characteristics, treatment approaches, and prognoses.

Exocrine Pancreatic Cancer

Exocrine tumours are the most common type of pancreatic cancer, accounting for about 95% of cases. These cancers start in the exocrine cells, which are responsible for producing digestive enzymes. Exocrine pancreatic cancer can be classified into the following types:

• Adenocarcinoma: The most prevalent type of exocrine pancreatic cancer, adenocarcinoma begins in the cells lining the pancreatic ducts. This type is typically aggressive and often diagnosed at a later stage.
• Squamous Cell Carcinoma: A rare form of pancreatic cancer that starts in the squamous cells, which can be found in the pancreatic ducts.
• Adenosquamous Carcinoma: This cancer has features of both adenocarcinoma and squamous cell carcinoma.
• Colloid Carcinoma: A rare form that tends to grow more slowly and is associated with a better prognosis compared to other exocrine cancers. It arises from a type of cystic tumour known as intraductal papillary mucinous neoplasms (IPMN).
• Acinar Cell Carcinoma: A rare type of exocrine pancreatic cancer that starts in the acinar cells, which produce digestive enzymes.

Endocrine Pancreatic Cancer

Endocrine tumours, also known as pancreatic neuroendocrine tumours (PNETs) or islet cell tumours, are much less common and account for about 5% of all pancreatic cancers. These tumours begin in the endocrine cells, which produce hormones like insulin and glucagon.

• Insulinoma: A tumour that produces excess insulin, leading to low blood sugar levels.
• Glucagonoma: A tumour that produces excess glucagon, leading to high blood sugar levels and a characteristic rash.
• Gastrinoma: A tumour that produces excess gastrin, which can cause Zollinger-Ellison syndrome, characterised by severe peptic ulcers and acid reflux.
• Somatostatinoma: A tumour that produces excess somatostatin, a hormone that inhibits several other hormones.
• VIPoma: A tumour that produces vasoactive intestinal peptide (VIP), leading to severe diarrhoea and electrolyte imbalance.
• Non-Functional Neuroendocrine Tumours: These tumours do not produce excess hormones and are often diagnosed at a later stage due to a lack of specific symptoms.

Resectable vs. Unresectable Pancreatic Cancer

Pancreatic cancer is classified into resectable and unresectable categories based on whether or not the tumour can be surgically removed. This distinction is crucial for determining the appropriate treatment approach and the potential outcomes for patients.

Resectable Pancreatic Cancer

Resectable pancreatic cancer refers to tumours that can be surgically removed entirely. This category offers the best chance for a cure, especially if the cancer is detected early. The criteria for a tumour to be considered resectable include:

• Location and size: The tumour is confined to the pancreas or has minimally spread to nearby tissues but has not invaded major blood vessels.
• Absence of metastasis: There is no evidence of distant metastasis, meaning the cancer has not spread to other organs such as the liver or lungs.
• Surgical margins: Surgeons believe they can achieve clear margins, meaning no cancer cells are left at the edges of the removed tissue.

Unresectable Pancreatic Cancer

Unresectable pancreatic cancer refers to tumours that cannot be completely removed surgically. This may be due to the cancer's location, size, or extent of spread. Unresectable cancers are further divided into:

• Locally Advanced (Borderline Resectable): Tumours that have spread to nearby blood vessels or other structures but have not metastasized to distant organs. These may sometimes become resectable after treatments like chemotherapy or radiation therapy to shrink the tumour.
• Metastatic: Cancer that has spread to distant organs, making surgical removal impossible. Treatment focuses on managing symptoms and prolonging life.

Understanding whether pancreatic cancer is resectable or unresectable is essential for guiding treatment decisions and managing patient expectations. 

Causes and Risk Factors of Pancreatic Cancer

Pancreatic cancer develops when cells in the pancreas begin to grow uncontrollably, forming a tumour. While the exact cause of pancreatic cancer is not always clear, several risk factors have been identified that can increase the likelihood of developing this disease. Here are some common causes and risk factors of pancreatic cancer:

Causes

The precise cause of pancreatic cancer is often multifactorial, involving a combination of genetic mutations and environmental influences. Some of the known causes include:

• Genetic mutations: Changes in the DNA of pancreatic cells can lead to uncontrolled cell growth. These mutations can be inherited or acquired over a person's lifetime due to environmental factors or random errors in cell division.
• Chronic inflammation: Conditions that cause long-term inflammation of the pancreas, such as chronic pancreatitis, can contribute to the development of pancreatic cancer.

