Pancreatic Cancer Surveillance in High-Risk Individuals

Introduction:

Pancreatic cancer is the third leading cause of cancer that results in death. These cancers rarely occur below the age of 40 years. The pancreas has mainly two components, exocrine and endocrine components. The cancers arising in the exocrine region are called exocrine tumors, while those that arise in the endocrine region are called endocrine tumors. Pancreatic ductal carcinoma, or pancreatic cancer, is an exocrine tumor.

What Is Pancreatic Cancer?

Pancreatic cancers are cancers that arise in the pancreatic tissues. The most common pancreatic cancer is pancreatic ductal adenocarcinoma (PDAC). Pancreatic cancer is usually detected only at a later stage because, at an early stage, there are fewer symptoms to identify pancreatic cancer. The symptoms often arise when cancer has spread to other organs.

What Are the Causes of Pancreatic Cancer?

The initial cause of pancreatic cancer is unknown. Some studies show that people who smoke and with certain inherited gene mutations have a higher risk of developing pancreatic cancer. Cancer occurs when there is a gene mutation. It results in an uncontrolled cell division forming a tumor. Most pancreatic cancers develop in the ducts of the pancreas, and this type of cancer is called pancreatic ductal adenocarcinoma (PDAC) or pancreatic exocrine cancer. Pancreatic cancers can also be seen in the neuroendocrine cells (hormone-producing cells). They are called pancreatic neuroendocrine tumors or pancreatic endocrine tumors, or islet cell tumors. These tumors are less common than pancreatic ductal adenocarcinomas.

What Are the Symptoms of Pancreatic Cancer?

Pancreatic cancer shows signs and symptoms when the disease is advanced.

• Radiating pain to the back in the abdominal region.

• Loss of appetite and weight loss.

• Jaundice (yellow discoloration seen on the skin and sclera of the eye).

• Pale-colored stools.

• Dark-colored urine.

• Fatigue.

• Blood clots.

What Are the Risk Factors for Pancreatic Cancer?

Anything that increases the chance of getting a disease is called a risk factor.

1. Risk Factors That Can Be Changed - These factors can be changed through changes in lifestyles and diet etc. They include -

• Tobacco Use - A most important risk factor of pancreatic cancer is smoking. People who smoke are two times more prone to pancreatic cancer than non-smokers. Both cigar and smokeless tobacco can increase the risk of pancreatic cancer.

• Obesity - People with a body mass index of more than 30 are 20 percent more likely to develop pancreatic cancer.

• Diabetes - People having diabetes can be more prone to developing pancreatic cancer. The incidence is found more often in individuals with type 2 diabetes mellitus.

• Chronic Pancreatitis - Inflammation of the pancreas for a long time is known as chronic pancreatitis. This is seen in people who are heavy alcohol drinkers and smokers.

• Exposure to Chemicals - During work, exposure to certain chemicals used in dry cleaning and metal working can cause pancreatic cancer.

2. Risk Factors That Cannot Be Changed - These factors cannot be controlled or changed.

• Age - As with the increase in age, the chance of getting pancreatic cancer also increases. People above the age of 45 years are more likely to get pancreatic cancer.

• Gender - Pancreatic cancer is seen more in males than females.

• Race - Incidences of African-Americans developing pancreatic cancer are more than other races. The exact reason for this predisposition is unknown.

• Family History - The chances of developing pancreatic cancer are associated with a past history of cancer within the family.

• Inherited Gene Syndromes - Genes that are transferred from parent to child are called inherited genes. Some genes may have mutations. These mutated genes are responsible for 10 percent of pancreatic cancers. Some genetic syndromes that cause pancreatic carcinoma are cancers caused by hereditary transfer, like breast and ovarian cancers, hereditary pancreatitis, Lynch syndrome, and Peutz-Jeghers syndrome.

How Is Pancreatic Cancer Surveillance Done in High-Risk Individuals?

Pancreatic cancer is often metastatic within a short time and progresses into advanced cancer. People at high risk of developing pancreatic cancer are kept under observation to detect precancerous lesions and cancers early so that treatment can start early. Many patients who are having high-risk of developing pancreatic cancer have been screened. Most of the high-risk patients have developed early-stage of pancreatic cancer eventually. Patients showing signs and symptoms are normally found to have advanced pancreatic cancer.

Most cancer that is diagnosed early during surveillance can potentially be cured. Some individuals skip midway during the surveillance and have poor survival rates. So regular screening is a must to evaluate the disease progression. Blood tests and imaging techniques like magnetic resonance imaging (MRI) and endoscopic ultrasound (EUS) are diagnostic modes utilized during the early stages of pancreatic cancer. Treatment is also provided for these people.

The surveillance study mainly focuses on people with risk factors that cannot be changed, like patients having a family history of pancreatic cancer, germline mutations, or inherited gene syndromes. These surveillance studies give not only the number of people diagnosed with any stage of cancer but also the number of people undergoing pancreatic surgery, the outcome of the disease, and the chances of any complications or adverse events likely to occur during the treatment procedures.

Screening should be done in a time interval of 12 months for people with very low risk of pancreatic cancer, six to twelve months for people with low risk, three to six months in cases of intermediate risk, and within three months for individuals with high risks.

How Is Pancreatic Cancer Diagnosed?

Physical examination of the pancreas cannot be done because the pancreas cannot be felt during a routine examination. Early-stage diagnosis is often difficult due to this.

• Blood Tests - Blood tests can be done to determine the presence of tumor markers. A high level of carbohydrate antigen indicates cancer.

• Endoscopic Ultrasound - It is a minimally invasive procedure in which a thin, flexible tube with a camera is inserted through the mouth to the stomach. High-frequency sound waves produce images of the stomach and digestive tracts.

• Biopsy - Tissue containing a portion of the tumor is taken if necessary during the endoscopic ultrasound.

What Is the Treatment for Pancreatic Cancer?

Treatment depends on the tumor's location, size, stage, and individual health.

• Pancreatectomy - Surgical removal of the pancreas or a part of the pancreas. Pancreatic cancer, along with the lymph nodes, is resected.

• Radiation Therapy - Killing cancer by using high-speed radiation energy.

• Chemotherapy - Use of drugs to kill the tumor.

• Immunotherapy - Killing the tumor by using the body’s immune system.

• Targeted Therapy - Targeted at certain genes or proteins that help in cancer growth.

• Clinical Trials - In clinical trials, new treatment methods are used in the form of procedures or drugs that have not been commercially released or approved by the drug authorities are used. There is no guarantee of a positive outcome, and it may or may not be successful. They can also have adverse impacts. Participation in these trials is only consensual if the patient agrees to it.

Conclusion:

Pancreatic cancer is highly metastatic when it is in the advanced stage. The prognosis depends upon the stage of pancreatic ductal adenocarcinoma. It can be cured easily in the early stages, but in an advanced stage, the treatment and prognosis can be difficult. Untreated pancreatic cancers can spread to different organs, blood vessels, and other distant body parts. Smoking and maintaining a healthy diet is compulsory to avoid getting cancer. In the case of individuals with high risks, they are kept under surveillance to detect and treat cancer at an early stage.