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Pancreatic Cancer: Causes, Symptoms, Diagnosis, Treatment, and Prevention

Pancreatic cancer is a type of cancer of the pancreas, an organ located beneath the stomach. Among the main functions of the pancreas are to produce hormones that control blood sugar levels as well as digestive juices that help digest and absorb food. In addition to being one of the most deadly and aggressive forms of cancer, pancreatic cancer usually does not cause symptoms until it has spread to other organs.

Causes and Risk Factors

The exact cause of pancreatic cancer is not known, but some factors may increase the risk of developing it. These include:

• Smoking: Cigarette smoking is the most significant risk factor associated with pancreatic cancer. Smokers are about twice as likely to develop pancreatic cancer as nonsmokers.

• Obesity: Being overweight or obese can increase the risk of pancreatic cancer by affecting insulin levels and causing inflammation in the pancreas.

• Diabetes: People with long-standing type 1 or type 2 diabetes have a higher risk of pancreatic cancer than people without diabetes. Diabetes may also be a symptom of pancreatic cancer, as the tumor can interfere with the production of insulin.

• Alcohol: Heavy alcohol consumption can damage the pancreas and cause chronic pancreatitis, which is a risk factor for pancreatic cancer.

• Family history: Having a close relative with pancreatic cancer can increase the risk of developing it. Some inherited genetic syndromes, such as hereditary pancreatitis, Lynch syndrome, BRCA mutations, and Peutz-Jeghers syndrome, can also increase the risk of pancreatic cancer.

• Age: The risk of pancreatic cancer increases with age. Most people who are diagnosed with pancreatic cancer are over 45 years old.

• Race/ethnicity: Pancreatic cancer is more common in Black people and Jews than in other groups.

• Other factors: Exposure to certain chemicals, such as pesticides and dyes, chronic inflammation of the pancreas, liver damage, hepatitis B infection, and cirrhosis may also increase the risk of pancreatic cancer.

Symptoms

Pancreatic cancer often does not cause any symptoms until it has advanced to other organs. When symptoms do occur, they may include:

• Abdominal pain that spreads to the sides or back

• Loss of appetite

• Weight loss

• Jaundice (yellowing of the skin and whites of the eyes)

• Itchy skin

• Light-colored or floating stools

• Dark-colored urine

• Nausea or vomiting

• Digestive problems, such as abnormal stools or diarrhea

• Fatigue or weakness

• New diagnosis of diabetes or diabetes that is getting harder to control

• Pain and swelling in an arm or leg, which may be caused by a blood clot

If you have any of these symptoms, you should see a doctor as soon as possible.

Diagnosis

To diagnose pancreatic cancer, your doctor will ask you about your medical history, family history, symptoms, and risk factors. You will also undergo a physical examination and some tests, such as:

• Blood tests: These can check for markers of pancreatic cancer, such as CA 19-9 and CEA. They can also measure your blood sugar levels and liver function.

• Imaging tests: These can provide detailed pictures of your pancreas and other organs. They may include computed tomography (CT) scan, magnetic resonance imaging (MRI), positron emission tomography (PET) scan, endoscopic ultrasound (EUS), or endoscopic retrograde cholangiopancreatography (ERCP).

• Biopsy: This is a procedure that involves taking a small sample of tissue from your pancreas or another organ to examine it under a microscope for signs of cancer.

The diagnosis of pancreatic cancer is confirmed by a biopsy. The results of the tests can also help determine the stage of your cancer, which indicates how far it has spread and how aggressive it is.

Treatment

The treatment options for pancreatic cancer depend on several factors, such as the stage of your cancer, your overall health, your preferences, and your goals. The main types of treatment are:

• Surgery: This is an operation that aims to remove all or part of your pancreas and any nearby organs that are affected by the cancer. Surgery may be done to cure the cancer if it is localized and has not spread to other organs. It may also be done to relieve symptoms or improve quality of life if the cancer is advanced and cannot be cured. The types of surgery for pancreatic cancer include:

• Whipple procedure (pancreaticoduodenectomy): This is the most common type of surgery for pancreatic cancer. It involves removing the head of the pancreas, part of the small intestine (duodenum), part of the stomach (pylorus), the gallbladder, part of the bile duct, and nearby lymph nodes.

