The pancreas is a thin, lumpy gland that lies between your stomach and your spine. It is normally about six inches long and is shaped something like a thin pear, the organ is wide at one end and narrow at the other end and has three sections. The wider right end is called the head, the midsection is the body, and the narrow left end is the tail. It is joined by a duct (the ‘pancreatic duct’) to the first part of the small bowel (the duodenum) into a common opening with the bile duct called the ampulla.
The pancreas plays two major roles in your body’s digestive system.
It produces insulin, which controls the amount of sugar in your blood. If the pancreas does not produce enough insulin, you will develop diabetes.
Other parts of the pancreas produce substances called enzymes, which help you to digest food. These enzymes pass from the pancreas into your duodenum through the pancreatic duct. If the release of these enzymes is blocked for any reason, the body cannot absorb food completely and may result in diarrhoea and weight loss.
Cancer of the pancreas develops when healthy cells in the pancreas become abnormal and grow too quickly. The abnormal cells form a mass in the pancreas called a tumor. When a tumor has the ability to spread to other parts of the body, it is called malignant (cancer).
The most common malignant tumors of the pancreas, known as adenocarcinoma, come from cells involved in the production of enzymes for digestion and accounts for 95 percent of all pancreatic cancers. Sometimes mass develops in the specialised cells of pancreas called islet cells.
Islet cell carcinoma involves cells that can secrete a variety of hormones. These tumors can be functional and make abnormally high amounts of hormones or can be non-functional and not produce any hormones. Most islet cell tumors are malignant, but some are benign such as insulin-producing islet cell tumors.
Which part of the pancreas is affected with cancer?
Cancer can affect any part of the pancreas, the head, body or the tail but is more common in the wide right end or commonly called as the head of pancreas. Sometimes a common label of “periampullary cancer” is used indicating that the location of cancer can be either in the head of pancreas, at the common opening called ampulla, at the lower end of the bile duct or at the intestine where the pancreatic duct opens.
What is a Biopsy?
A biopsy is nothing but diagnosis made under a microscope by a pathologist using a small bit of tissue removed from a suspicious area or lump that is found to be abnormal.
During the endoscopy (ERCP/ EUS), if the doctor sees anything unusual, they can pass small tools into the scope and take out some tissue that can then be examined under a microscope. A CT scan guided biopsy may also be performed in some cases. A biopsy is not always necessary in cases of pancreas cancer. Your doctor will give you more information on this.
What is metastasis?
The tests described in the earlier section will determine whether you have pancreatic cancer. Some can also show if it has spread. The cancer may have spread into blood vessels or lymph nodes near the bowel or into organs further away, like the liver or the lungs or the bone. This is called metastasis.
What are stents? When are stents used?
The cancer may cause jaundice by pressing on the bile duct as it passes through the pancreas. The narrowing of the bile duct prevents bile from passing from the liver into the duodenum and this causes a build-up in the bloodstream.
Your eyes and skin may look yellow and you may have uncomfortable, itchy skin. The bile duct blockage may affect your digestion of food and reduce your appetite, leading to weight loss.
Jaundice can be relieved by unblocking the bile duct. This may be done using an endoscopic treatment known as ERCP in which an X-ray control will be used to position a plastic or metal tube across the blockage to hold it open. This allows the bile to flow into the duodenum and relieve the jaundice and itch. It is not necessary to have this stent placed in all cases of jaundice due to pancreatic cancer. Your doctor will decide if a stent needs to be placed for you. It is necessary that you see a surgeon (who deals with pancreas cancer) before a stent is placed.
What are the causes of pancreatic cancer?
The exact causes of pancreatic cancer are still undetermined, but there are some known risk factors that can make a person more likely to get this disease.
Having a risk factor, or even several risk factors, does not mean that you will get the disease. And many people who get the disease may not have had any known risk factors.
Research has shown that some of these risk factors affect the DNA of cells in the pancreas, which can result in abnormal cell growth and may cause tumors to form.
Age: Pancreatic cancer can strike at any age, but it occurs most often in men and women over 50 years old.
Smoking: Smokers (and smokeless tobacco users) have a 2 to 10 times greater risk of developing pancreatic cancer than non-smokers.
Obesity: Very overweight people are more likely to develop exocrine pancreatic cancer, as are people who don't get much physical activity. Exercise lowers the risk of this cancer.
Diet: A diet low in fruits, vegetables and fibre and high in fat may increase your risk.
