Cancer

Pancreatic Cancer - Important Facts One Needs to Know

Written by
Dr. Saumya Mittal
and medically reviewed by iCliniq medical review team.

Published on Jan 23, 2017 and last reviewed on Nov 07, 2019   -  2 min read

Abstract

Abstract

In this article, I have discussed the types, causes, clinical features, signs, genetic risk factors, investigations, staging and treatment of pancreatic cancer.

Pancreatic Cancer - Important Facts One Needs to Know

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

Types of Pancreatic Cancer:

There are two types of pancreatic cancer. They are endocrine tumors and infiltrating ductal adenocarcinoma.

Causes:

  1. Cigarette smoking.
  2. Chronic pancreatitis - alcohol causes chronic pancreatitis and not pancreatic cancer.
  3. Diabetes mellitus.

Clinical Features:

The clinical features of the pancreatic cancer are jaundice, weight loss, abdominal discomfort, epigastric pain, pruritus, lethargy, backache, nausea, vomiting, diabetes and acute pancreatitis.

The signs of pancreatic cancer are jaundice, scratch marks, cachexia (muscle wastage), Courvoisier's sign- palpable gall bladder and metastasis causes hepatomegaly, Virchow's nodes and Sister Mary Joseph nodules.

Genetical Risk Factors of Pancreatic cancer:

KRAS gene mutations, inactivated p16, p53 SMAD-4 (tumor suppressor gene), interaction IGF1R with FAK, overexpression of c-Src and overexpression of survivin. Also, pancreatic cancer occurs in inherited condition as follows. Familial multiorgan carcinoma syndrome, familial adenomatous polyposis, Peutz-Jeghers syndrome and familial breast and ovarian syndrome, genetically driven chronic disease such as cystic fibrosis, ataxia-telangiectasia, hereditary pancreatitis and familial pancreatic cancer.

Investigations:

Pancreatic cancer can be investigated through CT, MRI, MRCP (magnetic resonance cholangiopancreatography), ERCP (endoscopic retrograde cholangiopancreatography), EUS (endoscopic ultrasound scan), FDG-PET (Fluorodeoxyglucose), EUS guided FNAC (fine needle aspiration cytology). ERCP provides ductal brushing or pancreatic juice sampling and serum marker CA19-9.

Staging of Pancreatic Cancer:

1) 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.

2) AJCC - II:

T3N1 - spread beyond the pancreas, to local lymph nodes.

3) AJCC - III:

T4 any N - spread to celiac axis and superior mesenteric artery.

4) AJCC - IV:

M1 - distant metastasis.

Treatment:

  • In the case of resectable disease, Whipple procedure is preferred. Pylorus-preserving pancreatic duodenectomy and postoperatively, 5FU (Fluorouracil) with FA (Folinic acid) or Gemcitabine are given.
  • 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.
  • For metastatic pancreatic cancer, chemotherapy is used and either one of the following combination is preferred.
  1. Gemcitabine.
  2. Gemcitabine and Erlotinib.
  3. Gemcitabine and Capecitabine.
  4. Gemcitabine and Nab-paclitaxel.
  5. FOLFIRINOX, a combination of 5FU/FA, Irinotecan and Oxaliplatin.

To know more about pancreatic cancer, consult a medical oncologist online --> https://www.icliniq.com/ask-a-doctor-online/medical-oncologist

Last reviewed at:
07 Nov 2019  -  2 min read

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