Let's learn exactly about pancreatic cancer. These things are important for you too!

Today we are going to talk about a disease that is a bit serious, but we all need to be aware of it. That is pancreatic cancer , or `(Pancreatic Cancer)`. In this, the cells of the organ called the pancreas in our body start to behave abnormally. Since this is actually a bit of a sneaky disease, the most important thing is to know it in time.

What is pancreatic cancer?

Simply put, pancreatic cancer is when cells in your pancreas divide rapidly and grow into a tumor, or lump. Now you're probably wondering what the pancreas is and where it's located, right? It's a gland inside our stomach, between the spine and the stomach. It makes hormones that control our blood sugar levels , and enzymes that help us digest food.

Most of these pancreatic cancers start in the ducts of the pancreas. The main pancreatic duct connects the pancreas to our common bile duct.

Unfortunately, this cancer is not easily detected by imaging tests in its early stages. So by the time most people find out they have it, the cancer has already spread, or metastasized. Another reason is that this cancer is resistant to many anti-cancer drugs. So it is a bit difficult to treat.

Research is still being done on this, especially through genetic testing and new imaging techniques, but we still have a lot to learn.

What are the types of pancreatic cancer?

There are two main types of pancreatic cancer :

• Exocrine tumors: More than 90% of pancreatic cancers are of this type. The most common type is called adenocarcinoma. This type starts in the cells that line the inside of our organs.
• Neuroendocrine tumors (NETs): This type of tumor accounts for less than 10% of all tumors. It is also called islet cell carcinoma.

How common is this cancer?

In a country like America, 3 out of every 100 types of cancer are called pancreatic cancer. It is the 10th most common cancer among men and the 8th most common cancer among women. Sadly, the number of people who are affected by this cancer is increasing day by day. According to some reports, it may become the second leading cause of cancer deaths in America by 2030. This is a time to be concerned about this in Sri Lanka as well.

What are the symptoms of pancreatic cancer?

Unfortunately, the early symptoms of this cancer are not obvious. Symptoms only start to appear when the tumor grows a little bigger and starts affecting other organs in our digestive system.

Symptoms of pancreatic cancer may include:

• Jaundice (yellowing of the skin): This is a yellowing of the whites of the eyes and skin. Some people also call it 'yellow fever'.
• Dark-colored urine: Urine turns dark yellow, sometimes the color of tea water.
• Light-colored stools: You may notice that your stools are clay-colored or gray.
• Upper abdominal pain: You may feel pain in the upper abdomen, especially above the navel.
• Mid-back pain: This is also something that many people report. Along with the stomach pain, there is pain in the middle of the spine.
• Fatigue: Not just tiredness, but a feeling of being exhausted no matter how much sleep you get.
• Itchy skin: This can occur especially with jaundice.
• Nausea and vomiting: Loss of appetite accompanied by nausea and vomiting.
• Bloating or bloating: Feeling full even after eating a small amount of food, a feeling of fullness in the stomach.
• Anorexia: Loss of desire to eat.
• Blood clots: Sometimes blood clots can form in the legs.
• Weight loss: You lose weight for no reason, without controlling your diet.
• New-onset diabetes: This can also be a symptom of diabetes that occurs suddenly in someone who has not had diabetes before.

If you have recently been diagnosed with diabetes mellitus, or if you have a condition such as pancreatitis (a painful inflammation of the pancreas), your doctor may suspect pancreatic cancer.

However, the symptoms of pancreatic neuroendocrine cancer can be a little different. For example, instead of jaundice and weight loss, symptoms such as diarrhea and anemia may occur.

How long does it take to know if you have pancreatic cancer?

As mentioned before, there are no obvious early symptoms. For some people, symptoms may start to appear gradually, and it can take up to a year before a definitive diagnosis is made.

Many people say that they first experienced back pain or stomach pain. This pain may come and go at first, but may worsen after eating or lying down.

What causes pancreatic cancer?

There's really no clear answer to this yet. We don't know exactly what causes it. However, experts have identified several risk factors that may contribute to it.

Risk factors for pancreatic cancer

A risk factor is something that increases the chance of developing a disease. Common risk factors for pancreatic cancer include:

• Smoking: The biggest risk is using cigarettes, cigars, and other types of tobacco.
• Obesity: People with excess fat, especially around the belly, are at higher risk.
• Diabetes: Especially for those with Type 2 diabetes, it has been said that the sudden onset of diabetes can also be a sign of pancreatic cancer.
• Exposure to certain chemicals: Things like pesticides and petrochemicals.
• Chronic pancreatitis: A long-term inflammation of the pancreas.
• Hereditary chronic pancreatitis: A condition passed down from parents to children due to gene mutations.
• Some hereditary syndromes: Conditions caused by changes in genes such as BRCA1 or BRCA2. These can also be passed down from parents to children.

What are the complications of pancreatic cancer?

Pancreatic cancer often spreads to nearby blood vessels and lymph nodes. It can then metastasize to the liver, the lining of the abdominal cavity (peritoneum), and the lungs.

Important: Most of the time, by the time pancreatic cancer is diagnosed, it has already spread outside the pancreas. That's why it's so dangerous.

