Pancreatic Cancer - Symptoms, Diagnoses, Stages & Treatment
What is Pancreas? What Does It Do?
The pancreas is an organ located at the back of the abdomen and has a length of about 14-15 cm. The duodenum is a gland-shaped organ next to the liver and large intestine and has essential functions in the body. The pancreas organ affects the proper functioning of the digestive system with the enzymes it secretes and controls the level of glucose obtained from food in the blood. The pancreas also produces insulin and glycogen. This allows hormones to mix with the blood and thus regulate blood sugar. However, it is the organ that secretes vitally essential digestive enzymes. The pancreas decomposes carbohydrates, fats, and proteins in foods and enables them to be converted into energy and stored in the body.
What is Pancreatic Cancer?
Pancreatic cancer is a type of cancer that is difficult to diagnose and difficult to treat. According to statistical data, pancreatic cancer is the fourth deadliest cancer in the world. Pancreatic cancer occurs when cells in the pancreas mutate and deteriorate and multiply beyond the body's control. As a result of these mutations, mass formation occurs in the pancreas, and normal healthy cells begin to die and lose their function. If not diagnosed and treated early, these mutated cancer cells can spread to other organs near the pancreas.
Pancreatic cancer usually occurs in the part of the exocrine cells. This condition is known in the medical world as adenocarcinoma (exocrine cancer). In some patients, pancreatic cancer rarely begins to form in the islet cells. This type is called “endocrine cancer.” In this case, cancer arises in the pancreas that produces hormones or in the neuroendocrine cells.
Despite the developing technology for the treatment of pancreatic cancer, there is no effective drug treatment yet. Therefore, a surgical operation is often used for the treatment of pancreatic cancer. The age of the patient and early diagnosis of the disease are critical factors for treatment.
What Causes Pancreatic Cancer?
The causes of pancreatic cancer are not fully known. There is no clear information on this subject yet. However, several factors increase the risk of developing pancreatic cancer. Age is the most critical factor. Pancreatic cancer usually occurs in people over the age of 60, starting in their 50s. Conditions such as smoking, diabetes, genetic predisposition to pancreatic cancer (BRCA2 mutation), Lynch or Peutz Jeghers Syndrome, family history of pancreatic cancer, and obesity (excessive weight) can be counted among the causes of pancreatic cancer. Because such situations significantly increase the risk of contracting the disease. In addition, people who are found to have a genetic predisposition to this cancer should have frequent checkups. Because, as in all cancers, early diagnosis of pancreatic cancer is of vital importance.
In Which Age Groups Does Pancreatic Cancer Occur?
Pancreatic cancer usually occurs in older people. In addition, to give a specific age range, it is mainly seen in people over 60.
What are the Symptoms of Pancreatic Cancer?
Pancreatic cancer is an insidious type of cancer that usually does not show any symptoms in the early stages. When we look at the symptoms of pancreatic cancer, rare diabetes, diarrhea, and depression, symptoms stand out. The most common symptoms are nausea, loss of appetite, sudden weight loss, jaundice, and pain in the stomach. Cancer in the head of the pancreas shows itself in the early stages as jaundice and a light color in the stool. When it spreads to the trunk and ends, a pain that usually hits the back occurs.
The most common symptoms of pancreatic cancer can be listed as follows:
- Loss of appetite and accompanying weight loss
- Stomach ache
- Nausea and vomiting
- Extreme tiredness and fatigue
- Abdominal pain after eating or lying down
- Pain that starts in the upper abdomen and radiates to the back
- Yellowing of the skin and under the eyes
- Darkening of urine color
- Light-colored fecal ablution seen in the color of glass paste
In chronological order, there is usually a feeling of discomfort in the upper abdomen and a general loss of appetite first. In addition, these symptoms are followed by bloating and indigestion. Cancer is usually not noticed by most patients; because it looks like an ordinary stomach disease. In some cases, diabetes may occur suddenly in patients, which increases the possibility of pancreatic cancer, and should be consulted with a doctor. In the later stages of the disease, abdominal pain intensifies and begins to hit the back, jaundice and an increase in weight loss are observed.
How is Pancreatic Cancer Diagnosed?
Pancreatic cancer is a type of cancer that is difficult to detect in the early stages, as it may initially manifest as an ordinary stomach ache or abdominal pain. For this reason, various tests may be requested by the doctor in patients with suspected pancreatic cancer. The methods used for the diagnosis of pancreatic cancer can be explained under the following headings:
- Blood Test: Various pancreatic-related substances such as bilirubin are measured. CEA, CA19-9, and CA-125 values are examined.
- Positron Emission Tomography (PET Scan): With the PET scanning method, radionuclide substances and labeled glucose are given to the patient. Injected glucose collects in cancerous cells. This makes it easier to detect cancerous cells.
- Laparoscopy: Laparoscopy is a surgical operation. By examining the internal organs in the abdomen, signs of disease and cancer are checked. A thin tube called a laparoscope is inserted through the abdominal wall. If necessary, incisions can be made in the area to take a tissue sample.
- Ultrasonography: In cases where pancreatic cancer is suspected, ultrasonography is first used. According to the ultrasound result, information about whether there is a mass in the pancreas if there is a mass, its size, and in which region it is.
