Pancreatic cancer

The pancreas is an organ of the digestive system that performs two main functions: 

• production of enzymes for the digestion of fats, proteins and carbohydrates;

• insulin production.

In 80% of cases, cancer develops in the head of the pancreas. There are several types of pancreatic cancer. The most common type is ductal adenocarcinoma, which develops from the glandular epithelium lining the surface of the bile ducts. It accounts for about 95% of all types of pancreatic cancer. 

Less common types: 

• Cystadenocarcinoma (cystic tumors) 

• Acinar cell carcinomas;

• Neuroendocrine tumors;

• Lymphomas

Risk factors for pancreatic cancer:

• Old age. In most cases, pancreatic cancer develops after the age of 65.

• Smoking. 3 out of 10 cases of pancreatic cancer in developed countries are associated with smoking. 

• Diet. A diet containing large amounts of red meat, as well as processed meat (ham, sausages, bacon, etc.), increases the risk of developing the disease. Regular consumption of sugar and fatty foods and a lack of fruits and vegetables in the diet are also associated with an increased risk of pancreatic cancer. 

• Alcohol. Moderate alcohol consumption does not affect the development of pancreatic cancer. But drinking alcohol in large quantities can lead to cancer, especially in smokers. 

• Body weight and physical activity.

According to the results of some studies, overweight (obesity) and a sedentary lifestyle can contribute to the development of pancreatic cancer. Presumably, 1 out of 8 cases of morbidity is associated with obesity. 

Certain diseases and conditions may also increase the risk of pancreatic cancer: 

• Chronic pancreatitis.People who suffer from chronic pancreatitis for a long time may have an increased risk of developing pancreatic cancer. The risk is higher in patients with hereditary pancreatitis. 

• Diabetes.Diabetes increases the risk of developing pancreatic cancer. At the same time, it should be understood that diabetes mellitus is common, and the vast majority of patients do not develop pancreatic cancer.

• Genetic predisposition. About 5-10 out of every 100 cases (5-10%) may be caused by a hereditary gene anomaly. If two or more family members on the same line have pancreatic cancer, their direct relatives are at risk. People with the BRCA2 gene mutation, who are at risk for breast cancer, as well as patients with Lynch syndrome/HCV (hereditary non-polypous colorectal cancer) also have a higher risk of developing pancreatic cancer. Hereditary diseases such as familial atypical nevi and melanoma syndrome (FAMMM syndrome) and Peitz–Jaegers syndrome are also associated with a high risk of pancreatic cancer. 

Symptoms of pancreatic cancer

Pancreatic cancer can be asymptomatic for a long time.

The most common symptoms are upper abdominal pain, weight loss, and jaundice.

The pain usually starts in the upper abdomen and can radiate to the back. The pain can be temporary or permanent, and usually increases in the prone position. 

Jaundice develops if a tumor located in the head of the pancreas blocks the bile duct. Bile accumulates in the body, causing symptoms such as yellowing of the skin and whites of the eyes, itching of the skin, darkening of urine. Please note that jaundice can be caused by other diseases.

Other possible symptoms of pancreatic cancer:

• loss of appetite;

• dyspepsia;

• feeling of fullness after eating;

• nausea;

• diarrhea

• fatigue

• depression. 

Most often, the above symptoms are associated with other diseases, and a doctor's consultation is necessary to clarify the diagnosis. 

Diagnostics

Diagnosis of pancreatic cancer at an early stage is difficult, as its symptoms coincide with the manifestations of other more common diseases.

The examination of the patient usually begins with a visit to the doctor, who conducts an examination, prescribes a urine test for bile enzymes, a general and biochemical blood test. 

• Instrumental examination methods – ultrasound, endoscopic ultrasound, CT, MRI make it possible to clarify the localization of the tumor and assess the extent of its spread to neighboring organs. In some cases, ERCP (endoscopic retrograde cholangiopancreatography), a method combining X–ray and endoscopic examination, is performed to eliminate obstruction of the bile ducts or to take a biopsy. 

• Biopsy – obtaining a small area of organ tissue for examination under a microscope. If pancreatic cancer is suspected, a biopsy is performed during endoscopic ultrasound or ERCP. In some cases, a puncture biopsy is performed under ultrasound or CT control. 

• Blood tests (cancer marker).In most cases of pancreatic cancer, an increased content of the CA 19-9 antigen is found in the blood. Nevertheless, elevated levels of CA 19-9 in the blood can occur in other diseases, and a normal level of this substance is not a guarantee that there is no cancer. Measuring the level of CA 19-9 is not the method of choice for primary diagnosis, but it is of great importance for monitoring the effectiveness of treatment and follow-up. 

• Laparoscopy or laparotomy.Diagnostic laparoscopy or laparotomy is performed if other methods have not confirmed the diagnosis of cancer or have failed to assess the prevalence of the disease, as well as before surgery to plan the scope of the intervention. 

At the EMC Institute of Oncology, patients can receive comprehensive care for pancreatic cancer. The treatment is carried out according to modern European and American protocols.