Pancreatic cancer

The pancreas is an organ located in the most posterior part of the abdomen, approximately 15 cm in length, completely covered with the stomach, duodenum and large intestine (colon). Although it has many important tasks, it plays an important role in digestion of foods taken and keeping blood sugar in balance. Although pancreatic cancers develop from all parts of the organ, they most often develop from the head region. Again, they originate from the most common secreting cells and are called adenocarcinomas.

Pancreatic cancer is difficult to diagnose and treat and is considered the fourth deadliest cancer in the world. Despite modern methods, an effective drug treatment has not been developed yet, and pancreatic cancer can only be intervened with surgical methods. The disease, which generally spreads rapidly, is mostly seen after the age of 60, and early diagnosis in pancreatic cancer is considered the most important factor for the treatment of the disease. When pancreatic cancer is diagnosed at an early stage, successful results can be obtained, especially with Whipple surgery.

The symptoms are;

1. Jaundice, it is usually painless and occurs when there is a bile duct obstruction. Jaundice may not be seen in the cancers of the body and tail of the pancreas. Itching on the skin may be a preliminary sign of jaundice.
2. Abdominal pain that can spread to the back in the upper abdomen (pain decreases partially when bending forward, and increases after meals)
3. Lack of appetite, feeling of early satiety, indigestion, bloating and gas not responding to treatments
4. Bad taste, bad smells and disgust towards food
5. Fatigue, loss of weight
6. Unexplained low-back pain
7. New and emerging diabetes
8. Depression
9. Oily stool (stool becomes lighter in color, bad odor, stool is not necessarily cleaned by flushing)

   Some factors that can cause Pancreatic Cancer are;

1. Tobacco: is responsible for around 30% of the pancreatic cancers.
2. Age: advanced age is a risk factor for pancreatic cancer.
3. Nutritional Habits: people with high-calorie and protein-heavy eating habits that lack fruits and vegetables have higher rates of pancreatic cancer.
4. Obesity: It is thought that people with high body mass index (BMI) are more prone to pancreatic cancer than those with low body mass index.
5. Occupational Exposure: people exposed to petroleum products and other chemicals have an increased risk of pancreatic cancer.
6. Chronic pancreatitis: Prolonged, incurable chronic inflammation of the pancreas increases the risk of developing pancreatic cancer.
7. Diabetes: Diabetes doubles the incidence of pancreatic cancer compared to healthy individuals. Diabetes is observed in 60-80% of pancreatic cancer patients.

Diagnosis of the Pancreatic Cancer  

The methods used to diagnose pancreatic cancer include ultrasound (US), endoscopic ultrasound (EUS), computed tomography (CT) scans, magnetic resonance imaging (MRI), and sometimes positron emission tomography (PET) scans. Examination of CA 19-9 tumor marker in blood is another reliable method in the diagnosis of early pancreatic cancer and in the follow-up of the disease.

Staging

After the diagnosis of pancreatic cancer, the next step is to determine the extent of the disease in order to plan the most appropriate treatment. Generally, the methods used in the diagnosis phase are sufficient for this job. Staging is done according to the diameter of the tumor, its relationship with surrounding tissues and whether it has spread to distant organs. Cancer cells can spread throughout the body through the lymph or blood. We call this situation ‘metastasis’.

Pancreatic Cancer Stage 1

Stage-1

The tumor is limited to the pancreas.

Pancreatic Cancer Stage-2

Stage-2

The tumor has advanced to the surrounding nonvascular tissue. There may be spread to regional lymph nodes.

Pancreatic Cancer Stage-3

Stage-3

Tumor is associated with the surrounding vessels.

Pancreatic Cancer Stage-4  

Stage-4

Tumor has spread to distant organs such as liver and lungs.

Treatment of Pancreatic Cancer

Surgery is often the only way for pancreatic cancer to heal. However, if the cancer spreads to the whole body, surgical treatment will not work. A certain part or whole of the pancreas can be removed by surgery. Removing the entire pancreas is called total pancreatectomy. When the tumor is in the head of the pancreas, “Whipple surgery” can be performed, and pancreatic resections can be performed on the trunk and tail. Open and closed (laparoscopic, robotic) surgery techniques are available. Treatment methods such as Chemotherapy and Radiotherapy are used in advanced stage pancreatic tumors.

Whipple Surgery

In the Whipple surgery; together with the head of the pancreas, the gall bladder, part of the common bile duct, duodenum, part of the stomach and surrounding lymph nodes are removed in block form. During or shortly after this surgery, in which a wide variety of organs are removed and re-sustained for a very long time, the patient may experience death (mortality) or bleeding, and bad complications (morbidity) such as leakage from the stitches made to maintain the continuity of the digestive system (fistula). The accepted death rate in the world is 5% and below. Again, the rate accepted in the world for postoperative complications is 15-20%.