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Pancreatic Cancer - Important Facts One Needs to Know

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Pancreatic Cancer - Important Facts One Needs to Know

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Pancreatic cancer is the fourth leading cause of death. It is usually detected late and 85 percent to 90 percent are inoperable. The most common age group is 60 to 79 years.

Medically reviewed by

Dr. P. C. Pavithra Pattu

Published At January 23, 2017
Reviewed AtMarch 1, 2024

What Is Pancreatic Cancer?

Malignant cells that grow in a portion of the pancreas cause pancreatic cancer. The exocrine or endocrine glands' ability to function as well as the pancreas' overall function may be impacted by this. Although the pancreas can develop cancer anywhere in its body, the head of the organ accounts for 70 percent of cases.

Over 95 percent of pancreatic cancer cases are exocrine tumors. Pancreatic duct lining cells are the initial site of the most prevalent kind, called an adenocarcinoma.

Pancreatic neuroendocrine tumors (NETs) make for about 5 percent of all pancreatic malignancies. They begin in the cells that produce hormones.

The Stages of Pancreatic Cancer

AJCC - I (American Joint Committee on Cancer):

  • T1N0: Limited to the pancreas, up to 2 cm.

  • T2N0: Limited to the pancreas, more than 2 cm.

AJCC - II:

  • T3N1: Spread beyond the pancreas, to local lymph nodes.

AJCC - III:

  • T4 any N: Spread to the celiac axis and superior mesenteric artery.

AJCC - IV:

  • M1: Distant metastasis.

What Are the Types of Pancreatic Cancer?

There are two types of pancreatic cancer.

Exocrine Pancreatic Cancer: The exocrine cells that make up the pancreatic ducts and exocrine glands are the source of exocrine pancreatic cancer. Enzymes secreted by the exocrine gland aid in the digestion of proteins, acids, lipids, and carbohydrates in the duodenum.

  • Adenocarcinoma: Over 90 % of cases of pancreatic cancer are of adenocarcinoma, also known as ductal carcinoma. It is the most prevalent kind of the disease. The pancreatic duct lining is affected by this malignancy.

  • Squamous Cell Carcinoma: Since squamous cells are not normally seen in the pancreas, this incredibly unusual nonendocrine pancreatic cancer originates in the pancreatic ducts. It is impossible to properly understand the roots of this disease due to the small number of documented instances. Studies have shown that because most cases are found after metastasis, the prognosis is very poor.

  • Adenosquamous Carcinoma: Of all exocrine pancreatic tumors, this uncommon kind accounts for 1 % to 4 %. Adenosquamous carcinoma has a worse prognosis and is a more aggressive tumor than adenocarcinoma. These tumors exhibit traits common to both squamous cell carcinoma and ductal adenocarcinoma.

  • Colloid Carcinoma: One to three percent of exocrine pancreatic tumors are colloid carcinomas, another uncommon form. Intraductal papillary mucinous neoplasms, a benign cyst type, are typically the source of these tumors (IPMN). Compared to other pancreatic cancers, the pancreatic colloid tumor is more unlikely to spread and is easier to cure since it is made up of malignant cells floating on a gelatinous substance called mucin. Its outlook is likewise far better.

Neuroendocrine Pancreatic Cancer: The endocrine gland of the pancreas secretes insulin and glucagon into the bloodstream to control blood sugar levels. From these cells, pancreatic neuroendocrine tumors (NETs) arise. Neuroendocrine malignancies are extremely uncommon, accounting for less than 5 % of instances of pancreatic cancer. They are sometimes referred to as endocrine or islet cell tumors.

What Are the Causes?

  1. Consuming tobacco.

  2. Age: Adults over 60 account for the majority of instances.

  3. Diabetes mellitus, especially if it has just been discovered.

  4. Ovarian, colon, or pancreatic cancer in the family history.

  5. Persistent pancreatitis.

  6. Overindulgence in alcohol.

  7. Being obese.

What Are the Signs and Symptoms?

The clinical features of pancreatic cancer are

  • Jaundice.

  • Weight loss.

  • abdominal discomfort.

  • epigastric pain.

  • Pruritus.

  • Lethargy.

  • Backache.

  • Nausea.

  • Vomiting.

  • Diabetes.

  • Acute pancreatitis.

The signs of pancreatic cancer are

  • Jaundice.

  • Scratch marks.

  • Cachexia (muscle wastage).

  • Courvoisier's sign- palpable gall bladder.

  • Metastasis causes hepatomegaly.

  • Virchow's nodes.

  • Sister Mary Joseph nodules.

How Is Pancreatic Cancer Diagnosed?

Pancreatic cancer can be investigated through

How Can Pancreatic Cancer Be Treated?

