Pancreatic Cancer

The exact cause of pancreatic cancer is not fully understood, but it is believed to involve a combination of genetic mutations and environmental factors that lead to uncontrolled cell growth.

• Age: Most cases occur in individuals over 60 years old.
• Tobacco use: Smoking increases the risk significantly.
• Chronic pancreatitis: Long-term inflammation of the pancreas increases the risk.
• Family history and genetics: Inherited mutations like BRCA1/2, Lynch syndrome, and others increase the risk.
• Obesity and poor diet: Diets high in fats and red meats and being overweight may contribute.
• Diabetes: Long-standing type 2 diabetes is linked with an increased risk.
• Alcohol consumption: Heavy, chronic drinking can increase the risk of pancreatic cancer.
• Gender: Men have a slightly higher risk than women.
• Exposure to certain chemicals: Industrial chemicals like pesticides and dyes are linked to a higher risk.

Symptoms may not appear until the cancer is advanced, making early detection difficult. Common symptoms include:

• Jaundice: Caused due to bile duct obstruction.
• Abdominal pain: Often localised in the upper abdomen or back.
• Unexplained weight loss: A significant and unintended weight loss.
• Loss of appetite: A lack of interest in food.
• Fatigue: Feeling unusually tired or weak.
• Nausea and vomiting: Due to blockage or issues with digestion.
• New-onset diabetes: A sudden diagnosis of diabetes may indicate underlying pancreatic issues.
• Digestive problems: Difficulty digesting food, often due to poor enzyme production.

• Imaging tests
  • CT scan: Commonly used to detect pancreatic tumours and evaluate their size and spread.
  • MRI (magnetic resonance imaging): Provides detailed images of the pancreas and surrounding areas.
  • Endoscopic ultrasound (EUS): A specialized ultrasound that uses a probe inserted into the digestive tract to view the pancreas directly.
  • PET scan: Can help identify cancer spread.
  • Endoscopic retrograde cholangiopancreatography (ERCP): Used to evaluate the bile ducts and pancreatic ducts.
• Biopsy: A sample of pancreatic tissue is taken (often via EUS or ERCP) to confirm cancer presence.
• Blood tests: Elevated levels of certain substances like CA 19-9 (a tumour marker) may suggest pancreatic cancer, though it’s not definitive.
• Genetic testing: In some cases, genetic mutations may be detected, aiding in treatment decisions and providing information on familial risks.

Treatment depends on the cancer’s stage, location, and overall health of the patient.

• Surgical Treatment
  • Whipple procedure (pancreaticoduodenectomy): A common surgery for tumours in the head of the pancreas, which involves removing part of the pancreas, small intestine, bile duct, and gallbladder.
  • Distal pancreatectomy: Removal of the tail or body of the pancreas.
  • Total pancreatectomy: Removal of the entire pancreas, sometimes combined with removal of nearby organs.
• Chemotherapy: Chemotherapy is often the primary treatment for advanced pancreatic cancer. Drugs like FOLFIRINOX (a combination of fluorouracil, leucovorin, irinotecan, and oxaliplatin) or Gemcitabine are commonly used.
• Radiation therapy: Used either as the main treatment or in combination with surgery or chemotherapy. It aims to shrink tumours or relieve symptoms.
• Targeted therapy: Targeted treatments focus on specific genes or proteins involved in cancer growth. For instance, Erlotinib is sometimes used for pancreatic cancer with specific genetic markers.
• Immunotherapy: While still experimental for pancreatic cancer, immunotherapy is an emerging treatment that may boost the body’s immune system to fight cancer cells.
• Palliative care: In cases where surgery is not an option or cancer is advanced, palliative care aims to manage symptoms and improve quality of life. This can involve pain management, nutritional support, and alleviating digestive blockages

The prognosis for pancreatic cancer depends on the stage at diagnosis:

• Early-stage: Surgery may be an option, offering the best chance for survival.
• Late-stage: The cancer is often not operable, and survival rates are generally low. However, treatments like chemotherapy and radiation may help prolong life and relieve symptoms.
• 5-year survival rate:
  • Localized (confined to the pancreas): ~40%
  • Regional (spread to nearby tissues): ~13%
  • Distant (metastasized): ~3%

While there is no guaranteed way to prevent pancreatic cancer, some steps can help lower the risk:

• Quit smoking and avoid tobacco products.
• Maintain a healthy weight and engage in regular physical activity.
• Limit alcohol consumption.
• Eat a balanced diet rich in fruits, vegetables, and whole grains.
• Manage diabetes and other risk conditions carefully.