Pancreatic Cancer

Overview of Pancreas

The pancreas is a pear-shaped gland located between the stomach and spine, with two primary functions:

1. Exocrine function: Produces enzymes to aid digestion.

2. Endocrine function: Produces hormones like insulin that regulate blood sugar.

Types of Pancreatic Cancer

1. Exocrine Tumors

• Ductal adenocarcinoma is the most common type.

• Other rare types include acinar cell carcinoma, colloid carcinoma, and undifferentiated carcinoma.

2. Endocrine Tumors

• Known as pancreatic neuroendocrine tumors (PNETs) or islet cell tumors, these constitute only 7% of pancreatic cancers.

Statistics

• 12,642 new cases of pancreatic cancer are reported annually in India.

• 24th most common cancer in the country.

• The 5-year survival rate is only 12% in the United States.

Risk Factors

• Age: Over 90% of cases occur in people aged 55+.

• Gender: Men are more likely to develop pancreatic cancer.

• Smoking: Increases risk by 2-3 times.

• Obesity: Diets high in fat and obesity are linked to higher risk.

• Alcohol consumption: Chronic drinking may lead to pancreatitis and cancer.

• Diabetes: Long-term diabetes raises the risk.

• Family History: Having first-degree relatives with pancreatic cancer increases the risk.

• Genetic mutations: BRCA1, BRCA2, PALB2, and others contribute to cancer risk.

• Hereditary conditions: Syndromes like Lynch, Li-Fraumeni, and FAP increase risk.

• Chronic pancreatitis: Long-term inflammation may lead to cancer.

• Chemical exposure: Prolonged exposure to pesticides, benzene, and other chemicals.

• H. pylori infection and Hepatitis B are also linked to increased risk.

Symptoms

• Jaundice (yellowing of skin and eyes)

• Abdominal or back pain

• Swelling in the abdomen

• Blood clots in hands or legs

• Loss of appetite and weight loss

• Nausea, vomiting, and indigestion

• Fatigue

• Fever and chills

Diagnosis

• Physical exam: Identifies lumps or abnormal swelling.

• Blood tests: Measures bilirubin and tumor markers like CA 19-9.

• Biopsy: Tissue sample analyzed under a microscope to confirm cancer.

• Genetic Testing: Identifies mutations in genes like KRAS and TP53.

• Endoscopy (ERCP): Examines the bile duct and pancreas.

• CT Scan, MRI, Ultrasound, PET-CT: Detects the spread of cancer.

Treatment Options

1. Surgery

• Whipple Procedure (Pancreaticoduodenectomy): Removes the head of the pancreas, part of the stomach, and bile duct.

• Distal Pancreatectomy: Removes the tail of the pancreas and spleen.

• Total Pancreatectomy: Removes the entire pancreas, gallbladder, part of the stomach, and bile duct.

• Laparoscopy: Detects cancer spread to other parts.

Side Effects: Digestive issues and insulin production problems, potentially leading to diabetes.

2. Radiation Therapy

• External Beam Radiation Therapy (EBRT): Delivers high-energy radiation to destroy cancer cells.

• Stereotactic Body Radiation Therapy (SBRT): High-dose radiation in fewer sessions.

• Proton Beam Therapy: Uses protons to minimize damage to healthy cells.

Side Effects: Fatigue, nausea, redness, and itching of the skin.

3. Chemotherapy

• Common drugs include Capecitabine, Fluorouracil (5-FU), Gemcitabine, and Oxaliplatin.

• Can be used before surgery (neoadjuvant) or after surgery (adjuvant).

Side Effects: Fatigue, nausea, infections, hair loss, and appetite loss.

4. Targeted Therapy

• Erlotinib and Olaparib target specific cancer cell proteins.

• Larotrectinib and Entrectinib treat cancers with certain genetic mutations.

5. Immunotherapy

• Drugs like Pembrolizumab (Keytruda) and Dostarlimab (Jemperli) boost the immune system to fight cancer.

Follow-Up Care

• Regular check-ups, blood tests, and imaging scans to monitor for recurrence.

• Manage side effects and address any complications from treatment.

Pancreatic cancer treatment requires early diagnosis and comprehensive care, often combining multiple therapies to improve outcomes.

‍

Pancreatic Cancer