The pancreas is an organ in our body that many people don't talk about much, and it's a bit hidden. Simply put, it's located inside your abdomen, behind your stomach and in front of your spine. This small organ does two very important things for our body. One is to produce hormones that control blood sugar levels. The other is to produce enzymes that help digest the food we eat. However, when the cells in this organ change uncontrollably and start dividing rapidly, a tumor forms. That's what we call pancreatic cancer.
Why is this cancer difficult to diagnose?
The biggest challenge with this disease is that it does not show any symptoms in the early stages . Even routine scans do not detect these tumors in the early stages. Therefore, by the time most people find out they have this disease, the cancer has already spread (metastasized) to other organs outside the pancreas. Also, this cancer is resistant to many anti-cancer drugs, so it can be a little difficult to treat. But don't worry, medical science is improving day by day, so new treatment methods are constantly being researched.
What are the types of pancreatic cancer?
There are two main types of pancreatic cancer.
1. Exocrine tumors: This is the most common type. More than 90% of cancers are of this type. The most common type of these is Adenocarcinoma . This starts in the cells that line the inside of the pancreatic ducts.
2. Neuroendocrine tumors (NETs): These are a bit rare, accounting for less than 10% of cases.
What are the symptoms of this disease?
As we mentioned earlier, there are no obvious symptoms in the early stages. Symptoms only start to appear when the cancer has grown and started to affect other organs in the nearby digestive system. Therefore, it is very important to be aware of these symptoms.
| Symptom | A simple explanation |
|---|---|
| Yellowing of the skin and eyes (Jaundice) | This occurs when the cancer blocks the bile duct from the gallbladder, causing a yellow chemical called bilirubin to accumulate in the body. |
| Dark-colored urine | Urine turns dark yellow or brown due to increased bilirubin levels in the body. |
| Light-colored stools | Due to blockage of the bile duct, the chemicals that give the stool its brown color are not collected, causing the stool to take on a light, clay-like color. |
| Upper abdominal and back pain | The tumor may enlarge and press on the surrounding nerves. The pain may worsen after eating or when lying down. |
| Weight loss without any reason | Weight loss occurs due to changes in the body's metabolism and loss of appetite due to cancer. |
| Anorexia and nausea | Loss of appetite, feeling like vomiting. |
| Itchy skin | It can be caused by bilirubin buildup in the skin. |
| New onset diabetes | If someone suddenly develops diabetes without other risk factors, especially after the age of 50, it may be a sign of pancreatic cancer. |
The important thing is that just having one or more of these symptoms does not necessarily mean that you have pancreatic cancer. These can also be symptoms of other diseases. However, if you have any of these symptoms, it is wise to see a doctor immediately for advice.
What are the risk factors for pancreatic cancer?
The exact cause of this cancer has not yet been discovered. However, doctors have identified some risk factors that increase the risk of developing the disease.
- Smoking: The use of cigarettes, cigars, and other tobacco products is a major risk factor.
- Obesity: Excess body weight, especially fat accumulation in the abdominal area, increases the risk.
- Diabetes: Having diabetes (especially type 2) for a long time is a risk. And as we mentioned earlier, the sudden onset of diabetes can also be a symptom.
- Chronic pancreatitis: Inflammation of the pancreas over a long period of time.
- Family history and genetic factors: The risk is higher if someone in the family (parents, siblings) has had pancreatic cancer or has genetic mutations linked to cancer such as BRCA1 and BRCA2 .
- Exposure to chemicals: Long-term exposure to things like pesticides and petroleum-based chemicals.
- Age: The risk increases with age.
How to diagnose the disease? (Diagnosis)
If your doctor suspects pancreatic cancer based on your symptoms, they will recommend several tests to confirm the disease.
1. Imaging tests
These are used to take pictures of the pancreas and surrounding organs inside the body to see if there is a tumor and how far it has spread.
