Pancreatic Cancer Overview

According to the American Cancer Society, pancreatic cancer is expected to surpass breast cancer to become the third leading cause of cancer-related deaths in the U.S. The reason is that this cancer has a tendency to spread silently before diagnosis. The lifetime risk of pancreatic cancer is about 1 in 65.

Types of pancreatic cancer

The type is classified based on the part of the pancreas that is affected. Pancreatic cancer can form in the exocrine and the endocrine cells, of the pancreas.

1- the Exocrine glands make pancreatic enzymes that help break down foods. 95% of pancreatic cancers are classified as exocrine tumors. The vast majority of these tumors are adenocarciniomas.

2- the Endocrine glands, clustered in islets, make the hormone insulin to control blood sugar.

Endocrine tumors are less common, accounting for less than 5% of all pancreatic tumors. They develop from abnormal hormone producing cells in the pancreas, and are called Islet Cell tumors or Neuroendocrine tumors ( PNETS or pancreatic NETS). Most are benign.

The cause of pancreatic cancer is not known.

Risks

  1. Smoking is the main risk factor believed to cause 20-30% of all pancreatic cancer. Smoking doubles the risk.
  2. Diabetes is has been linked to pancreatic cancer.
  3. This disease commonly strikes people after age 45.
  4. Race- African Americans are at highest risk. Ashkenazi Jews also have a higher incidence.
  5. Family history. When a family member has pancreatic cancer it increase the risk by 2-3 times.

A family history of breast or colon cancer, melanoma and pancreatitis also increases the risk.

  1. Obesity increases the risk by 20%.
  2. Chronic pancreatitis and cirrhosis of the liver
  3. Heavy use of Alcohol can cause chronic pancreatitis which is known to increase risk of pancreatic cancer.

Symptoms and Treatment

  1. Abdominal bloating (Ascites) an abnormal accumulation of fluid in the abdomen. This causes discomfort, difficulty breathing, shortness of breath, decreased appetite, abdominal pain and pressure, indigestion weight gain, fatigue, constipation, nausea and ankle swelling.
  1. Digestive problems occur when the tumor presses against the stomach or part of the small intestines, causing nausea and vomiting, or the tumor blocks the pancreatic duct.
  1. Jaundice is a common symptom of pancreatic cancer, caused by the tumor blocking the flow of bile. Jaundice is the buildup of bile in the blood that turns the skin yellow, and causes itching, abnormally dark urine and light stool.
  1. Weight loss, loss of appetite, elevated blood sugar levels. Patients with pancreatic cancer can develop diabetes.
  1. Abdominal Pain affects more than 80% of patients. It can appear as a dull ache in the upper abdomen or mid back. Pain medications are important but can lead to constipation. The other option is a celiac plexus block that is designed to damage the nerves that cause the pain. This procedure is used for patients with severe pain that cannot be managed with medication.

The celiac plexus block is performed during surgery, during endoscopic ultrasound or by going through the skin ( Percutaneous approach). This procedure is done under anesthesia. The effects commonly last 3-6 months.

  1. A sudden change in blood sugar levels in a diabetic who had well controlled diabetes suggests pancreatic cancer.

Diagnosis

Pancreatic cancer tends to stay silent and painless until it grows large enough to cause symptoms outside the pancreas. It is challenging to find this disease early. Blood tests, biopsy and imaging studies like CT Scans, MRI, endoscopic ultrasound, laparoscopy and biopsy are performed to aid diagnosis.

Treatments

Surgery can cure the disease if it has not yet spread outside of the pancreas. However, palliative surgery may be performed even if the cancer has spread, to lessen the symptoms.

Laparoscopic Surgery is minimally invasive and may be used in certain cases. Biliary bypass surgery or insertion of a stent to keep the bile duct open, can offer relief from a bile duct blockage that causes pain and digestive problems.

Other procedures to destroy tumors include radiofrequency ablation, microwave thermotherapy, cryosurgery. Another option is attempting to block blood flow to the cancer cells so that they die. It is called embolization.

Chemotherapy may be used alone, in combination with other therapies. Radiation therapy is used to relieve pain, prevent tumor growth, or to destroy cancer cells left after surgery. It may be used before surgery to reduce the size of the tumor so it is more easily removed. And it may be combined with Chemotherapy.

Targeted therapy- drugs used are targeted to the unique aspects of the cancer cells, leaving healthy cells alone. Pancreatic cancer vaccines are in development.

Medical Marijuana may help ease pain, nausea and loss of appetite in cancer patients.

The physicians at BASS Medical Group are sensitive to the emotional impact of cancer on their patients, and committed to providing compassionate care. Our multi-disciplinary team offers high quality, cost effective, personalized, integrated care and skilled, experienced surgeons to patient optimize outcomes.

Our offices are in San Francisco and the East Bay, California, to serve our patients. Find the location convenient to you. Then call BASS Medical Group to schedule a consultation to discuss your concerns, get answers to your questions and receive professional, quality care.