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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:

  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.

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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.

Last reviewed at:
07 Nov 2019  -  2 min read

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Dr. Saumya Mittal

Dr. Saumya Mittal

MD Internal Medicine, CC (Diabetes Mellitus), MBBS, Diploma (Vitamin D).,

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