  1. In the case of resectable disease, the Whipple procedure is preferred. Pylorus-preserving pancreatic duodenectomy and postoperatively, 5FU (Fluorouracil) with FA (Folinic acid) or Gemcitabine are given.

  2. In the case of inoperable and locally advanced disease, Gemcitabine is given. If a response is seen in three to six months, then radiotherapy may be added.

  3. For metastatic pancreatic cancer, chemotherapy is used and either one of the following combinations is preferred.

  • Gemcitabine.

  • Gemcitabine and Erlotinib.

  • Gemcitabine and Capecitabine.

  • Gemcitabine and Nab-paclitaxel.

  • FOLFIRINOX, a combination of 5FU/FA, Irinotecan, and Oxaliplatin.

What Are the Risk Factors for Pancreatic Cancer?

The following variables may increase the risk of pancreatic cancer:

  • Smoking.

  • Diabetes type 2.

  • Pancreatitis is the term for persistent pancreatic inflammation.

  • Genetic mutations can raise the risk of cancer running in the family. These include Lynch syndrome, familial atypical multiple mole melanoma (FAMMM) syndrome, and mutations in the BRCA2 gene.

  • History of pancreatic cancer in the family.

  • Being overweight.

  • Older years. Most pancreatic cancer patients are older than 65.

  • Excessive alcohol consumption.

What Are the Complications?

  1. Reduced Weight: Individuals who have pancreatic cancer may experience weight loss due to the disease's increased energy consumption. Eating may be difficult if cancer therapies are causing nausea and vomiting or if the malignancy is pressing on the stomach. The pancreas sometimes produces insufficient digestive fluids, which causes the body to have difficulties absorbing nutrients from food.

  2. Jaundice: The bile duct in the liver might become blocked by pancreatic cancer. Yellowing of the skin and the whites of the eyes are symptoms. Pale stools and black urine are two signs of jaundice. Jaundice frequently happens without abdominal pain.

  3. Pain: An expanding tumor may put pressure on the abdomen's nerves, resulting in potentially excruciating pain. Painkillers may make one feel more at ease. Chemotherapy and radiation therapy are two examples of treatments that may help reduce tumor growth and alleviate some pain.

  4. Blockage of the Bowel: Pancreatic cancer has the potential to invade or press against the duodenum, the first segment of the small intestine. This may stop food that has been broken down from moving from the stomach into the intestines.

What Is the Prognosis of Pancreatic Cancer?

The size and nature of the tumor, the involvement of lymph nodes, and the extent of metastasis (spread) at the time of diagnosis all affect the long-term prognosis for pancreatic cancer. The prognosis for pancreatic cancer is better the earlier it is identified and treated.

  1. Five-Year Survival Rate: The percentage of all patients who are still alive five years after diagnosis is quite low for pancreatic cancer (5 to 10 percent) when compared to many other malignancies. This is because a far higher number of patients receive a stage IV diagnosis after the illness has spread.

  2. Prognosis for Stage IV: The five-year survival rate for Stage IV pancreatic cancer is 1 percent. Patients with late-stage pancreatic cancer typically have a one-year survival rate following diagnosis.

  3. Potentially Curable If Discovered Extremely Early: Although pancreatic cancer has a generally dismal prognosis and is primarily incurable, it may be curable if discovered extremely early. After receiving therapy, up to 10 percent of patients with an early diagnosis recover completely from their illness. The typical survival duration for patients with pancreatic cancer is 3 to 3.5 years if they are discovered before the tumor grows significantly or spreads.

  4. Improved Prognosis for Resectable Tumors: Patients with tumors that can typically be surgically removed (resected) have better life rates overall than those whose tumors are discovered after they have spread or become locally advanced.

Of all pancreatic tumors, 15 to 20 percent are treatable. Tumors in stages I and II are among them. Rarely, locally progressed stage III tumors are described as "borderline," and if the patient has access to a skilled, highly qualified surgeon, they may be removed. Normally, these tumors are deemed unresectable, meaning they do not qualify for surgery.

Conclusion:

The pancreas is a gland in the abdomen that helps in digestion; pancreatic cancer affects this gland. Nausea, bloating, exhaustion, jaundice, and lack of appetite are some of the symptoms of pancreatic cancer. Among the treatments include radiation therapy, chemotherapy, and surgery. The medical professional is available to support one during this challenging period. Patients may choose to join a pancreatic cancer support group in the local area or online. Socializing with like-minded individuals may be uplifting and good for mental and emotional well-being. One can discuss their feelings with a social worker, therapist, or counselor as well. Patients and their family can benefit from a number of useful resources, and remember that knowledge is power.

Frequently Asked Questions

1.

Can Pancreatic Cancer Be Cured Completely?

