Medicaoncology Pancreatic Cancer

What is Pancreatic Cancer?

The pancreas is present beneath the stomach and assists in the digestion process. In addition, it plays a vital role in metabolic homeostasis. The pancreas secretes several enzymes that help in digestion. It also releases hormones that regulate sugar levels in the blood. Pancreatic cancer initiates in the pancreatic cells. Most commonly, cancer develops in the ducts that carry the digestive enzymes from the pancreas. Unfortunately, most patients do not have early symptoms of pancreatic cancer, resulting in its diagnosis in the advanced stage.

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    Following are the types of pancreatic cancer:

    Exocrine Pancreatic Cancer

    It is also known as non-endocrine cancer. It develops from exocrine cells, which build up the exocrine gland and ducts of the pancreas. These cells secrete enzymes that help break down carbohydrates, fats, proteins and acids in the duodenum. Exocrine pancreatic cancer makes up around 95 per cent of all pancreatic cancers. Some exocrine pancreatic cancers are adenocarcinoma, squamous cell carcinoma, adenosquamous cell carcinoma, colloid carcinoma etc.

    Endocrine Pancreatic Cancer

    It is also called pancreatic neuroendocrine tumors (PNETs) or islet cell tumors. They are less common than exocrine tumors, making up around 7% of all pancreatic cancers. A pancreatic neuroendocrine tumor can be functioning or non-functioning. A functioning tumor makes hormones. A non-functioning tumor no longer makes hormones. The types of pancreatic neuroendocrine tumors are insulinoma, gastrinoma, and glucagonoma.


    Signs and symptoms of pancreatic cancer do not generally occur in the early stage of the disease. Some these may include:

    • Stomach and back pain
    • Yellowish of skin and eyes
    • Dark color urine
    • Light-coloured stools
    • Pruritus (itchy skin)
    • Lose weight
    • GI Problem- indigestion, loss of appetite, vomiting, nausea
    • Diabetes
    • Swelling in the gallbladder or liver
    • Fatigue
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    Pancreatic cancer is believed to be caused by damage (or “modification”) to the DNA of the pancreatic cells. These DNA mutations may occur due to different reasons. For example, they can be inherited, they may be caused by behaviors such as smoking, or they may be accidental. However, it is not clear what causes pancreatic cancer.

    Other Risk Factors:

    Several factors increase the chances of developing pancreatic cancer. Some of them are:

    • Excessive Alcohol Consumption
    • Smoking: Smoking accounts for up to 30% of pancreatic cancer cases.
    • Obesity
    • Diabetes
    • Family history: Up to 10% of pancreatic cancer cases have a family history of pancreatic cancer.
    • Infections: H. Pylori infection in the digestive tract may enhance the risk of pancreatic cancer.
    • HPV: Some types of a viral infection such as human papillomavirus (HPV)
    • Radiation: Exposure to radiation, including UV radiations.

    Stage 0: The malignancy has not invaded the pancreas’ interior tissues and is restricted to the upper layers of pancreatic duct cells at this stage. Carcinoma in situ refers to these tumors.

    Stage I:Stage I has two substages:

    • Stage IA: The cancer is exclusively present in the pancreas at this stage, and the tumor is no more than 2 cm in diameter.
    • Stage IB: The cancer has not migrated to other parts of the body at this stage, and the tumor size ranges from 2 to 4 cm.

    Stage II: Stage II also is further divided into two subgroups:

    • Stage IIA: The pancreatic cancer has not spread here, and the tumor is larger than 4 cm in diameter.
    • Stage IIB: Pancreatic cancer has progressed to 1-3 lymph nodes, with tumors of different sizes.

    Stage III: The size of the tumors at this stage could range from 1 cm to 4 cm, or possibly larger, with the disease having spread to one or more lymph nodes.

    Stage IV: Pancreatic cancer cells have spread to other places of the body at this point. The tumour is more than 4 cm in diameter, and there may be more malignant lymph nodes present.


    There are several diagnostic techniques that the doctor uses to diagnose pancreatic cancer. Some of them are:

    • Physical Examination: The doctor performs the primary screening of pancreatic cancer based on the symptoms of the patient. The doctor may refer to stomach and back pain, sudden weight loss, abdominal swelling, and persistent fatigue.
    • Blood Tests: The doctor advises the patient to undergo a blood test to determine the presence of a tumor marker. A tumor marker elevated during pancreatic cancer is CA19-9. However, this test is not the confirmatory test for pancreatic cancer, as many patients with pancreatic cancer do not have high levels of CA19-9.
    • CT scan: The doctor may advise a CT scan to determine the presence and extent of pancreatic cancer.
    • MRI: Using magnetic resonance imaging, the scanner creates images of the abdomen, especially of the location around the pancreas, liver and gallbladder.
    • Ultrasound: Ultrasound also provides information about the presence of a tumor in the pancreas.
    • Biopsy: Core needle biopsy is used to collect a sample of tissue, which can be helpful for molecular or genetic testing of the tumor. But, a core needle biopsy has higher risks than an FNA (Fine needle aspiration), such as pancreatitis and bleeding.
    • ERCP: The doctor inserts a tube with a camera at its end in the mouth to the small intestine. The doctor can view the pancreas through the gastrointestinal system for the presence of any tumor.
    • Laparoscopy: It is a procedure that involves numerous small incisions. Using laparoscopy, a physician can collect tissue for biopsy and see in the stomach to decide if pancreatic cancer has spread.
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    The doctor may treat pancreatic cancer through the following therapies:

    Surgery: The patient may undergo surgery for pancreatic cancer depending upon the location and stage of cancer. In case of a tumor in the pancreatic head, the doctor may perform a Whipple procedure (pancreaticoduodenectomy).

    The doctor may remove the body and tail of the pancreas if the cancer is present at that part of the pancreas. The surgery is known as distal pancreatectomy. If cancer spread throughout the pancreas, the doctor needs to remove the complete pancreas. The procedure is known as pancreatectomy.

    If cancer progresses to an advanced stage and affects the nearby blood vessels, the doctor performs highly specialized surgery that removes the pancreas and blood vessels. It also involves reconstructing the removed blood vessels.

    Chemotherapy: In chemotherapy doctor administers the drugs that kills cancer cells. The doctor prescribes the injectable or oral medications during the chemotherapy regimen. The doctor also uses chemotherapy along with surgery or radiation therapy to make the treatment more effective.

    Radiation therapy: Radiation therapy involves using high-energy radiation to kill cancer cells. The doctor uses this option with surgery. Further, this treatment is effective when surgery is not viable for cancer treatment.


    Some methods may reduce the risk of pancreatic cancer. These are:

    • Avoid or reduce the consumption of alcohol
    • Maintaining a healthy weight (in people who are obese or overweight)
    • Live a healthy life and exercise daily.
    • Avoid smoking.


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