How is pancreatic cancer diagnosed?

Pancreatic cancer is very difficult to detect in the early stages because doctors cannot feel the pancreas during a routine examination. Nor can these tumors be seen on standard imaging tests.

If a doctor suspects pancreatic cancer, they will order several tests to check the function of the pancreas. These may include:

Imaging tests

Your doctor may tell you to do one or more of the following:

• CT scan (CT - computed tomography scans)
• MRI scan `(MRI - magnetic resonance imaging)`
• PET scan `(PET - positron emission tomography)`
• Endoscopic ultrasound (EUS): This involves inserting a small camera through the mouth to look closely at the pancreas.

Blood tests

Pancreatic blood tests can detect tumor markers. A tumor marker is a substance that indicates the presence of cancer.

For pancreatic cancer, a tumor can be suspected if a protein called ``Carbohydrate antigen (CA) 19-9'' (this is something released by pancreatic cancer cells) is present in high levels in the blood.

Staging laparoscopy

Sometimes, doctors use a procedure called laparoscopy to see how far pancreatic cancer has spread and whether it can be removed.

In this procedure, a surgeon makes several small incisions in the abdomen and inserts a long tube with a camera attached. This allows the surgeon to look inside the abdomen to see if there are any abnormalities. Often, a small sample is taken at this time for testing (biopsy).

Genetic testing

If you are diagnosed with pancreatic cancer, you may want to consider genetic testing. This is because you may have inherited a genetic predisposition to the cancer. It will also help your doctor decide what treatment is best for you.

Some people with pancreatic cancer have mutations in genes called BRCA1 and BRCA2. You may have heard of these genes as the "breast cancer genes." But mutations in the BRCA1 and BRCA2 genes can cause not only breast cancer, but also prostate cancer, ovarian cancer, and pancreatic cancer.

If someone in your family (parent, child, sibling) has had pancreatic cancer, consider getting a genetic test. This can tell you if you have a `BRCA1` or `BRCA2` gene mutation. But remember, having a gene mutation doesn't mean you'll develop cancer. But it's important to know your risk.

What is the difference between resectable and unresectable pancreatic cancer?

Doctors divide pancreatic cancer into four main categories:

• Resectable: The tumor is only in the pancreas. It has not spread to nearby blood vessels or other organs. It can be completely removed with surgery.
• Borderline resectable: The tumor is in the pancreas and has some involvement with nearby blood vessels, but a surgeon can still remove it.
• Locally advanced: The tumor is in the pancreas and has significantly spread to nearby blood vessels. In these cases, surgical removal may be difficult or even dangerous.
• Distant spread (Metastatic):The cancer has spread to distant parts of the body, such as the liver, lungs, or abdominal cavity. It may also have spread to organs, tissues, or lymph nodes near the pancreas.

If you have specific questions about the staging of pancreatic cancer, talk to your doctor. Understanding your diagnosis will help you make informed decisions about treatment.

Can pancreatic cancer be cured?

Although the survival rate for pancreatic cancer is low, complete remission is possible if detected and treated early. The only realistic way to cure pancreatic cancer is to completely remove the cancer through surgery.

How is pancreatic cancer treated?

The exact treatment depends on several factors, including:

• The exact location of the tumor.
• The stage of the cancer.
• Your overall health .
• Whether the cancer has spread outside the pancreas.

Pancreatic cancer treatments include:

Surgery

Surgery is the only realistic way to cure pancreatic cancer. But surgeons only recommend it if they think they can completely remove the cancer. Otherwise, it won't do much good.

For surgery to be successful, the cancer must be completely confined to the pancreas. Even then, it may not be possible to completely remove the cancer.

There are different surgical methods depending on the location and size of the tumor:

• Whipple procedure `(Whipple procedure - pancreaticoduodenectomy)`:

If the tumor is in the head of the pancreas (the widest part of the pancreas, near the small intestine), your doctor may recommend a Whipple procedure. This involves removing the head of the pancreas, your duodenum (the first part of the small intestine), your gallbladder, part of the bile duct, and nearby lymph nodes. The surgeon then connects the remaining bile duct and pancreas to your small intestine. This reorganizes your digestive system.

• Distal pancreatectomy:

If the tumor is in the tail of the pancreas, a surgeon may perform this surgery. This involves removing the tail of the pancreas and part of the body of the pancreas. Often, the spleen is also removed. Because the spleen helps us fight disease, your doctor may recommend that you get some vaccinations before this surgery.

• Total pancreatectomy:

If the cancer has spread to the entire pancreas but can still be removed (resected), your doctor may consider a total pancreatectomy. This surgery removes your entire pancreas, gallbladder, spleen, and part of your stomach and small intestine.

It is possible to live without a pancreas. But it can have serious side effects. Your pancreas makes hormones like insulin that help keep your blood sugar levels in check. When you lose your pancreas, you develop diabetes and have to take insulin injections to survive. You also have to take pancreatic enzyme pills to help you digest food.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. These drugs are given either as pills or as an IV (intravenous) injection into a vein in your arm.

