Cancer of the pancreas means a malignant tumor of the pancreas. This may occur anywhere along the length of the pancreas. The pancreatic cancer is uncommon cancer and not much is known about its cause despite so much research. However, we do know that smoking increases the risk. A history of pancreatic inflammatory disease (chronic pancreatitis) and pancreatic stone disease is associated with an increased risk of developing pancreatic cancer. There can also be a family history of pancreatic cancer. The pancreatic cancer is usually is a slow growing cancer and can spread to other parts of the body in the later stages of the disease. Its incidence is about 80-130 per million population in the western world. In Pakistan its incidence is on the lower side and it’s around 30 per million population per years. Usually it is more common in men and affects people over 50 years of age; however recently young patients in their 4th decade of life are being diagnosed with bile duct cancer in Pakistan.
DIAGNOSIS OF PANCREATIC CANCER:
Clinical evaluation by the doctor to look for the presence of jaundice (yellowness of skin and eyes) or presence of scar marks (due to itching) and presence of any lumps in the tummy.
Blood tests including LFT’s (bilirubin level in your blood will be high due to the blockage of the bile duct).
Hemoglobin (Hb level) can be low
Tumor markers: These are substances normally seen in the blood, however, in people with a cancer they may be high. In pancreatic cancer, the tumor marker that has been associated with it is Ca19.9.
MRI (magnetic resonance imaging)
Endoscopic Retrograde Cholangio-Pancreatography (ERCP)
Endoscopic ultrasound (EUS)
You may undergo one or more of the scans in order to help identify the tumor and assess your suitability for the various treatments.
Histology/cytology All of the previously mentioned tests may lead the doctor to diagnose bile duct cancer. However the only definite way to confirm this diagnosis is to examine some of the abnormal tissue (cancer cells) under a microscope. Some cells may be taken during the ERCP procedure (theses are called brushings). These cells are taken to the laboratory for cytology examination. However, the results of cytology do not always produce a diagnosis and may give a negative result, despite a cancer existing. If a larger sample of tissue is required we may perform a biopsy. This is when a needle is passed through your skin, into the affected area. If your doctor is planning to treat your cancer with surgery, you may not undergo a biopsy, as tissue confirmation can be obtained after the operation, by the laboratory.
TREATMENT OF PANCREATIC CANCER:
Complete surgical removal of the cancer is the main stay of pancreatic cancer treatment. The aim of the treatment is to treat the cancer and any symptoms it may cause. Treatment of the pancreatic cancer depends on the stage of the cancer and may differ from person to person because of the location, size and spread of the tumour. The age and associated medical problems of the patient are also important to consider.
Surgery may be offered as a potentially curable or palliative treatment. At present complete surgical removal of the cancer offers the only possible cure. The commonest surgical operation performed to remove the pancreatic cancer is a pancreaticoduodenectomy, often called a Whipple’s procedure. This operation take 5-7 hours and involves removing most, if not all of the pancreas, the gall bladder, the bile duct and part of the small intestine. Nearby lymph nodes may also be removed as a part of radical operation.
Palliative surgery: may be offered if the obstruction of the bile ducts or obstruction to the stomach by the cancer cannot be alleviated by any other means, for example, stent insertion (a fine plastic or metal tube).
Stenting: The insertion of a plastic or metal tube into the blocked bile duct, in order to keep it open is called stenting. It helps to restore the flow of bile in to the intestine and can alleviate jaundice. The stent can be inserted by a procedure called Endoscopic Retrograde Cholangio-Pancreatogram (ERCP) and it’s done by gastroenterologists/ hepatologists. This is the preferred way of stent placement as it is more convenient for the patient. In case of failed ERCP; the other way to insert the stent is called Percutaneous Transhepatic CholangioPancreatogram (PTC) and this procedure is done by specialist doctors called as interventional radiologists. PTC is only used for a very tiny proportion of the stents placed for patients with pancreatic cancer.
If the cancer is causing a narrowing of the small intestine (duodenum) this can cause problems with your ability to eat and drink and leads to vomiting after meals. A stent, larger than that used for the bile ducts, can be used and inserted into the duodenum to allow you to eat and drink, without nausea and/or vomiting.
Chemotherapy: The treatment of cancer with drugs is called chemotherapy). This treatment may be offered as a palliative treatment, where surgery is not possible, or as an add-on to surgical treatment. The aim of the palliative it to potentially slow down and/or shrink the cancer. As an “add-on” (adjuvant) treatment, it is offered to treat any cancer that may remain after surgery. Each dose of chemotherapy (single or combination) is called a cycle, each cycle is usually separated by a 2-3 weeks of a recovery period. This allows your body to receive the treatment, react/respond and recover.
Very occasionally patients may be offered chemotherapy, sometimes with radiotherapy, to shrink their tumor with a view to later performing surgery; this is called neo-adjuvant chemotherapy or chemo-radiotherapy. It can be very difficult to predict how someone, or a cancer, will respond to chemotherapy. However, in some people, even if a response is not achieved, they may find it alleviates their symptoms and may prolong their life expectancy.
Unfortunately, with pancreatic cancer, it is very difficult to predict whether it will respond to chemotherapy. However, in some people, even if a response is not achieved, they may find it can alleviate their symptoms and may prolong their life expectancy.