Cancer:
PANCREATIC CANCER
BY VISHWA.V
~INTRODUCTION~
Cancer – one of the most dreaded diseases of
human beings and is a major cause of death all over
the globe. More than a million Indians suffer from
cancer and a large number of them die from it
annually. The mechanisms that underlie
development of cancer or oncogenic transformation
of cells,
its treatment and control have been some of the
most intense areas of research in biology and
medicine.
In our body, cell growth and differentiation is highly
controlled and regulated. In cancer cells, there is
breakdown of these regulatory mechanisms. Normal
cells show a property called contact inhibition by
virtue of which contact with other cells inhibits their
uncontrolled growth. Cancer cells appears to have
lost this property,
As a result of this, cancerous cells just continue to
divide giving rise to masses of cells called Tumors.
Tumors are of two types:
Benign and Malignant.
-Benign tumors normally remain confined to their
original location and do not spread to other parts of
the body and cause little damage.
-The malignant tumors, on the other hand are a
mass of proliferating cells called neoplastic or
tumor cells. These cells grow very rapidly, invading
and damaging the surrounding normal tissues. As
these cells actively divide and grow they also starve
the normal cells by competing for vital nutrients.
Cells sloughed from such tumors reach distant sites
through blood, and wherever they get lodged in the
body, they start a new tumor there.
-This property called metastasis is the most feared
property of malignant tumor.
Pancreatic cancer is a malignant tumor with a
very poor prognosis and has a poor response to
systemic therapy.
– PANCREATIC CANCER –
PANCREAS:
The pancreas is about 6 inches (15 centimeters)
long and looks something like a pear lying on its
side. It is a endocrine and exocrine gland. It releases
hormones, including insulin, glycogon. These
hormones help the body process the sugar in the
foods you eat. The pancreas also makes digestive
juices to help the body digest food and take in
nutrients.
How pancreatic cancer forms:
Pancreatic cancer happens when cells in the
pancreas develop changes in their DNA. A cell's
DNA holds the instructions that tell a cell what to do.
In healthy cells, the instructions tell the cells to
grow and multiply at a set rate. The cells die at a set
time. In cancer cells, the changes give different
instructions. The incorrect data will give
instructions to multiply in large number quickly.
Cancer cells can keep living when healthy cells
would die. This causes there to be too many cells.
The cancer cells might form tumor. The tumor can
grow to invade and destroy healthy body tissue. In
time, cancer cells can break away and spread to
other parts of the body.
Most pancreatic cancer begins in the cells that line
the ducts of the pancreas. This type of cancer is
called pancreatic ductal adenocarcinoma or
pancreatic exocrine cancer.
Less often, cancer can form in the hormone-
producing cells or the neuroendocrine cells of the
pancreas. These types of cancer are called
pancreatic neuroendocrine tumors or pancreatic
endocrine cancer.
Pancreatic cancer is the seventh leading cause of
cancer-related death worldwide. In 2018, there were
432,242 deaths across the world due to pancreatic
cancer.
Causes
It's not clear what causes pancreatic cancer.
Doctors have found some factors that might raise
the risk of this type of cancer. These include
smoking and having a family history of pancreatic
cancer.
Risk factors
Factors that might raise the risk of pancreatic
cancer include:
● Smoking.
● Type 2 diabetes.
● Chronic inflammation of the pancreas, called
pancreatitis.
● Family history of DNA changes that can
increase cancer risk. These include changes in
the BRCA2 gene, Lynch syndrome and familial
atypical multiple mole melanoma (FAMMM)
syndrome.
● Family history of pancreatic cancer.
● Obesity.
● Older age. Most people with pancreatic cancer
are over 65.
● Drinking a lot of alcohol.
Complications
As pancreatic cancer progresses, it can cause
complications such as:
● Weight loss. People with pancreatic cancer
might lose weight as the cancer uses more of
the body's energy.
● Jaundice. Pancreatic cancer that blocks the
liver's bile duct can cause jaundice.
● Pain. A growing tumor may press on nerves in
the abdomen, causing pain that can become
severe.
● Bowel blockage. Pancreatic cancer can grow
into or press on the first part of the small
intestine, duodenum. This can block the flow of
digested food from the stomach into the
intestines.
Pancreatic cancer is difficult to
diagnose early.
Pancreatic cancer is difficult to detect and diagnose
for the following reasons:
● There aren’t any noticeable signs or symptoms
in the early stages of pancreatic cancer.