Risk Factors

Several risk factors are associated with an increased risk of developing pancreatic cancer. These include:

• Age: The risk of pancreatic cancer increases with age, with most cases occurring in individuals over 60.
• Gender: Men are slightly more likely to develop pancreatic cancer than women.
• Family history and genetics: Having a family history of pancreatic cancer or genetic syndromes such as BRCA mutations, Lynch syndrome, or familial atypical multiple mole melanoma (FAMMM) syndrome can increase the risk.
• Smoking: Tobacco use is one of the most significant risk factors, with smokers being twice as likely to develop pancreatic cancer compared to non-smokers.
• Obesity: Excess body weight, particularly abdominal obesity, is linked to an increased risk of pancreatic cancer.
• Diabetes: Long-standing diabetes, particularly type 2 diabetes, is associated with an increased risk of pancreatic cancer. Additionally, the sudden onset of diabetes in older adults may be an early sign of pancreatic cancer.
• Diet: A diet high in red and processed meats and low in fruits and vegetables may increase the risk of pancreatic cancer. Heavy alcohol consumption can also lead to chronic pancreatitis, which is a risk factor for pancreatic cancer.
• Chronic pancreatitis: Long-term inflammation of the pancreas is a known risk factor for pancreatic cancer, particularly in individuals with hereditary pancreatitis.
• Chemical exposure: Exposure to certain chemicals in the workplace, such as pesticides, dyes, and chemicals used in metal refining, has been linked to an increased risk of pancreatic cancer.

Complications of Pancreatic Cancer

Pancreatic cancer can lead to a variety of complications due to its aggressive nature and the critical functions of the pancreas in the body. These complications can significantly impact a patient’s quality of life and require comprehensive management strategies. Here are some of the common complications associated with pancreatic cancer:

• Digestive problems: The pancreas produces enzymes that aid in digestion. When a tumour interferes with enzyme production or obstructs the digestive tract, it can cause digestive issues such as nausea, vomiting, and difficulty digesting food. Management includes pancreatic enzyme replacement therapy (PERT) to aid digestion, dietary modifications, and medications to control nausea.
• Weight loss: Unintended weight loss is common due to the body’s inability to absorb nutrients properly, loss of appetite, and increased metabolic demands of the cancer. Nutritional support through dietary counselling, high-calorie supplements, and appetite stimulants can help manage this complication.
• Blood clots: Pancreatic cancer increases the risk of developing blood clots (deep vein thrombosis or pulmonary embolism). Management includes anticoagulant medications to prevent clot formation and manage existing clots.
• Diabetes: The pancreas regulates blood sugar levels. Pancreatic cancer can disrupt insulin production, leading to new-onset diabetes or worsening existing diabetes. Blood sugar monitoring and management with insulin or oral hypoglycemic agents are necessary.
• Bowel obstruction: Tumours can block the small intestine, causing an obstruction. Surgical intervention to bypass the obstruction or placement of a stent to keep the intestine open can manage this complication.
• Pancreatic ascites: Accumulation of fluid in the abdomen can occur due to cancer spread or obstruction of lymphatic flow. Procedures to drain excess fluid can alleviate symptoms.

Diagnosis of Pancreatic Cancer

Diagnosing pancreatic cancer involves a combination of medical history review, physical examinations, imaging tests, laboratory tests, and biopsy procedures. Early diagnosis is challenging due to the subtlety of early symptoms, but these diagnostic methods help to identify and assess the extent of the disease.

Medical History and Physical Examination

The diagnosis of pancreatic cancer typically starts with a review of the patient's medical history, family history of cancer, and any symptoms experienced. The doctor also checks for any signs of jaundice and palpates the abdomen for any unusual masses or tenderness.

Imaging tests

• Computed Tomography (CT) scan: Creates detailed cross-sectional images of the body, helping to identify tumours, determine their size, and check for spread to other organs.
• Magnetic Resonance Imaging (MRI): Uses magnetic fields and radio waves to produce detailed images of the pancreas and surrounding tissues, useful for detecting smaller tumours and evaluating the extent of the disease.
• Positron Emission Tomography (PET) scan: Involves injecting a small amount of radioactive sugar into the body; cancer cells absorb more sugar than normal cells, highlighting areas of potential cancer spread.
• Endoscopic Ultrasound (EUS): Involves inserting a thin, flexible tube with an ultrasound probe down the throat to the stomach and small intestine, allowing for detailed images of the pancreas and nearby tissues and guiding biopsy procedures.
• Endoscopic Retrograde Cholangiopancreatography (ERCP): Uses a contrast dye and X-rays to visualise the pancreatic and bile ducts, helping to identify blockages and allowing for biopsy collection.
• Magnetic Resonance Cholangiopancreatography (MRCP): A non-invasive imaging test that provides detailed images of the pancreatic and bile ducts using MRI technology.

