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A Comprehensive Guide To Pancreatic Cancer - CancerMitr
PANCREATIC CANCER
Pancreatic cancer, also known as PC, is a very rare type of cancer that affects the exo-endocrine gland of the pancreas. Dubbed as the “silent killer,” the disease is notorious for it’s extremely poor prognosis because symptoms and indicators only appear later in the disease’s progression. When compared to Western countries, where males over the age of 50 have a significant risk of having the disease, the incidence of pancreatic cancer in India is quite low.
Because the disease is uncommon, there is limited information on how to treat it. As a result, pancreatic cancer has a high death rate when compared to other types of cancer. India ranks 24th in the world in terms of reported cases (10860 new cases (1.03%) and 18th in illness mortality).
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What is pancreatic cancer?
The pancreas is an exo-endocrine gland that secretes insulin and glucagon, hormones that regulate blood glucose levels. It also releases digestive enzymes into the small intestine to help break down and digest food. Due to its dual function as a secreter of hormones and enzymes, the pancreas is called the exo-endocrine gland (exocrine and endocrine gland). In addition, it produces hormones in its cluster of endocrine cells known as islets of Langerhans.
Cells divide and form new fresh cells through a process named mitosis. When new cells are formed, the old cells die down. In some cases, the old cells divide abnormally and form lumps of tissue called tumours or neoplasms. Tumours can be non-cancerous (benign) or cancerous (malignant), where the latter tends to divide, spread and form a new tumour in other parts of the body (metastasis).
Pancreatic cancer is the condition where this malignant tumour forms in the pancreas. Pancreas lies in the abdominal region and is anatomically divided into three sections: head, body and tail.
In most of the reported PCs, the tumour starts in the cells that line the ducts of this endocrine gland. This type of PC is called pancreatic adenocarcinoma (pancreatic exocrine cancer). In rare cases, it forms in the neuroendocrine cells, the hormone-producing cells of the pancreas.
What are the notable signs and symptoms of pancreatic cancer?
One of pancreatic cancer’s most significant drawbacks is that its signs and symptoms do not appear until it is in its later stages, especially in those cases where the tumour grows in the body or tail region. Therefore, it is imperative for people to know about the basic signs and symptoms of the disease.
- Abdominal cramps
- Back pain
- Loss of appetite
- Abnormal or unexplained weight loss
- Yellowing of the skin (jaundice)
- Yellowing of the eyes’ whites region (jaundice)
- Light-coloured stools
- Dark-coloured urine
- Itchiness on the skin
- Diabetes
- Existing diabetes becomes severe or out of control
- Blood clots
- Fatigue
Silent symptoms of pancreatic cancer include light-coloured stools, loss of appetite, dark-coloured urine and unusual back pain (that might resemble pain due to a kidney stone). People who experience the symptoms mentioned above should consider doing a test for pancreatic cancer.
What are the different types of pancreatic cancer?
Pancreatic cancer types are divided into two large categories: exocrine pancreatic cancer and neuroendocrine pancreatic cancer.
Exocrine pancreatic cancer
The exocrine gland of the pancreas secretes enzymes, which consist of powerful substances that help break down and digest carbohydrates, fats, proteins and acids in the duodenum region of the small intestine.
Exocrine (or nonendocrine) pancreatic cancer develops in the exocrine cells that form the exocrine gland and ducts of the pancreas.
Endocrine pancreatic cancers are divided into the following;
- Adenocarcinoma or ductal carcinoma
It is the type of cancer that occurs in the pancreas’s ducts and accounts for 90% of all reported PC cases. - Acinar cell carcinoma
It is the type of cancer that occurs in the cells that create pancreatic enzymes and accounts for 1-2% of all reported PCs. It is important to know that though symptoms of acinar cell carcinoma are the same as adenocarcinoma, jaundice is not that common amongst the patients. - Squamous cell carcinoma
It is a rare type of exocrine cancer where the tumour cells are found in the pancreatic ducts made up of squamous cells. Due to its rarity, the data regarding squamous cell carcinoma and its treatment is very limited. In most cases, the symptoms appear only after they have metastasised or spread to other body parts. - Adenosquamous carcinoma
It is a type of cancer that shows the characteristics of ductal adenocarcinoma and squamous cell carcinoma and is very rare. - Colloid carcinoma
It is also a rare exocrine pancreatic cancer in which the malignant tumour cells float in a gelatinous substance called mucin. It is easier to treat than other pancreatic cancers and has a much better prognosis because it is unlikely to spread.
