What is pancreatic cancer ?

Pancreatic Cancer

 

The pancreas

The pancreas is part of the digestive system. It produces enzymes, which break down food so it can be absorbed and used by the body. It is a long, irregular shaped gland about 13–15cm long that lies between your stomach and spine. It is divided into:

  • A large rounded section, called the head of the pancreas
  • The middle part, known as the body
  • The narrow end, called the tail.

A tube called the pancreatic duct connects the pancreas to the first part of the small bowel (duodenum). Another tube called the common bile duct joins the pancreatic duct and connects the liver and gall bladder to the small bowel. The common bile duct carries bile, a substance that helps to digest fats.

What the pancreas does

It contains two types of glands, the exocrine glands and the endocrine glands, which release substances that help with digestion.

  • Exocrine glands

These produce juices called enzymes that help break down food. The juices flow from the pancreas into the duodenum through the pancreatic duct. Most of the pancreas is made up of exocrine glands.

  • Endocrine glands

These are scattered amongst the exocrine glands in small clusters called pancreatic islets (or islets of Langerhans). They release chemical messengers (hormones) that control the amount of sugar in the blood. The hormone insulin decreases blood sugar levels, while the hormone glucagon increases blood sugar levels.

 

What is pancreatic cancer?

Pancreatic cancer occurs when malignant cells develop in part of the pancreas. This may affect how the pancreas works, including the functioning of the exocrine or endocrine glands.

It can occur in any part of the pancreas, but about 70% of pancreatic cancers are located in the head of the pancreas.

Cancer can also spread to nearby lymph nodes (part of the immune system), blood vessels or nerves. Cancer cells may travel through the bloodstream to other parts of the body, such as the liver.

What types are there?

There are two types of pancreatic tumours:

Exocrine tumours

Make up more than 90% of pancreatic tumours. The most common exocrine tumour, called an adenocarcinoma, begins in the lining of the pancreatic duct.

Other types of tumours include adenosquamous carcinomas and undifferentiated carcinomas.

Pancreatic neuroendocrine tumours (PNETs)

Rare types of tumours affecting the endocrine system. They begin in the endocrine cells, which produce hormones that control the growth of cells in the body.

PNETs are categorised as either hormone secreting (functioning) or non-hormone secreting (non-functioning). Functioning tumours are usually named after the type of hormone they produce.

Types of PNETs include:

  • gastrinomas – produce too much gastrin
  • insulinomas – produce too much insulin
  • glucagonomas – produce too much glucagon
  • somatostatinomas – produce too much somatostatin
  • VIPomas – create a hormone-like substance called vasoactive intestinal polypeptide (VIP).

 

How common is it?

  • About 48,960 people (24,840 men and 24,120 women) will be diagnosed with pancreatic cancer.
  • About 40,560 people (20,710 men and 19,850 women) will die of pancreatic cancer

Rates of pancreatic cancer have been fairly stable over the past several years.

Pancreatic cancer accounts for about 3% of all cancers in the US, and accounts for about 7% of cancer deaths

 

What are the risk factors?

Research has shown that people with certain risk factors are more likely than others to develop pancreatic cancer. Risk factors include:

  • getting older – it is most common in people aged over 65
  • smoking – cigarette smokers are 2–3 times more likely to develop pancreatic cancer
  • new onset diabetes – about 15–20% of people with pancreatic cancer have newly diagnosed diabetes
  • chronic inflammation of the pancreas (pancreatitis)
  • a family history of inherited cancer syndromes.

The importance of family history

Most people with pancreatic cancer do not have a family history of the disease. However, about one in 10 people who develop pancreatic cancer have a faulty gene that can run in families.

You may have an inherited family risk if you have two or more first-degree relatives affected by pancreatic cancer, or a history of an inherited syndrome. Some inherited syndromes that may cause pancreatic cancer include Peutz-Jeghers syndrome, the familial breast cancer gene (BRCA1 and BRCA2), familial atypical multiple mole melanoma syndrome, Lynch syndrome and hereditary pancreatitis.

Some PNETs are caused by a rare inherited syndrome, such as multiple endocrine neoplasia type 1 (MEN-1) or neurofibromatosis.

The ‘degree of relationship’ describes how many genes are shared between two blood relatives. A first-degree relative shares about half their genes with you, for example, your parents, siblings or children.

If you are concerned about your family history or if you want to know more about genetic testing,  talk to us about further genetic testing.

What are the symptoms?

Early stages of pancreatic cancer rarely cause symptoms. Symptoms may go unnoticed until the cancer is large enough to affect nearby organs.

Symptoms of pancreatic cancer may include:

  •  indigestion (heartburn)
  • appetite loss
  • feeling sick (nausea)
  • vomiting
  • weight loss
  • pain in the upper abdomen, side or back, which may cause you to wake up at night
  • changed bowel motions – either diarrhoea, severe constipation, or stools that are pale and hard to flush away
  • jaundice, which causes yellowish skin and eyes, dark urine, pale bowel motions and itchiness
  • onset of diabetes within the last two years, or worsening of existing diabetes – in up to 50% of people with pancreatic cancer, the cancer stops the pancreas from making insulin properly
  • for PNETs, too much sugar in the blood (hyperglycaemia)

 

I have been denied an operation for my newly diagnosed pancreatic cancer. What are my options?

 

Unfortunately, only 20% of patients who were diagnosed with pancreatic cancer are not a candidate for an operation. This is partly due to the tumor may have invaded major blood vessels nearby which are vital for our survival. If the tumor is very close to the blood vessel and has not involved, it may still be resectable. We specialize in removing such tumors which are very close to the blood vessels .

Often times you may have been denied an operation due to the lack of surgical expertise. You may want to get the opinion from a surgeon who sees these cancers on a routine basis. At our practice, we specialize in resection of such complex pancreatic cancers and liver cancers.

 

Please feel free to reach us at 832-930-3132 directly to discuss your situation. We understand you may be in an unfortunate situation to discuss about pancreatic cancers, but we promise to you our best advice and strive for a surgical cure.