Doctors also give chemotherapy as a single treatment - especially for people whose cancer has spread. They may also recommend chemotherapy before surgery to shrink the tumor or to kill any remaining cancer cells after surgery.

Radiation therapy

Radiation therapy is the use of high-energy X-rays to destroy cancer cells. This method is commonly used for pancreatic cancer.

Doctors often combine radiation therapy with chemotherapy (chemoradiation). It may be given before surgery, after surgery, or as part of the main cancer treatment. Radiation therapy can also help reduce the symptoms of pancreatic cancer in people who cannot have surgery (when the cancer has spread).

Targeted therapy

This treatment uses drugs that 'target' certain proteins. These proteins control how cancer cells grow and spread. Doctors may combine targeted therapy with other treatments, such as radiation therapy.

The most common targeted therapy drugs used for pancreatic cancer are:

• `Erlotinib`
• `Olaparib`
• `Larotrectinib`
• `Entrectinib`

Pain management

Pancreatic cancer can be very painful because it can affect nearby nerves. Your doctor may be able to help control your pain with oral medications, anesthesia, or steroid injections.

If you have pancreatic cancer and start having severe, persistent pain, be sure to tell your doctor . He or she will find a treatment that will reduce your symptoms.

Can I prevent pancreatic cancer?

Pancreatic cancer cannot be completely prevented, but there are things you can do to reduce your risk:

• Do not smoke.
• Limit alcohol consumption.
• Eat lots of fresh fruits, vegetables, and whole grains.
• Reduce your intake of red meat, sugary drinks, and processed foods.
• Limit exposure to harmful chemicals like asbestos, pesticides, and petrochemicals.
• Maintain a healthy weight for you.

Pancreatic cancer screenings

Doctors do not usually perform routine screenings for pancreatic cancer. However, doctors recommend regular monitoring with imaging tests and endoscopic ultrasounds for people who are at increased risk of developing pancreatic cancer due to a genetic predisposition.

If a first-degree relative in your family (parents or siblings) has had pancreatic cancer, you should talk to a doctor about your risk of developing pancreatic cancer and about appropriate screening and genetic testing.

What can I expect if I have pancreatic cancer?

Finding out you have pancreatic cancer can be overwhelming. Everyone is different, and each person's situation is different. Your doctor will put together a team of specialists to determine the best treatment plan for your situation. Your medical team may include:

• Gastroenterologist
• Pathologist
• Oncologists (medical, surgical and radiation)
• Social worker

Pancreatic cancer spread timeline

Typically, it takes 10 to 20 years for a single cancer cell in your pancreas to develop into a tumor. The goal of current research is to find out how to detect pancreatic cancer at an early stage, when it is most treatable.

Survival rate for pancreatic cancer

In a country like America, the five-year survival rate for people with pancreatic cancer is 11%. That means that 11 out of every 100 people are alive five years after diagnosis.

Survival rates are only estimates. They don't tell you how long you will live or how well you will respond to treatment. If you have specific questions about these rates or how they might affect you, talk to your doctor.

When should I see a doctor?

Early pancreatic cancer has no obvious symptoms. However, see a doctor right away if you experience any of the following:

• Jaundice
• Stomach or back pain
• Weight loss for no reason
• Sudden onset of diabetes

What questions should I ask my doctor?

Build an open, collaborative relationship with your doctor. If you or a loved one is diagnosed with pancreatic cancer, you can ask questions like these:

• What stage is the cancer in? What will it mean for me?
• What treatment options do I have? What do you recommend and why?
• What side effects might I experience from the treatment?
• Is genetic testing right for me?
• Are there clinical trials?
• Will I be able to continue working and doing my daily activities?
• Can you tell me where I can find financial assistance?
• Can you tell me about places where I can get mental relief?
• What should I do to stay as healthy as possible?

What are the signs that pancreatic cancer has spread?

As pancreatic cancer progresses, you may develop new symptoms. Symptoms of advanced pancreatic cancer may include:

• Abdominal pain
• Extreme fatigue
• Weight loss for no reason
• Jaundice
• Abdominal swelling (ascites)

Learning that you have pancreatic cancer can be a devastating and life-changing experience. Your doctor is there to help you through this difficult time. If you can, join a local or online support group for people with pancreatic cancer. Spending time with others who are going through the same thing can be very good for your mental health. You can also talk about your feelings with a counselor, therapist, or social worker. Knowledge is power. There are many resources available to help you and your family.

In summary, things we need to remember (Take-Home Message)

Pancreatic cancer is a complex and insidious disease, but it is important to be aware of it. Since there are few symptoms in the early stages, the best thing to do is to be aware of your risk factors and see a doctor as soon as possible if you notice anything unusual. Remember, do not ignore jaundice, persistent abdominal/back pain, sudden weight loss, or new onset of diabetes. If you have a genetic risk, talk to your doctor about it and get tested. There are treatments available, and new research is constantly being done. The most important thing is not to be afraid, seek medical advice if you have any doubts, and stay positive.

`Pancreatic Cancer, Pancreatic Cancer, Pancreas, Cancer Symptoms, Cancer Treatment, Jaundice, Diabetes