Introduction
A thin pear-shaped gland about six inches in length called the pancreas is in the middle of the spine and abdomen. The pancreas is divided into three sections. The head is the broad end of the pancreas, the body is the immediate region, and the tail is the thin end.
It is made up of two parts -
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Exocrine part.
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Endocrine part.
In the exocrine part of the pancreas, enzymes help the digestion of food, especially fats, which are released into the small intestines.
In the endocrine pancreas, hormones like insulin are formed for the body's metabolism. Insulin helps maintain blood sugar, glucagon, pancreatic polypeptide, somatostatin, etc.
What Is Pancreatic Cancer?
Pancreatic cancer forms from the tissues of the pancreas. When the healthy cells of the pancreas do not function normally and start growing abnormally, they form a tumor. These tumors can be cancerous or noncancerous and can affect the functioning of the pancreas or spread to other parts of the body.
What Are the Types of Pancreatic Cancer?
Cancer in the pancreas can be divided into two types depending on the tumor's location. They are
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Exocrine cancer.
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Endocrine cancer.
Endocrine cancer is also known as islet cell tumors or pancreatic neuroendocrine tumors. These tumors help in hormone production and are known as functioning tumors. Those which do not interfere with hormone production are called non-functioning tumors. The tumors are named based on the hormones produced; for example, insulinoma is a cell tumor that produces insulin.
What Is Exocrine Pancreatic Cancer?
Cancer in the exocrine part of the pancreas is called exocrine pancreatic cancer. Although this cancer occurs frequently, the causative factors of this type of cancer are unknown.
What Are the Types of Exocrine Pancreatic Cancers?
The most commonly seen exocrine pancreatic cancer is adenocarcinoma.
It is subdivided into
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Ductal Adenocarcinoma - Cancer that develops from the pancreatic ducts is called ductal adenocarcinoma.
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Acinar Adenocarcinoma - When the tumors grow in the cells that produce enzymes, it is called acinar cell adenocarcinoma.
Other rarely seen exocrine cancers include-
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Acinar cell carcinoma.
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Adenosquamous carcinoma.
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Colloid carcinoma.
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Giant cell tumor.
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Hepatic carcinoma.
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Mucinous cystic neoplasms.
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Squamous cell carcinoma.
What Are the Symptoms of Exocrine Pancreatic Cancer?
Following symptoms are seen in a person who has exocrine pancreatic cancer.
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Jaundice - The head of the pancreas is blocked because of a possible tumor obstructing the flow of bile juice in the common bile duct, causing symptoms of jaundice.
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Upper Abdominal Pain - The tumor from the body or tail part of the pancreas starts to put pressure on the surrounding organs. This is the most common symptom observed during the advanced stage. When lying down or after having food, the patient can experience severe pain.
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Weight Loss - There is a decrease in weight as there is a shortage of functional pancreatic enzymes which produce the required enzymes.
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Diabetes - People with normal body mass index can observe sudden diabetic changes. This can be seen as a warning sign of pancreatic illness.
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Indigestion and Nausea - A block in the digestive tract can be seen due to the pressure from the tumor of the pancreas, causing nausea and indigestion.
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Diarrhea - The tumor can block the pancreatic duct, and as a result, insufficient pancreatic juices are produced, which fails to absorb the required food, causing diarrhea.
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Stool Changes - The food remains undigested because of the lack of required enzymes; hence, a foul-smelling, watery, and unusually pale stool is noted.
What Are the Treatment Options for Exocrine Pancreatic Cancer?
Following are the various treatment options -
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Surgery - Surgery removes the tumor, cures the disease, and relieves the symptoms, thereby avoiding future complications.
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Chemotherapy - Cancer cells are destroyed with the aid of drugs in chemotherapy. Therefore, the patient is given one or more drug combinations in their respective chemo cycles.
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Radiation Therapy - X-rays are used to destroy the cells causing cancer. External beam radiation therapy is used largely for pancreatic cancers.
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Immunotherapy - In this treatment, using lab-developed materials, the body's immune system is designed and developed to fight cancer by the body.
What Surgical Interventions Are Done in Pancreatic Cancer?
Surgery is the best treatment to cure cancer, but many individuals with pancreatic cancer are inoperable when the condition is first detected. The survival rate after surgery is also minimal. Hence, before opting for surgery in this case, certain preoperative considerations are considered. They include
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Staging Laparoscopy - This procedure helps prevent laparotomy (a cut to inspect the abdominal organs) in advanced stages and decreases the death rate. In addition, simple laparoscopy helps detect the adenocarcinoma spread from the initial site. After laparoscopy and evaluation of the specimens, laparotomy can be followed to remove the tumor in the same go.
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Role of Preoperative Biliary Drainage - A common complication in pancreatic cancer is a biliary obstruction (bile duct flow between the liver and small intestine). Therefore, managing biliary drainage becomes essential in the surgical treatment of patients with pancreatic cancer.
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Role of Neoadjuvant Chemotherapy - In this, chemotherapy is given before the surgical procedure to decrease the tumor size and increase the survival rate.
The following surgical methods are performed in pancreatic cancers.
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Pancreatic Duodenectomy- It is also known as the Whipple procedure. It is used when the tumor is in the head of the pancreas. In this standard method, part of the stomach, duodenum, gall bladder, portion of the bile duct, and head of the pancreas is removed. Then, the remaining bile duct, stomach, and pancreas are sutured to let the flow of enzymes. The other method is the pylorus-sparing Whipple procedure, in which the stomach section is not removed.
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Distal Pancreatectomy - When the tumor is observed in the body and tail of the pancreas, the part with the pancreatic tumor is removed from the pancreas. The complication which usually occurs post this procedure is pancreatic leakage. During this procedure, at times spleen can also be removed.
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Total Pancreatectomy - In this procedure, the whole pancreas is removed. The spleen is also removed as the pancreas is not present. This method is done when cancer has spread entirely to the pancreas, and no healthy tissue can be preserved.
How Is the Prognosis for Exocrine Pancreatic Cancer?
The average survival rate of exocrine pancreatic cancer is five percent. Though the prognosis is poor compared to other cancers, clinical advancements and trials have led to good improvement. Cancer deducted early can be treated better and have good long-term survival.
Conclusion
Exocrine pancreatic cancer, or silent cancer, has a low survival rate since most pancreatic cancers are detected at their advanced stages. The main treatment associated with good survival is early detection and surgery to remove the tumor. Certain preoperative methods are done to avoid unnecessary diagnosis methods and treatment of cancer. Symptoms of pancreatic cancer should not be discarded and must need an immediate consultation with the oncologist.
