Pancreatic Cancer - Treatments, Symptoms, Causes

Pancreatic Cancer - Treatments, Symptoms, Causes

What is pancreatic cancer? Causes - what are the risk factors? What are the types?

There are two types of pancreatic cancer. The most common pancreatic cancer begins in the ducts that carry pancreatic juice. This type of pancreatic cancer is called exocrine pancreatic cancer. The rarer type of pancreas begins in the cells that produce the hormones. This type of pancreatic cancer is called endocrine pancreatic cancer or islet cell cancer.

Exocrine Pancreatic Cancer

Resectable (suitable for surgical intervention, operable)

If the tumor can be removed, the surgical method, which has the only chance to cure this disease, should be applied. Unfortunately, even if the entire tumor is surgically removed, cancer recurrence is often possible. Studies have shown that chemotherapy treatment given after surgery delays the recurrence of cancer for 6 months and prolongs the life of patients. Gemcitabine (gemzar) or 5-FU can be used in chemotherapy treatment.

Some patients may be given chemotherapy or chemoradiotherapy before surgery. Due to the long post-operative rehabilitation period, some cancer centers prefer to give chemotherapy treatment before surgery. However, it has not yet been proven whether this method gives better results than postoperative chemotherapy.

Regionally advanced.

In locally advanced pancreatic cancer, the tumor has spread to nearby blood vessels and other tissues, but has not yet spread to distant organs and tissues such as the liver. Such tumors are not suitable for surgical intervention. In some studies, it has been determined that the removal of a part of the tumor does not prolong the life of the patient. In this type of locally advanced cancer, surgical methods are used only to open the clogged bile ducts or to intervene by bypassing the small intestine blocked by the cancer.

Neuroendocrine Pancreatic Cancer (PNET)

Resectable (suitable for surgical intervention)

If surgical intervention can be performed, the appropriate surgical technique is determined according to the type and size of the tumor and its location in the pancreas, and the tumor is removed. Preoperative laparoscopy can be performed to determine the stage and exact location of the tumor.

Before any surgery, drug treatment is usually applied to control the complaints caused by the tumor. For example, proton pump inhibitors can be given to inhibit stomach acid, while diazoxide is preferred to prevent excessively low blood sugar levels in insulinoma patients. In addition, if the tumor is seen on Somatostatin Receptor Scintigraphy, octreotide can be used to keep complaints under control. After the operation, the patient should be kept under observation as spreading and recurrence may occur.

Unresectable (not suitable for surgical intervention)

Since neuroendocrine pancreatic tumors usually grow slowly, the tumor in the patient can be examined using laboratory tests and imaging methods. Gallium 68 DOTATOC method, which is one of the molecular imaging methods we call endocrine cancer imaging in this group of tumors, is extremely instructive. It is a guide for showing the spread of the disease and applying the treatments we call targeted molecular radiotherapy.

Statistical data in pancreatic cancer

Although the cause of pancreatic cancer is unknown, it is more common in people who smoke and are overweight (obese). In almost 30% of patients, the cause of pancreatic cancer is smoking. In addition, pancreatic cancer associated with adult-type diabetes should also be discussed. The rate of development of pancreatic cancer due to hereditary gene mutation is low. This disease is more common in men than women, and the risk ratio increases with age. The average age rate for men with pancreatic cancer is 63 years and 67 for women.

What are the risk factors for pancreatic cancer?

While some recent studies associate up to 30% of pancreatic cancers with smoking, 10% are attributed to hereditary factors. The factors that cause pancreatic cancer are not fully known.

Some factors that can cause pancreatic cancer:

  • Effect of Smoking on Pancreatic Cancer: It is responsible for approximately 30% of pancreatic cancers.
  • Effect of Age on Pancreatic Cancer: Advanced age is a risk factor for pancreatic cancer.
  • Nutritional Habit in Pancreatic Cancer: The rates of pancreatic cancer are higher in people who eat plenty of calories and protein, devoid of fruits and vegetables.
  • Obesity in Pancreatic Cancer: It is thought that people with a high body mass index (BMI) are more prone to pancreatic cancer than those with a low body mass index (BMI).
  • Occupational Exposure in Pancreatic Cancer: People exposed to petroleum products and other chemicals are at higher risk of developing pancreatic cancer.
  • Chronic Pancreatitis in Pancreatic Cancer: Long-term, untreated chronic inflammatory condition of the pancreas increases the risk of developing pancreatic cancer.
  • Diabetes in Pancreatic Cancer: Diabetes doubles the rate of developing pancreatic cancer compared to healthy individuals. Diabetes mellitus is observed in 60-80% of pancreatic cancer patients.
  • It is possible to have pancreatic cancer without having any of the above-mentioned risk factors, or to have many of them and not have pancreatic cancer. Scientific data on this subject are still insufficient.

