Every year around 2000 people in Bulgaria hear the diagnosis of pancreatic cancer, and the cases are increasing. Only 10% of newly detected pancreatic tumours can be removed. In 2030, this disease is expected to take second place among cancers.
What is pancreatic cancer?
The pancreas is located behind the lower part of the stomach. It produces enzymes that help digest food and hormones that help control blood sugar. Pancreatic cancer occurs when cells in the pancreas develop changes in their DNA.
Most pancreatic cancers begin in the cells that line the ducts of the pancreas. This type of cancer is called pancreatic ductal adenocarcinoma or exocrine pancreatic cancer. Less commonly, cancer can form in the hormone-producing cells or neuroendocrine cells of the pancreas. These cancers are called pancreatic neuroendocrine tumors or endocrine pancreatic cancer.
Pancreatic cancer is rarely detected in its early stages, when the chance of cure is greatest. This is because it often does not cause symptoms until it has spread to other organs.
What are the causes of this type of cancer?
There is no clear answer. It is not known exactly what causes pancreatic cancer. But experts have identified some risk factors.
Risk factors for pancreatic cancer:
- Smoking cigarettes, cigars and using other forms of tobacco
- Obesity
- Diabetes, especially type 2 diabetes. Sudden onset diabetes may be a sign of the disease
- Exposure to certain chemicals, such as pesticides and petrochemicals
- Chronic pancreatitis- permanent inflammation of the pancreas
- Hereditary chronic pancreatitis due to gene changes (mutations) passed from parent to child.
- Inherited syndromes with mutations in genes, such as the BRCA1 or BRCA2 genes.
How does a pancreatic tumor develop and what are the first symptoms?
Pancreatic cancer often does not cause symptoms until the disease is advanced. When they do occur, signs and symptoms of pancreatic cancer may include:
- Abdominal pain that spreads to the side or back
- Loss of appetite
- Weight Loss
- Yellowing of the skin
- Light or floating stools
- Dark colored urine
- Itching
- Newly diagnosed diabetes or diabetes that is becoming increasingly difficult to control
- Pain and swelling in the arm or leg that may be caused by a blood clot
- Fatigue or weakness
Screening for people at high risk of pancreatic tumour
Screening uses tests to look for signs of pancreatic cancer in people who have no symptoms. The risk may be high in people who have a family history of the disease or if they have an inherited change in their DNA that increases their risk of cancer.
Screening for pancreatic cancer may include imaging tests, such as MRI and ultrasound. These tests are usually repeated every year. The goal of screening is to find pancreatic cancer when it is small and most likely to be cured.
Genetic testing for pancreatic tumour risk
If you have a family history of pancreatic cancer, discuss it with a healthcare professional. A health professional can review your family history and help you figure out if genetic testing is right for you. Genetic testing can detect changes in your DNA that increase your risk of cancer.
How is a pancreatic tumor diagnosed?
Tests used to diagnose the disease include:
- Image tests. Imaging tests used to diagnose pancreatic cancer include ultrasound, CT scan, MRI and sometimes PET scanner.
- Taking a tissue sample for examination.
- Blood tests. A tumor marker test used in pancreatic cancer is CA19-9. Doctors often repeat this test during and after treatment to find out how the cancer is responding. Some types of pancreatic cancer do not produce extra CA19-9, so this test is not useful for all patients.
- Genetic testing. Genetic tests use a sample of blood or saliva to look for inherited changes in DNA that increase cancer risk. The results of genetic testing can help guide your treatment. The results can also show whether family members may have an increased risk of pancreatic cancer.
How is pancreatic cancer treated?
Treatment for pancreatic cancer depends on the stage of the cancer and the location. When surgical treatment is not possible, the focus may be on improving the patient's quality of life and preventing the cancer from growing or causing more harm.
Treatment for pancreatic cancer may include surgery, radiation, chemotherapy, or a combination of these.
Surgery can cure pancreatic cancer, but it is not an option for every patient. It can be used to treat cancer that has not spread to other organs. Surgery may not be possible if the cancer becomes large or spreads to nearby blood vessels. In these situations, treatment may begin with other options, such as chemotherapy. Sometimes surgery may be done after these treatments.
Operations used to treat pancreatic cancer include:
- Surgery for pancreatic head cancer. The Whipple procedure, also called pancreatoduodenectomy, is surgery to remove the head of the pancreas. It also involves removing the first part of the small intestine and the bile duct. Sometimes the surgeon removes part of the stomach and nearby lymph nodes.
- Surgery for cancer of the body and tail of the pancreas. Surgery to remove the body and tail of the pancreas is called distal pancreatectomy. In this procedure, the surgeon may also need to remove the spleen.
- Surgery to remove the entire pancreas. This is called a total pancreatectomy. After surgery, medicines are taken to replace the hormones and enzymes produced by the pancreas.
- Surgery for cancer that affects nearby blood vessels. When pancreatic cancer grows and involves nearby blood vessels, a more complicated procedure may be needed. The procedure may need to involve removing and repairing parts of the blood vessels.
Chemotherapy
- Chemotherapy may be the first treatment used when surgery is not possible. Chemotherapy may also be given at the same time as radiotherapy. Sometimes this combination of treatments shrinks the cancer enough to make surgery possible.
- Chemotherapy is often used after surgery to destroy any cancer cells that may remain.
- When the cancer is advanced and has spread to other parts of the body, chemotherapy can help control it.
Radiotherapy
- Radiation can be used before or after surgery. It is often done after chemotherapy. It may also be combined with chemotherapy.
- When cancer has spread to other parts of the body, radiation therapy can help relieve symptoms.
Immunotherapy
Immunotherapy helps immune system cells detect and kill cancer cells. Immunotherapy may be an option if the pancreatic cancer has specific changes in its DNA that would make it respond to these treatments.
Clinical trials
Clinical trials are studies of new treatments. These trials provide an opportunity to try out the latest treatments. The risk of side effects with these treatments may not be known.
What should patients who are interested in treating the disease abroad do?
"Medical Carragee offers pancreatic cancer patients the most advanced and innovative treatment at some of the best cancer centers in the world. All patients who come to us receive a free consultation with some of the best specialists in pancreatic cancer treatment. This way they can find out if they are on the right track in their treatment or if there are other more effective and advanced treatment methods.