Neuroendocrine pancreatic cancer
Tumour cells that develop from cells in the endocrine gland of the pancreas are called Pancreatic neuroendocrine tumours or Pancreatic NETs.
Neuroendocrine cancers are also known as endocrine or islet cell tumours because they form in the cells that secrete the hormones insulin and glucagon. They are rare and account for only 5% of all reported cancer cases.
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What are the different stages of pancreatic cancer?
The staging of cancer focuses on the extent to which the cancer cells have grown and spread into different parts of the human body. The treatment process is determined based on how much cancer there is in the human body. The staging process of pancreatic cancer is slightly different when compared to other cancers. It uses the American Joint Committee on Cancer (AJCC) TNM staging system, which focuses on three things;
T – (T) stands for tumour and focuses on how big the tumour is and if it has grown outside the pancreas into nearby blood vessels.
N – (N) stands for nodes of the lymph and focuses on how far it has spread to lymph nodes nearby.
M – (M) stands for metastasis and focuses on whether cancer has spread to other parts of the body.
Based on the above-mentioned factors, cancerous tumours are divided into the following stages;
- Stage 0 – Small and localised
- Stage 1 – Small and confined, size is less than 2 cms.
- Stage 2 – Small and bigger than 2 cm but not yet spread to lymph nodes.
- Stage 3 – Cancer has spread to nearby lymph nodes
- Stage 4 – Cancer has metastasised
Are you having unusual back pain? Urine that is dark in colour? Tiredness or a loss of appetite?
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What are the different grades of pancreatic cancer?
Tumour grading is the process of examining abnormal cells under a microscope to determine how closely they resemble normal pancreatic cells. It is divided into three;
- G1 or Grade 1: The tumour cells resemble normal pancreatic cells.
- G2 or Grade 2: The tumour might resemble normal or abnormal cells.
- G3 or Grade 3: The tumour looks abnormal.
G1 divides and grows slower than G3. Therefore, people with G3 pancreatic cancer tend to have a lower prognosis.
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How is pancreatic cancer diagnosed?
Also known as sonography, it is a method that utilizes sound waves to produce images of structures within the human body. This method can be used to check for abnormal cells in the pancreas.
An imaging diagnostic method that uses X-rays and computer technology to perform detailed imaging of various body parts, including the organs and glands like the pancreas.
It combines strong magnetic fields and radio waves to produce detailed images of the human body. MRI is the most dependable imaging method to check for the abnormal tumour in the human body.
It uses a radioactive drug (tracer) to check for your tissues and organs’ metabolic or biochemical function.
The images of the pancreas are made using an ultrasound device from inside the abdomen. A thin tube called the endoscope is passed into the stomach through the esophagus for the same.
It is the surgical removal of a portion of the tissue to check for the presence of abnormal cells. The biopsy method checks if the tumour is benign or malignant.
Pancreatic cancer cells shed specific proteins, and a blood test helps determine their presence through tumour markers called CA19-9.
What are the various pancreatic cancer treatment methods?
Surgery
Surgery involves the removal of the portion of the pancreas with a tumour or the whole pancreas to prevent the further spread of the tumour. The surgery aims to achieve negative margins or clear margins where there are no cancer cells in the edges of the tissue removed from the body. Different types of surgical methods are as follows:
- Laparoscopy: It is a process where the medical expert checks for the spread of the cancer cells to various parts of the body. A small hole is created in the abdomen, and a camera is passed into it. The doctor doesn’t recommend removing the primary tumour if the cancer has spread.
- Whipple procedure or pancreaticoduodenectomy: It is a surgical procedure done if the cancer tumour is present in the head of the pancreas.
- Distal pancreatectomy: It is a surgical procedure done if the cancer is located on the left side of the tail of the pancreas.
- Total pancreatectomy: It is a surgical procedure if the entire pancreas is affected and has to be removed to prevent the further spread of the disease.