• Distal pancreatectomy: This involves removing the tail and body of the pancreas, as well as the spleen and nearby lymph nodes.

• Total pancreatectomy: This involves removing the entire pancreas, as well as the duodenum, part of the stomach, the gallbladder, part of the bile duct, the spleen, and nearby lymph nodes.

• Surgery for pancreatic cancer is a major operation that carries a high risk of complications, such as bleeding, infection, leakage of digestive fluids, diabetes, and malnutrition. You will need to stay in the hospital for several days or weeks after the surgery and have a long recovery period. You will also need to take medications to replace the hormones and enzymes that your pancreas used to produce.

• Chemotherapy: This is a treatment that uses drugs to kill cancer cells or stop them from growing. Chemotherapy can be given before or after surgery to shrink the tumor or prevent it from coming back. It can also be given alone or in combination with other treatments if the cancer is advanced and cannot be removed by surgery. Chemotherapy can be given by mouth (orally) or through a vein (intravenously). The types of drugs used for pancreatic cancer include:

• 5-fluorouracil (5-FU)

• Capecitabine (Xeloda)

• Gemcitabine (Gemzar)

• Irinotecan (Camptosar)

• Oxaliplatin (Eloxatin)

• Nab-paclitaxel (Abraxane)

• Chemotherapy can cause side effects, such as nausea, vomiting, hair loss, fatigue, low blood cell counts, mouth sores, and nerve damage.

• An effective treatment for cancer is radiation therapy, which uses high-energy beams, such as X-rays or protons, to stop cancer cells from growing or shrink the tumor. Radiation therapy can be given before or after surgery to shrink the tumor or prevent it from returning. Radiation therapy can also be given alone or in combination with other treatments in cases where surgery cannot be used to remove the cancer. You can receive radiation therapy either externally (external beam radiation) or internally (brachytherapy). Radiation therapy can cause side effects, such as fatigue, nausea, vomiting, diarrhea, and loss of appetite.

• An effective treatment for cancer is targeted therapy that targets the specific genes and proteins that distinguish cancer cells from normal cells. If the cancer has a genetic mutation that makes it more susceptible to targeted therapy, it can be given alone or in combination with other treatments. Types of drugs used in treating pancreatic cancer include:

• Erlotinib (Tarceva)

• Everolimus (Afinitor)

• Sunitinib (Sutent)

• Targeted therapy can cause side effects, such as rash, diarrhea, mouth sores, fatigue, and high blood pressure.

• Using drugs that stimulate your immune system, immunotherapy helps your body attack cancer cells. If the cancer has certain genetic mutations that make it more responsive to these drugs, immunotherapy can be used alone or in combination with other treatments. Pancreatic cancer is treated with the following drugs:

• Pembrolizumab (Keytruda)

• Nivolumab (Opdivo)

• Immunotherapy can cause side effects, such as rash, itching, fever, chills, fatigue, nausea, diarrhea, and liver problems.

The treatment plan for pancreatic cancer is individualized and may change over time depending on your response and tolerance to the treatments. You will need to have regular follow-up visits with your doctor to monitor your condition and adjust your treatments as needed.

Prevention

There is no sure way to prevent pancreatic cancer, but you can reduce your risk by making some lifestyle changes. These include:

• Quitting smoking or avoiding exposure to secondhand smoke

• Maintaining a healthy weight and exercising regularly

• Eating a balanced diet that is rich in fruits and vegetables and low in red meat and processed foods

• Limiting alcohol consumption

• Managing diabetes and other chronic conditions

• Avoiding contact with harmful chemicals

• Getting regular check-ups and screening tests if you have a family history of pancreatic cancer or other risk factors

You should consult your doctor if you have any symptoms or concerns regarding pancreatic cancer. Early detection and treatment can improve your chances of survival and quality of life.