It is difficult to cure pancreatic cancer completely. Diagnosing the condition at an earlier stage will prevent cancer from spreading to other parts of the body. A life-saving surgery could be the only option for pancreatic surgery.

2.

What Are the Early Warning Signs of Pancreatic Cancer?

The following are the warning signs of pancreatic cancer:
- Loss of appetite.
- Jaundice.
- Back pain or abdominal pain. Pain in the abdomen is commonly seen in pancreatic cancer.
- Nausea.
- Vomiting.
- Weight loss.
- Gallbladder enlargement.
- Formation of blood clots.
- Diabetes.
- Liver enlargement.

3.

How Long Can a Person Live With Pancreatic Cancer?

The life expectancy of patients with pancreatic cancer will vary according to the health condition of the patient. The average lifespan of pancreatic cancer patients is three months. With proper treatment, it is possible to extend the life of the patient in a good way.

4.

Is Chemotherapy Beneficial for Pancreatic Cancer?

Yes, chemotherapy treatment is known to be beneficial for patients with pancreatic cancer. This might not be applicable to all the patients, though. Chemotherapy agents play a vital role in reducing the speed of cancer growth. This will provide more time for the individual to live. The most commonly used drug is Gemcitabine.

5.

Can Anyone Survive Stage 4 Pancreatic Cancer?

It is hard for patients who are in stage 4 pancreatic cancer to live for a long time. The average lifespan of them is expected to be around two to six months. You should consult your doctor and discuss the ways to increase the effectiveness of your treatment.

6.

How Does Pancreatic Cancer Pain Feel?

Patients experience too much pain when they lie down. It is known to begin in the middle of the abdomen and then radiate to the back. The pain is known to get relieved when the person is bending forward. It also increases after eating.

7.

Who Is at High Risk for Pancreatic Cancer?

Patients who are having other medical conditions are at high risk. Factors that might increase the risk of pancreatic cancer are:
- Diabetes.
- Smoking.
- Family history of pancreatic cancer.
- Obesity.
- Older age.
- Lynch syndrome.
- BRCA2 gene mutation.
- FAMMM (Familial atypical mole-malignant melanoma) syndrome.

8.

How Do You Detect Pancreatic Cancer?

Pancreatic cancer can be detected by using a Computed Tomography Scan (CT Scan). This will help in identifying the internal structure of the pancreas in a precise way. The spread of cancer to the other organs and enlargement of the lymph can also be identified using a CT scan.

9.

How Quickly Does Pancreatic Cancer Develop?

There are four stages of pancreatic cancer. Medical reports suggest that it takes approximately 14 months for cancer to progress. If the medical health condition of the patient is poor, cancer might develop very quickly.

10.

Does Your Stomach Swell With Pancreatic Cancer?

The most common complication associated with pancreatic cancer is the build-up of fluid in the abdomen. This will result in a condition called ascites, where swelling would be seen. This will cause discomfort and pain in the abdomen. Patients with ascites will have difficulty in sleeping.

11.

Can You Detect Pancreatic Cancer With an Ultrasound?

Yes, pancreatic cancer can be detected using ultrasound techniques. The endoscopic type of ultrasound is more beneficial than an abdominal ultrasound. The ultrasound will show precise images of the pancreas, along with the surrounding tissues. The size of the tumor and the exact location can be identified.

12.

What Is the Most Effective Treatment for Pancreatic Cancer?

The condition of pancreatic cancer can be treated well with non-surgical options. The surgical methods are not beneficial for all patients. The non-surgical options include chemotherapy and radiotherapy. The doctor will decide whether to go for chemotherapy with or without radiotherapy procedures.

13.

How Many Chemotherapy Treatments Are Needed for Pancreatic Cancer?

If the patient’s health condition is not critical, the patient might be advised to take two chemotherapy drugs together. The drug is administered through the oral route or intravenous route.

14.

Is Pancreatic Cancer Curable if Caught Early?

If pancreatic cancer is diagnosed in an earlier stage, the rate of favorable prognosis is higher. The spreading of the cancerous condition can be restricted, and lifespan can be gradually increased. However, we cannot conclude that all types of pancreatic cancer can be cured.

15.

How Serious Is Cancer in the Pancreas?

Pancreatic cancer is a life-threatening condition. Most patients with pancreatic cancer die. The most challenging part of pancreatic cancer is diagnosis. The patients do not show any symptoms, and it would be difficult to identify the cancer of the pancreas. Since the condition is unpredictable, it can be the critical one.

16.

Is Pancreatic Cancer Fatal?

Yes, pancreatic cancer is fatal because the death rate is higher with pancreatic cancer. It is almost impossible to cure the condition of pancreatic cancer completely. You should get help from your doctor for better improvement in health.
Dr. Saumya Mittal
Dr. Saumya Mittal

Internal Medicine

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pancreatic cancer
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