All You Need To Know About Pancreatic Cancer
“An overwhelming 95 per cent of pancreatic cancer arises from the pancreatic juice producing cells”
The area of the abdomen, broadly described as ‘stomach,’ is actually tightly packed with several organs which are crucial to the process of digestion. Most important are the stomach and the small bowel, where the digestion of food takes place. Just above the small bowel is the liver, which produces bile and the gall bladder which stores bile until needed.
Right next to the gall bladder is the bile duct, which as the name suggests, carries the bile from the gall bladder to the first part of the small bowel (also known as duodenum). Sitting snugly in the curve of the small intestine is the pancreas. This knowledge of the positioning Is important, because It helps to understand the way in which cancer of the pancreas grows and spreads.
The Role Of The Pancreas
The pancreas has two important tasks. One is to produce pancreatic juice, which travels to the small intestine and assists the process of digestion of food. The second is to produce the hormones, insulin and glucagon, which maintain blood sugar levels in the body. When there is excess of sugar, insulin transforms it into glycogen which is stored in the liver. When sugar is needed for the purpose of metabolism and energy, glucagon converts the glycogen back into glucose.
The pancreas is about six inches long and two inches wide at the head, which lies next to the small bowel. It is shaped like a carrot, which means, it is widest at the head and narrowest at the bottom. Both the insulin-glucagon cells. known as the islets of Langerhans and the pancreatic juice-producing cells are scattered throughout the pancreas.
Cancer Of The Pancreas
An overwhelming 95 per cent of pancreatic cancer arises from the pancreatic juice producing cells, more than half of which start in the head region. The remaining five per cent have their origin in the islet cells that secrete insulin and glucagon and these are called neuroendocrine tumors or NET
Cancer cells that begin to grow from the pancreatic head may eventually spread to the body of the pancreas and the surrounding organs that is the liver, gall bladder, the bile duct and the small bowel. When it invades the body of the pancreas, it may reach out to the stomach just in front. The next targets of metastasis are usually the spleen, further to the left and the vertebral bones behind.
Signs And Symptoms
Pancreatic cancer is not easily felt or palpable from physical examination and most of the symptoms become evident when the function of pancreas or the adjacent organs are impaired or obstructed due to the tumour. For instance, if the bile duct and pancreatic duct are invaded, there would be jaundice, apart from bloating of the stomach, poor appetite, severe loss of weight etc.
At some stage, the islet cells would be impacted and result in diabetes (due to lack of insulin). Even later, when most of the pancreas has been riddled with cancer, involvement of the spleen would weaken the immune mechanism. This would make an individual vulnerable to every passing infection. Then there are the vertebral bones, which if affected would cause severe, almost unbearable pain.
Genetics And Contributing Risk Factors
Several genetic changes such as mutations, chromosomal alterations, epigenetic silencing etc. have been observed in pancreatic cancer. Inherited mutations account for two- ten per cent of all pancreatic cancers. Individuals with a family history of hereditary conditions such as familial breast and ovarian cancer, family X syndrome, hereditary pancreatitis etc. are known to have a predisposition for pancreatic cancer.
Several risk factors can increase an individual’s chance of getting pancreatic cancer. But, these can be changed by lifestyle choices. About 20-30 percent of pancreatic cancer is caused by smoking. Obese people too are 20 per cent more likely to develop pancreatic cancer. Type 2 diabetes is also a known risk factor for pancreatic cancer.
Most cases of pancreatic cancer are diagnosed too late for an effective cure. Hence, even in western nations, only 20 per cent of patients survive a year after diagnosis. The survival rate after five years could be as little as five percent.
The operation that most surgeons prefer, If the cancer is diagnosed early Es to remove the part of the pancreatic head, the gall bladder and a part of the nearby segment of the small intestine. If the spleen or a part of the stomach is involved, the operation is more extensive. However, in some cases of extensively spread cancer, surgeons may perform a limited procedure just to relieve some of the symptoms. This is known as palliative surgery.
Radiation And Chemotherapy
These may be given before surgery in an attempt to shrink the tumor or afterwards to tackle the cancer cells that might remain. Chemotherapy may consist of giving a single or combination of drugs to kill the cancer cells.
This is also known as ‘precision medicine’ as these drugs or molecules target the tumour specifically, unlike other chemotherapeutic drugs that act on both normal and tumor cells in similar manner.