● The signs and symptoms of pancreatic cancer,
when present, are like the signs and symptoms
of many other illnesses.
● The pancreas is hidden behind other organs
such as the stomach, small intestine, liver,
gallbladder, spleen, and bile ducts.
Tests that can check pancreatic
cancer:
● Endoscopic retrograde
cholangiopancreatography (ERCP)
● Endoscopic ultrasound (EUS)
● CT scan
● Tumor marker test
● MRI (magnetic resonance imaging)
● Biopsy
(Pancreatic ultrasound
During an endoscopic ultrasound of the pancreas,
Doctor inserts a thin, flexible tube (endoscope)
down the throat and into the stomach. An
ultrasound device at the end of the tube emits
sound waves that generate images of the digestive
tract and nearby organs and tissues.)
★ Stages of Pancreatic Cancer★
The following stages are used for pancreatic cancer:
● Stage 0 (Carcinoma in Situ)
● Stage I pancreatic cancer
● Stage II pancreatic cancer
● Stage III pancreatic cancer
● Stage IV pancreatic cancer
•Stage 0 pancreatic cancer –
Abnormal cells are found in the lining of the
pancreas. These abnormal cells may become cancer
and spread into nearby normal tissue.
•Stage I pancreatic cancer –
Cancer is found in the pancreas only. In stage IA,
the tumor is 2 centimeters or smaller. In stage IB,
the tumor is larger than 2 centimeters but not larger
than 4 centimeters.
•Stage II pancreatic cancer –
1. Stage IIA pancreatic cancer. The tumor is larger
than 4 centimeters.
2. Stage IIB: The tumor is any size, and cancer has
spread to 1 to 3 nearby lymph nodes.
•Stage III pancreatic cancer.
The tumor is any size and cancer has spread to (a)
4 or more nearby lymph nodes; or (b) the major
blood vessels near the pancreas. These include the
portal vein, common hepatic artery, celiac axis
(trunk), and superior mesenteric artery.
•Stage IV pancreatic cancer.
The tumor is any size and cancer has spread to
other parts of the body, such as the lung, liver, or
peritoneal cavity (the body cavity that contains most
of the organs in the abdomen).
Treatment Options
There are different types of treatment for patients
with pancreatic cancer.
The following types of treatment are used:
1. Surgery
2. Radiation therapy
3. Chemotherapy
4. Chemoradiation therapy
5. Targeted therapy
•Surgery
One of the following types of surgery may be used
to take out the tumor:
1. Whipple procedure is surgery to remove the
head of the pancreas, the gallbladder, part of
the stomach, part of the small intestine, and the
bile duct. Enough of the pancreas is left to
producedigestive juices and insulin.
2. Total pancreatectomy is surgery to remove the
whole pancreas, part of the stomach, part of the
small intestine, the common bile duct, the
gallbladder, the spleen, and nearby lymph
nodes.
3. Distal pancreatectomy is surgery to remove the
body and the tail of the pancreas. The spleen
may also be removed if cancer has spread to
the spleen.
•Radiation therapy
Radiation therapy uses high-energy x-rays or other
types of radiation to kill cancer cells or keep them
from growing. Pancreatic cancer is sometimes
treated with external beam radiation therapy. This
type of radiation therapy uses a machine outside the
body to send radiation toward the area of the body
with cancer.
•Chemotherapy
Chemotherapy uses drugs to stop the growth of
cancer cells, either by killing the cells or by
stopping them from dividing.
Chemotherapy for pancreatic cancer is usually
systemic, meaning it is injected into a vein or given
by mouth. When given this way, the drugs enter the
bloodstream to reach cancer cells throughout the
body.
Chemotherapy drugs used to treat pancreatic
cancer may include:
1. capecitabine
2. fluorouracil (5-FU)
3. gemcitabine
4. irinotecan
5. leucovorin (a vitamin that improves the
effectiveness of 5-FU)
6. oxaliplatin
Combinations of these drugs may be used. Other
chemotherapy drugs not listed here may also be
used.
Chemotherapy may also be combined with other
kinds of treatment. For example, it may be combined
with radiation therapy or targeted therapy.
•Chemoradiation therapy
Chemoradiation therapy combines chemotherapy
and radiation therapy to increase the effects of both.
•Targeted therapy
Targeted therapy is a type of treatment that uses
drugs or other substances to identify and attack
specific cancer cells. Erlotinib is a targeted therapy
drug used to treat pancreatic cancer.