- CT (Computed Tomography) Scan
- MRI (Magnetic Resonance Imaging) scan
- PET (Positron Emission Tomography) scan
- Endoscopic Ultrasound (EUS): A close-up examination of the pancreas using a camera and scanner attached to a thin tube inserted through the mouth.
2. Blood tests
The blood is checked for certain proteins (tumor markers) produced by cancer cells. In pancreatic cancer, the level of a tumor marker called CA 19-9 may be elevated.
3. Biopsy
This is the definitive way to confirm the disease. In this procedure, a very small piece of tissue is taken from the pancreatic tumor and examined under a microscope to see if there are any cancer cells. This piece of tissue can be taken during the EUS examination.
4. Genetic testing
If you are diagnosed with cancer, your doctor may recommend genetic testing. This will help determine if there is a hereditary cause for your cancer and help you choose the treatment that is best for you.
Determining the stage of cancer (staging)
Before starting treatment, it is very important to determine the stage of the cancer. This means whether the tumor is confined to the pancreas or has spread to nearby blood vessels or other organs. Simply put, cancerous tumors are divided into 4 main categories.
| Cancer stage | Meaning |
|---|---|
| Resectable (can be removed surgically) | The tumor is confined to the pancreas. It has not spread to surrounding blood vessels. It can be completely removed with surgery. |
| Borderline resectable | The tumor is somewhat connected to the surrounding blood vessels, but is still at a level where a skilled surgeon can remove it. |
| Locally advanced | The tumor has spread well into the surrounding major blood vessels. Surgical removal may be difficult or dangerous. |
| Metastatic | The cancer has spread to distant organs, such as the liver, lungs, or abdominal cavity. |
What are the treatment options?
The treatment method is determined by the type of cancer, stage, location of the tumor, and the patient's overall health.
Surgery
The only realistic way to completely cure pancreatic cancer is to remove the entire tumor through surgery . But this can only be done in the early stages, when the cancer is confined to the pancreas.
- Whipple procedure: The main surgery performed if the tumor is in the head of the pancreas. In this procedure, the head of the pancreas, part of the small intestine, the gallbladder, and surrounding lymph nodes are removed.
- Distal pancreatectomy: If the tumor is in the tail of the pancreas, that part and the spleen are removed.
- Total pancreatectomy: If the cancer has spread to the entire pancreas, the entire pancreas is removed. This means you will need to take insulin injections and digestive enzyme pills for the rest of your life.
Chemotherapy
This involves giving the body drugs that kill cancer cells. These are given as pills or through an injection into a vein. They are used to shrink a tumor before surgery, to kill any remaining cells after surgery, or as the main treatment for cancer that has spread.
Radiation therapy
The use of high-energy X-rays to destroy cancer cells. This is often given in combination with chemotherapy (chemoradiation).
Targeted therapy
These are a new type of drug that works by targeting specific proteins that help cancer cells grow and spread.
Pain management
Because pancreatic cancer affects the nerves around the pancreas, it can sometimes cause severe pain. Therefore, pain control is a very important part of treatment. Your doctor will recommend appropriate pain medications or other methods for you. Don't tolerate the pain, talk to your doctor about it.
Can we avoid this disease?
There is no way to completely prevent pancreatic cancer, but there are some things we can do to reduce our risk.
- Avoid smoking completely. This is the most important thing.
- Limit alcohol consumption.
- Maintain a healthy weight.
- Eat a diet rich in fresh fruits, vegetables, and whole grains.
- Reduce your intake of red meat, sugary drinks, and processed foods.
Take-Home Message
- Pancreatic cancer is a silent disease that does not show any symptoms in the early stages.
- Watch for symptoms such as yellowing of the skin and eyes (jaundice), persistent pain in the stomach or back, unexplained weight loss, and new onset of diabetes.
- Smoking is a major risk factor for this cancer, so it is very important to avoid it.
- This disease can only be completely cured if it is detected at an early stage and the tumor is completely removed through surgery.
- If you or someone in your family has the above symptoms or risk factors, do not be afraid or delay in seeing a doctor for advice.
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