Pancreatic Cancer Treatment

Doctors Panel of Pancreatic Cancer Treatment

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WHAT IS THE PANCREAS?

The pancreas is a small organ located at the back of your abdomen. It measures about 15 cm and has two main functions: producing enzymes that aid the digestive process by breaking down foods, releasing nutrients and energy, and releasing the hormones insulin and glucagon that control sugar levels in your body. Insulin reduces high sugar levels, and glucagon raises sugar levels when they are low.

The pancreas has two kinds of cells, which are called the exocrine and neuroendocrine portions. The exocrine cells secrete digestive enzymes and form most of the pancreatic mass, nearly 85 per cent.

The neuroendocrine portion has cells in small clusters called islets of Langerhans, which produce the crucial hormones insulin and glucagon.

WHAT IS PANCREATIC CANCER?

When the cells in the pancreatic tissue undergo mutation or changes and multiply out of control, it leads to cancerous tumors. Typically, cells multiply to replace the dying cells, and cell replication is a controlled process in a healthy body. But when they multiply beyond the usual pattern, it leads to an extra mass of cells which may be benign (non-cancerous) or malignant (cancerous).

TYPES OF PANCREATIC CANCERS

Pancreatic cancer is classified into two types: exocrine or neuroendocrine tumors. Most pancreatic cancers - more than 90 per cent - are exocrine tumors that start in the cells responsible for secreting digestive enzymes. Knowing which cell type has become cancerous is critical to devise the appropriate treatment because the two categories of cells call for different treatments.

Pancreatic Adenocarcinoma: is the most common exocrine pancreatic cancer that starts in the cells lining the pancreatic duct. It is also called ductal carcinoma.

Acinar Cell Carcinoma: When cancer develops in the cells that produce digestive enzymes, it is called acinar cell carcinoma. It is rare exocrine cancer that comprises only one to two per cent of pancreatic cancers.

Squamous Cell Carcinoma: Another extremely rare form of exocrine pancreatic cancer, it forms in the pancreatic ducts and comprises purely squamous cells, which are not usually found in the pancreas. Squamous cells resemble fish scales and are generally located in skin tissue, hollow organ lining, and respiratory and digestive tracts.

Adenosquamous Carcinoma: This is also a rare type of exocrine pancreatic cancer, occurring in less than one to 4 per cent of exocrine pancreatic cancers. Adenosquamous Carcinoma reveals characteristics of Adenocarcinoma and Squamous Cell Carcinoma.

Pancreatic Neuroendocrine Tumors (PNETs): This neuroendocrine pancreatic cancer occurs due to abnormal growth in the islets of Langerhans, the cells producing insulin and glucagon in the pancreas. The cells in these tumors may produce hormones or not, however, most PNETs are non-functional and do not release hormones.

Tumors in cells that release gastric enzymes are classified as:

  • Gastrinoma: A tumor in the cells that makes gastrin, an acid that helps digest food. Most gastrinomas are malignant.
  • Insulinoma: A tumor in the cells that make insulin, the hormone that controls sugar levels in the blood. Insulinoma is usually non-cancerous.
  • Glucagonoma: Aa condition where a tumor forms in the pancreas’ glucagon-making cells. Glucagon helps the liver break down stored glycogen and release it into the bloodstream to boost low sugar levels. A majority of glucagonomas are cancerous.

PANCREATIC CANCER: CAUSES & RISK FACTORS

There is no substantive evidence to determine the cause of pancreatic cancers through genetic predisposition and lifestyle are significant drivers of the disease. Below are the most likely factors that can cause pancreatic cancer:

Smoking: It is a significant risk factor for pancreatic cancer. People who smoke or use tobacco products are twice as likely to get it than non-smokers, and quitting smoking reduces the risks.

Excess body weight: Obesity is a significant risk factor for pancreatic cancer. Individuals with a Body Mass Index (BMI) of over 30 are at a higher risk than those who may not be overweight but have heavy waistlines and abdominal fat.

Diabetes: Type 2 diabetics are at high risk for pancreatic cancer though the exact reason for this is unknown.

Chronic pancreatitis: Long-term inflammation of the pancreas, called pancreatitis, is associated with an increased risk of pancreatic cancer. People who drink and smoke heavily develop pancreatitis.