What are the symptoms of pancreatic cancer?

Pancreatic cancer, also called silent disease, rarely shows symptoms in its early stages. Unfortunately, when it starts to give symptoms, the tumor usually extends beyond the pancreas and the probability of successful treatment decreases.

The most common complaints in patients with pancreatic cancer are pain, jaundice and weight loss. Apart from these, some signs and symptoms that may be the harbinger of this disease can be listed as follows:

  • Diarrhea, constipation, gas pains, bloating
  • Nausea, vomiting and loss of appetite
  • sudden onset diabetes
  • dark or bloody urine
  • general malaise
  • Enlargement of the liver and gallbladder
  • Itching
  • clay-colored stool
  • Variscous veins

Pancreatic cancer is the fourth cause of cancer-related deaths and the second-leading cause of gastrointestinal cancer-related deaths after colorectal cancer in the United States. We have discussed below some of the risk factors that increase the likelihood of contracting this disease.

It has been observed that pancreatic cancer is more common in smokers and overweight people. In almost 30% of patients, the cause of pancreatic cancer is smoking. Diabetes doubles the incidence of pancreatic cancer compared to healthy individuals. Diabetes mellitus is observed in 60-80% of pancreatic cancer patients. It is also known that up to 10% of pancreatic cancers are familial or hereditary. Therefore, genetic counseling is recommended for those with a family history of pancreatic cancer. This disease is more common in men than women, and the risk ratio increases with age. The average age rate for men with pancreatic cancer is 63 years and 67 for women.

How is pancreatic cancer treated?

Certain factors affect the course of the disease and treatment options. Some of these factors are:

  • Whether the tumor can be removed by surgical intervention,
  • The stage of the cancer (the size of the tumor, the spread of the cancer outside of the pancreas to nearby tissues, vessels, lymph nodes or other areas),
  • General health and condition of the patient,
  • Whether cancer diagnosis is new or a previously treated and relapsed diagnosis.

Unfortunately, pancreatic cancer can only be brought under control when it is detected before it spreads to other areas and is suitable for surgical intervention. If the cancer is detected late and has spread, palliative treatment is applied to improve the patient's quality of life by controlling the complications and symptoms caused by the disease.

Treatment methods of pancreatic cancer consist of surgery, chemotherapy and radiotherapy and require the intervention of physicians from many different fields. The treatment process of pancreatic cancer is possible with the application of a coordinated and planned treatment program by physicians specialized in gastroenterology, surgery, medical oncology, radiation oncology and many other fields.

Pancreatic cancer surgery

In pancreatic cancer, there are two commonly used surgical methods:

Cure surgeries in Pancreatic Cancer: These are surgeries used for tumors that can be completely removed by surgery using imaging methods.
Palliative (mitigative) surgeries in Pancreatic Cancer: It is the surgical technique used in tumors that are found to have spread over a large area using imaging methods and cannot be completely removed. The aim of this type of surgery is to eliminate or alleviate the obstructive complaints caused by the disease. It is preferred in serious cases such as obstruction in the bile duct or intestines.
Some studies have shown that removing a portion of the tumor does not prolong a patient's lifespan. Pancreatic cancer surgery is one of the most difficult surgeries a surgeon can perform. The long post-operative rehabilitation period and the seriousness of possible complications show that this surgery is also very difficult for patients. When this is the case, patients should weigh the benefit and harm relationship of the surgery very well before the surgery.

Possible Healing Surgeries in Pancreatic Cancer
Almost all of the possible curable surgeries are performed for tumors formed in the head of the pancreas. Since such tumors occur in an area close to the bile duct, they cause jaundice in a short time and thus allow early diagnosis. All of the surgical methods listed below can only be applied for tumors that are suitable for surgery.