Type 2 Diabetes: Pancreatic cancer is more common in people with this disease. The reason for this link is not known. This type of diabetes most often starts in adulthood. It is often related to being overweight or obese.
Chronic Pancreatitis: This means a long-term inflammation of the pancreas. This condition is linked with an increased risk of pancreatic cancer, but most patients with pancreatitis never develop pancreatic cancer. The link between chronic pancreatitis and pancreatic cancer is strongest in smokers.
What are the common symptoms of pancreatic cancer?
Jaundice: Jaundice occurs when bilirubin, a substance produced in the liver, builds up in the blood. Bilirubin travels down the bile duct and passes through the pancreas just before emptying into the duodenum, a section of the small intestine. If the bile duct becomes blocked (by a tumor, for example), bilirubin builds up in the blood causing noticeably yellow skin and eyes.
Change in colour of the Stool or Urine: Urine may turn orange or the colour of iced tea. Stool may turn grey or chalky-white. These are also symptoms of a blocked bile duct.
Pain: Pain in the back and upper abdomen occurs when a pancreatic tumor presses against the nerves in those areas. Typical pancreatic pain is dull, fairly constant and mostly localized to the mid and upper back and upper abdomen. Sometimes the pain starts in the abdomen and radiates to the back or shoulder.
Indigestion: (especially with fatty foods), Lack of Appetite, Nausea, Diarrhoea and/or Weight Loss. These may occur when a pancreatic tumor presses against the stomach and small intestine. Digestion problems may also occur for complex reasons not specifically related to the location of the tumor.
Sudden Onset of Diabetes, or for Diabetics, a Sudden Change in Blood Sugar Control: Diabetes may be an early symptom and a risk factor.
If you have not been diagnosed with pancreas cancer and are just looking through this booklet, please be aware that most symptoms of pancreatic cancer are nonspecific and can be caused by several different problems.
It is important to see your doctor if any of these symptoms occur and do not resolve with simple management.
What tests are carried out to diagnose pancreatic cancer?
This section lists common tests that may be performed and it is not necessary for all the tests to be performed for a patient. Your doctor will select the tests that will assist him /her to have the maximum information about the tumor/ disease.
Computerised tomography (CT) scan
A CT scan is a type of x-ray that gives a picture of organs and other structures (including any tumours) in your body. It is used to see more details of a cancer and its relation to the surrounding organs in your body. It also gives information related to cancer spread into the lymph nodes, liver or lungs.
Magnetic resonance imaging (MRI)
This test is like a CT scan, but it uses magnetism instead of x-rays to build up pictures of the organs in your abdomen. Like a CT scan, MRI is painless and the magnetism is harmless. MRI scan may be used to see the extent of blockage of bile duct and in case the patient is allergic to contrast dye injection used for CT scans.
Endoscopic ultrasound scan (EUS)
This involves a special endoscope equipped with an ultrasound probe and a small needle at the end. The scope is placed through the mouth into the oesophagus (food pipe) and the first portion of the small intestine for more detailed information about the local spread of the tumor. EUS also allows the physician to get a tissue sample (biopsy) of the pancreas.
In this test, a thin, flexible ‘telescope’ called an endoscope is put into your mouth then passed down your throat into your digestive system so that the doctor can examine you inside.
The procedure is called ERCP, or endoscopic retrograde cholangio-pancreatography. Through the endoscope, the doctor can inject a liquid directly into the pancreatic duct and bile duct, allowing images of these organs to appear on x-ray pictures.
The test can show blockages and inflammation in these ducts, and allow the doctor to judge whether these are due to cancer or other problems.
The doctor is also able to take a tissue or
fluid sample through the endoscope, to help with the diagnosis.
Positron emission tomography (PET) scan
This test may be used to build up more information after an MRI or CT scan. PET-CT scan is not necessary for all patients. Your doctor will decide if you need to undergo this scan.
This test is combined with a CT scan by injecting a radioactive material in the body to highlight all areas where the tumor has or can spread.
Blood tests check how well the liver and kidneys are working and provide a full blood count. Pancreatic cancer often sends a protein (Ca 19.9) into the blood. This can be measured. It is not used to diagnose pancreatic cancer, but it can give your doctor important information about the cancer and its
response to treatment.
Copyright @ 2010. All Rights Reserved Dr.Deepak Chhabra Designed By SDA
"This website has been designed for informational and educational purposes only. Care has been taken to provide readers with the right information about various cancers and their treatment and it is not intended to replace medical advice offered by other surgeons, physicians or health care providers".