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Pancreatic Cancer Symptoms, Diagnosis and Treatment

Pancreatic cancer is the sixth leading cause of cancer death in 70-year-old men[1]?and women in Hong Kong, accounting for approximately 500 cancer deaths every year. Known as the deadliest type of cancer, pancreatic cancer has the highest mortality rate of all major cancers, far exceeding that of lung cancer and colorectal cancer.

It has drawn a substantial amount of attention around the world as a global medical challenge. According to the latest statistics published by the Cancer Council of Australia, the five-year survival rate for pancreatic cancer is only 7%, and approximately 30% of deaths occurred two months after diagnosis. Over 80% of pancreatic cancer patients were diagnosed with cases of advanced pancreatic cancer that were inoperable[2].

In the past ten years[3], a number of international medical studies have recognized the therapeutic potential of a new pancreatic cancer treatment option called stereotactic body radiation therapy (SBRT) that improves the overall effectiveness of pancreatic cancer treatment. According to pancreatic cancer research from The University of Texas MD Anderson Cancer Center, SBRT has proven to effectively shrink the size of pancreatic cancer tumors, with close to 90% of patients who undertook the surgery seeing their cancer tumors removed completely[4]. The research results are bringing a new hope to the world’s battle against this deadly type of cancer.

Below is the latest information about pancreatic cancer treatment and an overview of options, including frequently asked questions and answers regarding pancreatic cancer symptoms and treatments during diagnosis and treatment period.

How does pancreatic cancer occur?


The pancreas is an organ located in the digestive system. It is responsible for producing secretory products critical to proper digestion, converting the food we eat into fuel for the body’s cells. By producing insulin, the pancreas allows our body to use sugar (glucose) from carbohydrates in the food that we eat for energy or to store it for future use.

When pancreatic cells begin to grow out of control, these accumulating cells can form a cancerous tumor, spreading to surrounding organs and blood vessels. Pancreatic cancer is notoriously difficult to detect in its early stage. There are fewer symptoms in early-stage pancreatic cancer because the pancreas is located deep inside the body. The development of pancreatic cancer is often characterized by early and rapid spread beyond the area of the pancreas to other organs, making traditional chemotherapy and electrotherapy treatments rather ineffective. These reasons explain why a pancreatic cancer prognosis tends to be grim.

Symptoms of pancreatic cancer


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When pancreatic cells begin to grow out of control, these accumulating cells can form a cancerous tumor, spreading to surrounding organs and blood vessels. Pancreatic cancer is notoriously difficult to detect in its early stage. There are fewer symptoms in early-stage pancreatic cancer because the pancreas is located deep inside the body. The development of pancreatic cancer is often characterized by early and rapid spread beyond the area of the pancreas to other organs, making traditional chemotherapy and electrotherapy treatments rather ineffective. These reasons explain why a pancreatic cancer prognosis tends to be grim.

Pancreatic cancer at advanced stages could lead to severe weight loss, jaundice and related symptoms. If the below pancreatic cancer symptoms are present, the disease tends to be much more difficult to treat:

  1. Weight loss – Pancreatic cancer prevents the pancreas from producing enough digestive fluids to convert food into fuel and nutrients, causing unintended weight loss.
  2. Jaundice and related symptoms– Jaundice is caused by the buildup of bilirubin that blocks the bile duct, leading to the yellowing of the eyes and skin and dark urine
  3. Abdominal pain – Pain occurs when a pancreatic cancer tumor grows large enough to put pressure on surrounding abdominal organs or invades surrounding nerves.
  4. Back pain – The pain from the abdomen spreads to the back, becoming more intense after meals.
  5. Bloating and constipation – A pancreatic cancer tumor that grows or presses against the duodenum obstructs the passage of food from stomach to intestines, leading to bowel obstruction.

If the above pancreatic cancer symptoms persist, please consult a doctor as soon as possible.

Pancreatic Cancer Causes and Risk Factors


The causes of most pancreatic cancer aren’t completely understood, but there have been some research studies pointing to smoking, obesity and unhealthy diet habits as some of the factors that may increase the risk of developing pancreatic cancer. Statistically speaking, most of the genetic mutations that occurr in pancreatic cancer are not hereditary but acquired during life, such as long-term inhalation exposure to carcinogens (cancer-causing chemicals) including cigarette smoke, insecticide, petroleum and dyes. The causes of many cases concerning mutations of genes in pancreatic cancer remain largely unknown.

Factors that may increase the risk of getting pancreatic cancer include:

  1. Chronic pancreatitis
  2. Helicobacter pylori (H. pylori)[5]– The risk of getting pancreatic cancer is twice higher than for those without H. pylori.
  3. Diabetes
  4. A family history of pancreatic cancer
  5. Inherited genetic syndromes (including BRCA2 mutations, Lynch syndrome, Melanoma)
  6. Tobacco use
  7. Obesity
  8. Unhealthy diet (including diets that are high in red and processed meats)
  9. Age – Most pancreatic cancer patients are at least 65 years old.

