Pancreatic Cancer

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Cancer is a disease characterized by uncontrolled division and growth of cells. When this unchecked growth of cells occurs in pancreas, it is called pancreatic cancer. Cluster of cancer cells form lumps or masses of tissues called tumour. When this tumour spreads to other parts of body from its original site invading other organs in the body by the way of the blood or lymphatic system, it is called metastasis.

The tumour in the pancreas can be benign, which means simple growth and not cancer. When left untreated can show cancerous change (precancerous stage).

Pancreatic Cancer

Pancreas is a 6 inch long organ situated behind the stomach which is divided into 3 parts: head, body and tail. There are two types of glands in pancreas:

  1. Exocrine glands
  2. Endocrine glands

These glands secrete pancreatic juices, hormones and mainly insulin. Pancreatic juices help in the digestion of fat, proteins and carbohydrates in food.

Depending upon invasion of exocrine and endocrine glands by cancer cells different types of tumours are formed in pancreas.

About 95 % of the pancreas is made up of exocrine glands which are:

  • Adenosquamous carcinoma
  • Squamous cell carcinoma
  • Giant cell carcinoma
  • Acinar cell carcinoma
  • Small cell carcinoma

The endocrine cells releases insulin and glucagon the two main hormones that manage sugar level in blood. 4 % of all pancreatic cancer is tumours of endocrine glands depending on the type of cells which are:

  • Insulinomas (insulin-producing cells)
  • Glucagonomas (glucagon-producing cells)
  • Somatostatinomas (somatostatin-producing cells)
  • Gastrinomas (gastrin-producing cells)
  • VIPomas (vasoactive intestinal peptide secreting cells)
  • Non-secreting islet tumors of the pancreas.

The tumour interferes with the normal functioning of pancreas which leads to signs, symptoms and complications.

Risk factors of Pancreatic Cancer

There are certain risk factors that increase the chance of pancreatic cancer.

Adults of more than 45 years of age are primarily affected.

Men are more affected with pancreatic cancer than women.

Tobacco smoking is one of the most important risk factor for pancreatic cancer. Smokers are twice at risk compared to non-smokers.

Diabetes mellitus: Pancreatic cancer is found to be more common in diabetics.

Family history of pancreatic cancer increases the risk due to genetic link researched in about 10-15 % of cases.

Being over-weight and obesity increases the risk for diabetes and thereby pancreatic cancer.

Certain pesticides, dyes, and chemicals used in metal refining are found to be the causative agents in the cancer.

Chronic pancreatitis: It is long term inflammation of pancreas. A small number of cases with chronic pancreatitis develop pancreatic cancer.

Liver cirrhosis: chronic intake of alcohol lead to cirrhosis (scarring of liver) which in turn increases the risk.

Signs and Symptoms of Pancreatic Cancer

Pancreatic cancer is also known as “silent killer” as it doesn’t produce any signs or symptoms in its early stage. Hence it is very hard to diagnose pancreatic cancer in initial stage and prevent its progress.

Symptoms depend on the extent and location of the tumour in pancreas.

  • Abdominal pain: Severe cramping pain in upper abdomen which radiate to back and shoulders is the typical symptom in those with deranged functioning of pancreas.
  • Jaundice: 80 % of tumours in the head of the pancreas develop jaundice. Yellowing of skin, whites of the eyes, light-colored stools, dark urine and generalised itching are the symptoms accompanying jaundice.
  • Nausea and/or vomiting: Delayed emptying of food due to lack of pancreatic juices causes fullness and feeling of vomiting.
  • Unintentional weight loss because of lack of appetite.
  • Diabetes: pancreatic cancers cause diabetes (high blood sugar) because they destroy the
  • Insulin-making cells
  • Diarrhea: Indigestible food that passes through stomach causes loose stools because lack of pancreatic enzymes.
  • Steatorrhea (excess fat in stool)
  • Spontaneous blood clots formed in the portal blood vessels, deep veins of the arms and legs, or other superficial veins. (Trousseau’s sign)

Diagnosis of Pancreatic Cancer

  • Ultrasound of the abdomen
  • Endoscopic Ultrasonography (EUS)
  • ERCP (endoscopic retrograde cholangiopancreatography)
  • Computed Tomography (CT)

Treatment for Pancreatic Cancer

Surgery is the method of treatment in cases of localised tumour in pancreas. If surgery is contra-indicated a combination of chemotherapy and radiation or chemotherapy is advised.