Laboratory Tests

• Blood tests: Can detect tumour markers such as CA 19-9 and CEA (carcinoembryonic antigen), which may be elevated in pancreatic cancer. However, these markers are not specific and can be elevated in other conditions.
• Liver function tests: Assess the function of the liver and bile ducts, which can be affected by pancreatic cancer.

Read more - Liver Function Tests: Types, Purpose and Normal Ranges

Biopsy

• Fine Needle Aspiration (FNA): During an EUS or CT-guided procedure, a thin needle is used to extract a small sample of tissue from the pancreas for microscopic examination.
• Core needle biopsy: A larger needle is used to obtain a larger tissue sample, providing more information for diagnosis.
• Laparoscopy: A minimally invasive surgical procedure in which a camera and instruments are inserted through small incisions in the abdomen to obtain tissue samples and assess the extent of the disease.

Genetic Testing

• Genetic counselling and testing: For individuals with a family history of pancreatic cancer or other cancers, genetic testing can identify inherited mutations that may increase the risk of pancreatic cancer.

Treatment for Pancreatic Cancer

Treatment for pancreatic cancer depends on the stage of the disease, the location of the tumour, and the patient's overall health. The primary treatment options include surgery, chemotherapy, radiation therapy, targeted therapy, and immunotherapy. A multidisciplinary team approach is often required to provide comprehensive care.

Surgical Treatment

• Whipple procedure (Pancreaticoduodenectomy): The most common surgery for pancreatic cancer located in the head of the pancreas. It involves the removal of the head of the pancreas, part of the small intestine, the gallbladder, and a portion of the bile duct.
• Distal pancreatectomy: Involves the removal of the body and tail of the pancreas, often including the spleen. This procedure is used for tumours located in these regions.
• Total pancreatectomy: Removal of the entire pancreas, which is less common and typically reserved for widespread or multiple tumours within the pancreas.
• Open Surgery: Open surgery for pancreatic cancer involves a large incision in the abdomen, providing direct access to the pancreas and surrounding organs. It allows the surgeon to have a clear view and space to remove the affected areas. While it is effective, open surgery typically requires a longer recovery period and carries higher risks of infection, blood loss, and postoperative complications.
• Robotic Surgery: Robotic surgery, a form of minimally invasive surgery, uses small incisions and a robotic system to assist the surgeon in removing pancreatic tumours. This advanced technique allows for more precision, smaller incisions, less blood loss, and faster recovery times compared to traditional open surgery. Robotic procedures, however, may not be suitable for all cases and require specialised surgical expertise.

Chemotherapy

• Adjuvant chemotherapy: Administered after surgery to eliminate any remaining cancer cells and reduce the risk of recurrence.
• Neoadjuvant chemotherapy: Given before surgery to shrink tumours, making them more easily removable and increasing the chances of a successful surgery.
• Palliative chemotherapy: Used in advanced stages to control the growth of the cancer, alleviate symptoms, and improve quality of life.

Common chemotherapy drugs for pancreatic cancer include gemcitabine, 5-fluorouracil (5-FU), and combinations like FOLFIRINOX (a regimen that includes folinic acid, fluorouracil, irinotecan, and oxaliplatin).

Radiation therapy

• External Beam Radiation Therapy (EBRT): Uses high-energy rays to target and destroy cancer cells. It can be used before surgery to shrink tumours, after surgery to eliminate remaining cancer cells, or as a palliative treatment to relieve pain and other symptoms.
• Stereotactic Body Radiation Therapy (SBRT): A form of EBRT that delivers precisely targeted radiation in fewer high-dose treatments, minimising damage to surrounding healthy tissue.

Targeted Therapy

• Targeted therapy drugs: These drugs specifically target abnormalities in cancer cells. For example, erlotinib is a targeted therapy used to treat pancreatic cancer by inhibiting the epidermal growth factor receptor (EGFR), which is involved in the growth and spread of cancer cells.

Immunotherapy

• Immune checkpoint inhibitors: These drugs help the body's immune system recognize and attack cancer cells. Pembrolizumab, for instance, is an immunotherapy drug that targets PD-1, a protein on immune cells that helps keep them from attacking normal cells in the body, including some cancer cells.

Palliative Care

• Symptom management: Palliative care focuses on relieving symptoms and improving the quality of life for patients with advanced pancreatic cancer. This may include pain management, nutritional support, and psychological support.
• Procedures: Stent placement to relieve bile duct or bowel obstruction, nerve blocks for pain relief, and drainage procedures for pancreatic ascites.

