Pancreatic Cancer

Facts

The pancreas is pear shaped and is approximately 6 inches in length located deep within the abdomen between the stomach and spine. The pancreas is composed of 3 components, the head, the body, and the tail. It is responsible for hormone production including insulin which helps to regulate blood sugar levels in the body; it also provides enzymes that help digest food. Pancreatic cancer is most common in individuals aged 60-80 and its prevalence is more or less equal in men and women. The exact cause of pancreatic cancer is unknown; however smokers are 2-3 times more likely to develop the condition. People in certain occupations are also at higher risk for example jobs that require contact with coal, gas, pesticides, and those that work in an industrial environment. Individuals with a family history of pancreatic cancer are 3 times more likely to develop the condition.

Symptoms

Symptoms of pancreatic cancer in its early stages may be unclear. Indications will become more obvious once the cancer has spread to other organs or bile ducts and may include: weight loss, lack of appetite, jaundice, upper abdomen pain, back pain, weariness, nausea and vomitting 10-20%, and symptoms similar to diabetes as the cancer halts insulin production.

Diagnosis

• A CT Scan can offer an imaging of tumour/s in the pancreas. An increase in size of lymph nodes, a mass in the liver, bile duct obstruction can be key indicators of cancer.
• Using a scope to inject dye into the pancreatic ducts. Endoscopic retrograde cholangiopancreatography (ERCP) uses a dye to highlight the bile ducts in your pancreas. During ERCP, an endoscope is passed down your throat, through your stomach and into the upper part of your small intestine. A dye is then injected into the pancreatic and bile ducts through a small hollow tube (catheter) that’s passed through the endoscope.
• PTC- the PTC method is similar to ERCP in that a dye is used to show up the obstruction on X-ray. Instead of the tube being inserted through an endoscope, a needle will be inserted through the skin just below your rib cage and a fine guide-wire passed through the liver and into the blockage in the bile duct.

Some patients may require an increase incarbohydrate antigen 19-9 (CA 19-9) levels

Stages

1. Stage IA – Cancer has not spread out of pancreas and is smaller than 2 cm. Has not spread to lymph nodes.
2. Stage IB- Cancer has not spread out of pancreas however is larger than 2 cm. has not spread to lymph nodes
3. Stage IIA – Cancer has spread out of pancreas but not to major arteries or lymph nodes
4. Stage IIB Cancer may or may not have spread out of pancrease. It has not spread to major arteries but has spread to surrounding lymph nodes
5. Stage III Cancer has spread out of pancreas into major arteries, and may or may not have spread to lymph nodes
6. Stage IV Cancer has spread to organs throughout the body

Surgery

There are only a small number of inviduals who are unsuitable for surgical treatment of pancreatic cancer. The Whipple Operation is effective in removing small tumours not that are easily accesible.

Other treatment methods includes chemotherapy or radiotherapy, these may be used in combination simultaneously. It can be used to reduce pain or unclogg bile duct or digestive tract obstruction.

New non-surgical treatment methods may which include IRE, Cyrotherapy, radiotherapy (I-125) are currently being research and may be used to reduce symptoms and size of tumour.

Author

Dr. Wutthi Sumetchotimaytha
Surgical Oncologis