Exposure to chemicals: Certain chemicals may raise the risk of pancreatic cancer—for example, dry cleaning solutions and metal-making chemicals.

Inherited gene mutations: It is a hereditary condition where people inherit gene changes that increases the risk of pancreatic cancer.

Acquired gene mutations: Lifestyle or environment-related conditions can also lead to gene mutations in the pancreatic tissues causing pancreatic cancer.

Age & Gender: Individuals above the age of 70 are more likely to get pancreatic cancer. The risk increases with age, and men are more likely to get it.

Wrong diet: Eating excessive quantities of red meats and fried and processed foods could increase the risk of pancreatic cancer.

WHAT ARE THE SYMPTOMS OF PANCREATIC CANCER?

Pancreatic cancer is typically not detected in its early stages as it often doesn't lead to symptoms. It becomes evident only after it spreads to other parts of the body. In a more advanced stage of the disease, the symptoms include:

  • Pain in the abdomen that spreads to the back: A sensation of cramps when sitting or lying down that increases as the disease progresses.
  • Loss of appetite and unexpected weight loss: Cancerous growth in the pancreas inhibits its ability to produce digestive enzymes, so food is not digested correctly, and the body cannot process nutrients leading to weight loss.
  • Nausea: It is caused due to changes in digestive processes.
  • Change in stool color: Undigested food due to diminished pancreatic enzymes leads to pale stools.
  • The onset of diabetes: Some cases of pancreatic cancer give birth to diabetes due to impaired insulin release.
  • Fatigue: It is an early warning system. An individual has low energy, a lack of focus and a slow mental speed.
  • Blood clots: Pancreatic cancer promotes blood clots which can form in the veins (Deep Vein Thrombosis, DVT), lung (pulmonary embolism), or organs.
  • A sudden bout of jaundice-like effects: Skin and whites of the eyes look yellow because of bilirubin build-up in your body. Bilirubin, a yellowish substance found in bile juice, is manufactured by the liver and helps clear waste from the body. Due to cancer in the pancreas and its diminished functions, the bile duct, which passes through the pancreas, gets blocked, leading to bilirubin build-up that gives urine a dark brown color, a sign of pancreatic cancer.
  • Itchy skin: It occurs to the build-up of bilirubin in the body.

STAGES OF PANCREATIC CANCER

Just like all cancers, pancreatic cancer also has stages of development.

The AJCC or American Joint Committee on Cancer TNM system is most used to chart the course of pancreatic cancer. It considers the following factors:

  • How large is the tumor (T)?
  • Has it spread outside the pancreas affecting the nearby lymph nodes (N)?
  • Has it metastasized (spread to other body parts) (M)?

Using the TNM system, doctors use a five-part Pancreatic Cancer staging system from Stage 0 to Stage 4. It offers them a guide to how far cancer has spread, its severity and the best treatment.

In ascending order, the higher the stage, the more cancer has spread.

Stage 0: Abnormal cells which may turn cancerous are detected in the pancreas’ lining.

Stage I: Only the pancreas is affected by cancerous cells. Doctors determine the size of the tumor at this stage.

Stage II: Cancer has potentially spread to adjacent tissue, organs, or lymph nodes. The area of the cancer spread is determined to arrive at an accurate diagnosis.

Stage III: Cancer has spread beyond the pancreas to the major blood vessels and perhaps the nearby lymph nodes, but it has not contaminated other organs.

Stage IV: The cancer tumor has spread to organs farther from the pancreas.

American Hospital Dubai is at the forefront of cancer treatments. It is in step with the evolving cancer staging system to deliver the most accurate cancer diagnosis and the most effective treatment and care.

HOW IS PANCREATIC CANCER DIAGNOSED?

If you experience any pancreatic cancer symptoms, do not delay a diagnosis. Book an appointment immediately. Doctors at American Hospital Dubai will do the following tests:

Physical check-up and health history: An overall check-up to detect any abnormal issues, along with an analysis of the patient’s health history.

Imaging tests: These involve taking pictures of your internal organs, including the pancreas, using ultrasound, computerized tomography (CT) scans, magnetic resonance imaging (MRI) and positron emission tomography (PET) scans.