- MR (Magnetic Resonance): The most accurate way of diagnosing pancreatic cancer is the magnetic resonance imaging technique, in which drugs are administered orally and intravenously to the patient. Using the MRI method, the stage of the tumor is determined, and the nature of the tumor in the patient is clearly understood.
What are the Stages of Pancreatic Cancer?
Pancreatic cancer consists of 5 stages. The treatment method will vary depending on the stage of the patient.
Stage 0: At this stage, cancer has not spread yet and is located in the upper layer of the pancreatic duct. At this stage, it is not possible to detect cancer with any imaging method.
Stage 1: Local (regional) growth is seen in stage 1 of pancreatic cancer. The cancer is still inside the pancreas, with no spread to other organs. It is divided into Stage 1A and Stage 1B. If the tumor size is less than 2 cm, it is Stage 1A, and if the size of the tumor is between 2-4 cm, it is Stage 1B.
Stage 2: In the second stage, there is a regional spread. Pancreatic cancer in stage 2 now grows out of the pancreas and can spread to the lymph nodes. There is no spread to other organs yet, but now the risk begins to increase. Tumor size exceeds 4 cm.
Stage 3: The tumor present in the pancreas in stage 3 spreads to a larger area. It can progress to nearby vessels and nerves. At this stage, metastasis is not seen; there is no spread to other organs.
Stage 4: It is known as the last stage of pancreatic cancer. At this stage, it can spread to distant organs such as the liver, intestines, stomach, lungs, and even the brain.
How is Pancreatic Cancer Treated?
The treatment method of pancreatic cancer is determined by the characteristics of cancer and the stage it is in. Early diagnosis is of great importance in the treatment of pancreatic cancer. Age, state of health, the health of other organs are also taken into account. Surgical treatment, systemic treatment (chemotherapy and treatments that strengthen the immune system), and radiotherapy in pancreatic cancer. The mentioned treatment methods can be used in combination with each other depending on the progression and type of the disease. If pancreatic cancer can be diagnosed before it spreads to other areas and the patient's condition is suitable for surgical intervention, it can be controlled. However, if the cancer is detected late and has spread, palliative treatments are applied to reduce the damage and negative symptoms caused by cancer. In addition, in pancreatic cancer, surgery is not used in cases where the tumorous structure spreads to the main blood vessels adjacent to the pancreas.
Pancreatic Cancer Surgery
In cases where the tumor has spread to the pancreas, it is possible to remove it by performing surgical interventions. In some patients, the entire pancreas needs to be removed. Patients whose pancreas is completely removed have to take insulin and similar enzymes secreted by the pancreas from outside throughout their lives.
Whipple Method in Pancreatic Cancer
If the mutated cells caused by pancreatic cancer are in the head of the pancreas, the tissue in the pancreas and the tumor area can be removed from the patient by applying the Whipple method. In Whipple surgery, part of the gallbladder and bile duct, lymphatic tracts near the pancreas, head or body part of the pancreas, part of the small intestine (duodenum part), and stomach can be removed. As a result, if necessary, the entire duodenum, the part of the biliary tract adjacent to the pancreas, a part of the stomach, and the head of the pancreas are removed with the Whipple operation. The rest of the pancreas is connected with the stomach. In addition, a direct connection is established between the bile duct and the small intestine. The most critical and demanding aspect of this operation is the coordination of the organs and tissues taken from the patient with each other in a way that does not cause complications.
The Whipple method, also known as pancreatoduodenectomy, is the most commonly used to treat pancreatic cancer. For the Whipple method, which is technically a difficult task, it will be helpful to consult doctors who are experts in this field. It has a 15-20% failure rate when performed in small clinics without appropriate equipment or by doctors who do not have experience in the subject. In institutions experienced in the Whipple method, the risk rate in these surgeries is reduced by about three times. The Whipple procedure will not be suitable for these patients in advanced stages of pancreatic cancer, as the tumors will have spread to nearby blood vessels.
Remote Pancreatectomy Method:
It is the process of removing the spleen, pancreatic tail, and part of the pancreatic body from the patient's body. It is a method mainly applied in the treatment of neuroendocrine tumors. Since the spleen will be removed from the body with this operation, the person's immune system will be weakened, and your doctor will recommend various vaccines and drugs to reduce the risks of future diseases.
Total Pancreatectomy Method:
With this operation, the entire pancreas and spleen are removed. However, since removing the pancreas entirely will create other significant difficulties for the patient (such as continuous external insulin supplementation), this method is not preferred.
Post-Pancreatic Cancer Process
Since the disease is usually noticed in the late stages, surviving this disease by surgical methods is not very high compared to other diseases. The first 3 years period should be followed very carefully; the doctor should be contacted regularly in case of recurrence of the disease. Improvement can be seen in people’s daily lives after the surgery, but the body’s response to the treatment depends on many different variables. It has been determined that more positive results are obtained after surgery in pancreatic cancer diagnosed at an early stage. Smoking, which will cause bad cells in the body, should be avoided, and alcohol should not be consumed. The individuals in question; After the surgery, to minimize the risk of cancer recurrence and strengthen their immune systems, they should eat regularly and healthily, avoid gaining excess weight and reduce the stress factor in their lives as much as possible.
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