Radiation therapy
Radiation therapy involves the usage of high-energy beams or particles to destroy the tumour cells. Types of radiation therapy include;
- Stereotactic body radiation therapy (SBRT): It is a treatment process where multiple beams of X-rays are directed at abnormal tissues through the skin (without an incision).
- Three-dimensional (3-D) conformal radiation therapy: Also known as radiation oncology, this type of treatment uses radiation to kill cancer cells and prevent them from multiplying.
- Intensity-modulated radiation therapy (IMRT): It is a process where advanced technology is used to manipulate radiation’s photon and proton beams to conform to the shape of the tumour cells.
- Image-guided radiation therapy (IGRT): It is a process that uses high-intensity radiation to kill cancer cells. Prior to that, images of the tumour cells are taken to check the treatment progress.
- Volumetric modulated arc therapy (VMAT): It is a modern-day technique that continuously delivers high-energy radiation doses while taking precautions to protect nearby healthy tissue cells.
Chemotherapy
Chemotherapy is the administration of powerful drugs to destroy cancer cells in the human body. It is given both before (neoadjuvant) and after (adjuvant) surgery.
Targeted therapy
Targeted therapy is the process of targeting and destroying specific genes, proteins, or the tissue of cancer with powerful drugs.
Immunotherapy
Immunotherapy is the process of triggering the body’s immune system to fight cancer cells and its growth. Inhibitors like anti-PD-1 antibodies such as pembrolizumab (Keytruda) and dostarlimab (Jemperli) are used for the treatment.
What are the common side effects of pancreatic cancer?
Some of the common side effects of pancreatic cancer treatment include;
- Fatigue or weakness
- Diarrhoea
- Nausea and vomiting
- Sore mouth
- Hair loss
- Peripheral neuropathy (numbness in toes and fingers)
- Blood clots
- Dry or itchy skin
- Constipation
However, a lot of pancreatic cancer treatment causes severe pain in the stomach or abdomen region. Medical expert assesses the pain based on the following;
- Where it started
- Where it is located
- Pain’s intensity
- Impact of cancer treatment
Appropriate treatment methods are suggested to deal with the pain accordingly.
What are the supportive treatment methods for pancreatic cancer?
Nutrition is the most important factor that drives the recovery of a pancreatic cancer patient. Pancreatic cancer patients should follow the following tips:
- Drink a minimum of 8 glasses of water every day.
- Reduce the intake of alcohol and caffeine to prevent dehydration.
- In case of nausea and vomiting, replace solid food with more nutrition semi-solid or liquid food items. Consume more chopped, soft and boiled food that is easy to digest.
- Consume small but frequent meals instead of having big meals three times a day.
- Consume protein-rich food items like beans, soy, peanuts, milk, and eggs.
- Choose essential whole-grain food items like oatmeal, whole-grain bread, brown rice, whole-grain pasta, bulgur, corn, farro, and quinoa.
- Avoid or reduce food items that increase blood sugar levels, like sweets or refined flour.
Other forms of supportive therapies recommended for cancer patients include;
- Meditation
- Guided imagery
- Massage
- Hypnosis
- Acupuncture
- Physiotherapy
- Mental health counselling
What are the important follow-up care steps after pancreatic cancer treatment?
The medical experts want to keep track of how well you are doing after the treatment and what side effects are there. Pancreatic cancer patients are recommended to go through follow-up care steps every six months.
Doctors recommend;
- Physical examinations
- Imaging tests (CT scan every 3-6 months)
- Blood test (monitoring the function of tumour marker CA 19-9)
- Liver function tests
- Kidney function tests
Cancer patients are also advised to undergo;
- Physical therapy
- Occupational therapy
- Career counselling
- Pain management
- Nutritional planning
- Emotional counselling
In conclusion,
Co-founder of CancerMitr, who survived a low-grade malignant pancreatic tumour, said that “people who pull through the severe pain that comes with cancer treatment are warriors.”
Cancer is not the end of the journey; it is part of the long walk of life. However, people can overcome all cancer-related challenges owing to advanced technology and treatment options. As a good friend, CancerMitr is here to guide and support all cancer patients with access to the required resources and technology.
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