For those with an unhealthy lifestyle such as tobacco use, the risk of getting pancreatic cancer tends to be at least twice as much as those with a healthy lifestyle. About 20% to 30% of pancreatic cancer cases are believed to be caused by smoking. In addition, alcohol use can also lead to conditions such as chronic pancreatitis which is known to increase the risk of developing pancreatic cancer, with about 70% of chronic pancreatitis caused by heavy alcohol use. Other high-risk factors include eating too much processed meats such as sausages and bacon and obesity. In the United Kingdom alone, about 10% of pancreatic cancer cases are closely related to obesity problems[6].

Screening for Pancreatic Cancer


Tests for pancreatic cancer include:

Blood tests – to assess the severity of pancreatic cancer

Imaging tests – such as CT scans and ultrasound which can identify the type and location of the suspicious lump

Endoscopy – such as endoscopic retrograde cholangiopancreatography (ERCP), magnetic resonance cholangiopancreatography (MRCP) and percutaneous transhepatic cholangiography (PTC)

Biopsy – removal of a small sample of a suspicious lump which is examined by a pathologist

Common Pancreatic Cancer Treatment Approaches


Surgery is relatively effective in treating pancreatic cancer but not all pancreatic cancer cases are operable. The best treatment for pancreatic cancer depends on its stages and the location of the tumor. Common pancreatic cancer treatment includes:

1.Stereotactic Body Radiation Therapy (SBRT)

Pancreatic cancer patients tend to get diagnosed at advanced stages and therefore may not be treatable with traditional surgery. Cancer sufferers at advanced stages could consider taking stereotactic body radiation therapy (SBRT) to slow down the development of the cancer tumor[7]. This treatment method is a targeted radiation therapy through ERCP and an advanced radiation therapy design, using a narrower beam of radiation that allows the doctors to more precisely target the tumor for better results.

SBRT requires one to five days to complete. The biggest advantage is that patients do not always experience many side effects like they do with other radiation therapies. Patients do not experience hair loss, and their daily life will largely remain unaffected.

2.Surgery

If pancreatic cancer is detected early and the tumor is located in the head of the pancreas, surgery can be performed on the patients to remove the tumor. Before the surgery, patients will get screened through imaging tests or laparoscopy, where a small, thin tube with a lens will be inserted in the abdomen to locate the cancer cells and make sure that they have yet to spread to other parts of the body. The surgery normally requires the removal of parts of the pancreas and spleen.

After the surgery, the patients are required to receive further treatments including chemotherapy and radiation therapy or both, known as chemoradiotherapy. The objective of post-operative treatment is to destroy all the remaining cancer cells to prolong the lives of the patients and reduce the risk of recurrence.

Whipple’s procedure – also known as a pancreaticoduodenectomy – is the most common type of surgery for pancreatic cancer. It involves the removal of any parts to which cancer cells have spread such as pancreas, duodenum, gallbladder and sometimes a portion of the stomach. The death rate for patients undergoing the surgery is less than 5%[8].

3.Pre-operative chemotherapy

For patients diagnosed with a stage III pancreatic cancer, relying on surgery alone will not be able to remove the tumor because the cancer cells have spread beyond the pancreas to its surrounding areas. Chemotherapy or radiation therapy may be used to reduce the size of the tumor. The doctor will continue to monitor the development of the disease through imaging tests and surgical methods to assess the feasibility of a surgical treatment on the patients.

4.Targeted Therapy

Targeted therapy tends to be used alongside with chemotherapy for pancreatic cancer treatment. It can target the changes in cancer cells that help them grow, divide and spread by interfering with specific proteins that help tumors grow and spread throughout the body.

5.Palliative Treatment

Palliative treatment is normally recommended to patients diagnosed with a stage IV pancreatic cancer. It focuses on providing the patients with relief from the symptoms, pain and stress induced by the disease so as to slow down the growth of the cancer cells, prolonging the patient’s lives and improving their quality of life. The medication choice and treatment time will depend on how the patients react to the treatment and how they cope with the side effects of the treatment.

Pancreatic Cancer: Frequently Asked Questions


Given that the causes of most pancreatic cancer remain largely unknown, there are no proven ways as to how to prevent pancreatic cancer effectively. However, some commonly known risk factors of pancreatic cancer should and can be avoided such as smoking, unbalanced diet and chronic pancreatitis.

If pancreatic cancer has spread to other parts of the body, the priority of the treatment is to focus on alleviating symptoms and maintain the patients’ quality of life. Palliative pancreatic cancer treatment approaches include maintaining adequate levels of nutrition and relieving pain. If the tumor causes a blockage in the common bile duct, the physician will insert a stent into the bile duct to allow the bile or food to flow into the bowel again. If obstructions occur in the intestines, bypass surgery is usually done to palliate the obstructive symptoms. Patients should have follow-up consultations as requested for better monitoring and control of the disease.

At the later stages of pancreatic cancer, the tumor may press against surrounding nerves and cause severe pain to the patient. The doctor may prescribe pain medications to prevent the pressured nerves from transmitting the pain messages to the brain or adopt injections of alcohol as a nerve block in the pain affected area for pain relief.

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