Preventing Pancreatic Cancer

While it is not always possible to prevent pancreatic cancer, especially given the role of genetic and other uncontrollable factors, adopting certain lifestyle changes and taking preventive measures can significantly reduce the risk. Here are some key strategies for lowering the risk of pancreatic cancer:

• Quit smoking: Smoking is one of the most significant risk factors for pancreatic cancer. Quitting smoking can substantially reduce the risk. Seeking support through smoking cessation programs, medications, and counselling can help individuals quit successfully.
• Maintain a healthy weight: Consuming a diet rich in fruits, vegetables, and whole grains while limiting red and processed meats can help maintain a healthy weight and reduce cancer risk. Engaging in regular physical activity can help maintain a healthy weight and improve overall health. Aim for at least 150 minutes of moderate-intensity exercise per week.
• Manage diabetes: Proper management of diabetes through medication, diet, and exercise can reduce the risk of pancreatic cancer. Regular check-ups with a healthcare provider to monitor and manage blood sugar levels effectively are important.
• Limit alcohol consumption: Limiting alcohol intake can reduce the risk of chronic pancreatitis and consequently pancreatic cancer. The recommended limit is up to one drink per day for women and up to two drinks per day for men.
• Healthy diet: Incorporating foods high in antioxidants, such as berries, nuts, and leafy green vegetables, can help protect cells from damage. Emphasise whole, unprocessed foods to support overall health and reduce cancer risk.
• Avoid exposure to harmful chemicals: Follow safety guidelines to avoid exposure to harmful chemicals, particularly in industries where there is a risk of exposure to carcinogens.
• Regular medical check-ups: Regular medical check-ups can help detect early signs of pancreatic issues and other health conditions. If there is a family history of pancreatic cancer or genetic syndromes associated with an increased risk, discuss genetic counselling and testing with a healthcare provider.
• Genetic counselling and testing: For those with a family history of pancreatic cancer or related genetic conditions, genetic counselling and testing can identify specific inherited risks and inform personalised prevention strategies.
• Awareness of symptoms: Being aware of the symptoms of pancreatic cancer, such as jaundice, unexplained weight loss, abdominal pain, and new-onset diabetes, can lead to earlier diagnosis and treatment.

Other FAQs About Pancreatic Cancer

Q. How common is pancreatic cancer?

Pancreatic cancer is relatively rare but is one of the deadliest forms of cancer. It accounts for about 3% of all cancers in the United States and about 7% of all cancer deaths. The incidence of pancreatic cancer has been slowly increasing over the past few decades.

Q. How long does it take to notice pancreatic cancer?

Pancreatic cancer is often difficult to detect in its early stages because symptoms can be vague or non-existent. By the time symptoms such as jaundice, abdominal pain, and weight loss appear, the disease is usually advanced. The time from the onset of initial symptoms to diagnosis can vary widely, but many cases are not diagnosed until the cancer has progressed significantly.

Q. Is pancreatic cancer curable?

The curability of pancreatic cancer depends on the stage at which it is diagnosed. Early-stage pancreatic cancer, where the tumour is localised and resectable (able to be surgically removed), offers the best chance for a cure. Unfortunately, most cases are diagnosed at an advanced stage, making complete surgical removal challenging. For advanced stages, treatments focus on managing symptoms and prolonging life rather than cure.

Q. What can I expect if I have pancreatic cancer?

The prognosis for pancreatic cancer varies depending on the stage at diagnosis and the individual's overall health. Early-stage cancer may be treated with surgery, chemotherapy, and radiation therapy, potentially leading to remission. Advanced-stage cancer may require palliative care to manage symptoms and improve quality of life. It is important to work closely with a healthcare team to understand the treatment options and develop a personalised care plan.

Q. What are some signs that pancreatic cancer has spread?

Signs that pancreatic cancer has spread (metastasized) can include severe abdominal and back pain, unexplained weight loss, jaundice, digestive problems, changes in stool, and new-onset diabetes. Other symptoms might include fatigue, loss of appetite, and the presence of lumps in the abdomen. The specific symptoms can vary based on where the cancer has spread, such as the liver, lungs, or peritoneum.

Final words

Pancreatic cancer is a complex and challenging disease, but early diagnosis and appropriate treatment can significantly impact outcomes. Understanding the symptoms, risk factors, and available treatments is crucial. If there are concerns or symptoms related to pancreatic cancer, consulting with a specialist is essential for accurate diagnosis and effective management. Max Hospitals offers advanced diagnostic tools and a team of experienced specialists dedicated to providing comprehensive and personalised care. Don't hesitate to reach out to Max Hospitals for expert consultation and support in navigating this challenging diagnosis. Your health and well-being are our top priorities.