Scoping the pancreas: The endoscopic ultrasound (EUS) creates images of your pancreas to detect the growth of any abnormal mass.

Tissue samples: A small pancreas tissue is obtained through the endoscopic ultrasound (EUS) to conduct a biopsy. We also sometimes use a fine needle biopsy inserted into the pancreas through the skin to get a tissue sample.

Blood test: Our doctors may recommend a blood test to lab test it for specific proteins released by the pancreas with malignant cells and levels of bilirubin in the blood.

Tumor marker test: Blood, urine, or tissue samples are analyzed to measure certain substances released in the body. When these substances are high, it indicates the possibility of cancer.

Endoscopic Retrograde Cholangiopancreatography (ERCP): It uses an endoscope and a catheter tube to check if the bile ducts and pancreatic ducts are blocked due to tumor growth.

Percutaneous Transhepatic Cholangiography (PTC): The procedure injects dye into the liver to detect any blockages of the bile ducts through X-ray. If the dye travels freely, the bile ducts are clear, and no tumor is blocking them.

TREATMENT OPTIONS FOR PANCREATIC CANCER

Pancreatic cancer treatment includes several approaches, such as surgery, chemotherapy, radiation therapy, vaccination, pain management, immunotherapy, or a combination of these approaches and dietary changes.

Surgery

Potentially curative surgery: It is only done when the diagnosis says it is possible to remove all the cancerous mass in the pancreas.

Palliative surgery: If the cancer is widespread and cannot be removed entirely, palliative surgery alleviates symptoms.

Whipple procedure (pancreaticoduodenectomy): This procedure removes cancerous tissue in the head of the pancreas and, sometimes, the pancreas's body. It may also involve removing parts of adjacent organs such as the small intestine, the bile duct, the gallbladder, lymph nodes, and the stomach and realigning the organs’ remaining portions to allow food processes to carry on in the digestive tract. The procedure is done routinely the at American Hospital Dubai, a leader in advanced complex cancer surgery using the most advanced techniques by American-Board certified surgeons.

Distal pancreatectomy: This procedure is used to eliminate cancers in the tail and body of the pancreas.

Total pancreatectomy: This procedure is undertaken if cancer has spread throughout the pancreas and also entails the removal of adjacent lymph nodes, a portion of the stomach, duodenum, gallbladder and possibly the spleen. Losing the pancreas will leave the patient unable to make insulin, which means they will be required to take insulin externally, and enzyme replacement to compensate for the loss of normal pancreatic functions.

Bile duct stent: If cancer is present in the head of the pancreas, the extra mass of tissue can block the bile duct, which passes through this area leading to bile build-up that causes abdominal pain, digestive problems, jaundice, nausea, vomiting, etc. Inserting a stent in the bile duct keeps it open to combat the pressure of the surrounding cancerous tissue.

Bile duct bypass surgery: The procedure, which can be performed laparoscopically, reroutes bile flow from the blocked duct into the small intestine, skirting the pancreas.

Radiation Therapy: High-energy X-rays (or particles) attack cancer cells. It can be combined with chemotherapy depending on the extent of cancer and tumor aggression. The duration of the radiation and chemo depends on the cancer containment rate and the outcome.

Chemotherapy: It involves injecting or administering an anti-cancer and can be used to treat pancreatic cancer at any stage, before surgery to shrink the tumor, post-surgery to eliminate any remaining cancer cells, or during the advanced stage of pancreatic cancer when surgery is not feasible. The last type is known as palliative chemotherapy, which aims to lessen the symptoms and pain from pancreatic cancer.

Immunotherapy: Immunotherapy is a form of treatment that helps the body's fight diseases with naturally produced body chemicals which prevent the cancer cells’ from fooling the immune system from detection. The use of immunotherapy, along with chemotherapy, is under review as a new form of treatment for pancreatic cancer.

Targeted therapy:This procedure focuses on the specific cancer-causing genes. It focuses on eliminating the proteins and genetic drivers that help cancer grow, thus limiting harm to healthy cells. Every tumor has a different targeted therapy because the triggers for cancerous tumors vary. Doctors analyze many factors before drawing up a tailored treatment program for the type and stage of pancreatic cancer.