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Pancreatic Cancer


OVERVIEW OF Pancreatic Cancer :

The cancer cells multiplying in the pancreas constitutes the pancreatic cancer. These cells have their origin from both the neuroendocrine cells and excocrine part of the pancreas.


STRUCTURE of Pancreatic Cancer :

The pancreas is an elongated organ that is located at the back of the belly. It has head, tail and body.

The head is widest part of the pancreas and it is often present nearer the duodenum that is the first part of the small intestine.

The body continues from head.

The tail is located nearer to the spleen which is present in the left side of the abdomen.

Exocrine: the exocrine part of the pancreas secreate digestive enzymes.

Endocrine: this secreate the hormones which are taken to the distant organs. The islet of Langerhans takes part in this.


EPIDEMIOLOGY :

It has very low 5 year survival rate. It ranks seventh cancer which has higher fatality rate.


CAUSES :

Age

Diabetes

Genetic

H.pylori infection

Chronic pancreatitis

Diet

Obesity

Physical inactivity

Intake of caffeine

Alcohol

Infections


PATHOPHYSIOLOGY :

The pancreatic cancer occurs due to the over activation of the oncogenes and inactivation of the tumour suppressor gene.

Deregulation of certain molecules happens such as EGFR, Akt, NF-κB .

Activation of ras oncogene plays an vital role in the development of the pancreatic cancer.

The point mutation and the amplification of  ras genes also produce a considerable effect.

These above process results in the activation of the cyclo oxygenase pathway which might inturn leads to the activation of the prostaglandins. These prostaglandins aids in the cell growth.

Amplification of the Akt2 and MYb  genes results in pancreatic cancer.

Up-regulation of cyclin D1 has been found in pancreatic cancers and over-expression of cyclin D1 is associated with poor prognosis. 


COMMON CLINICAL SIGNS AND SYMPTOMS :

Belly pain

Back pain

Weight loss

Loss of appetite

Nausea


DIAGNOSTIC :

Biopsy:

It is the removal of a small amount of tissue for examination under the microscope. A biopsy is the confirmatory test for pancreatic cancer.

Fine needle aspiration:

In this type of biopsy the physician moves the fine needle  through the abdomen and take the tissue needed for the diagnosis.

Endoscopic biopsy:

In this type of biopsy, the physician uses an endoscope an hollow tube . light emitting structure to down the small intestine and into the pancreas and tissues are obtained.

Biomarker  testing of the tumour:

The colorectal cancer should be tested for problems in mismatch repair proteins called mismatch repair defect.

Blood test:

Patient with the pancreatic  cancer  tends to show low levels of platelets, white blood cells, red blood cells.  This results in the aneamia in patients. Complete blood count might reveal whether the bleeding is occurring or not.

Computed tomography:

A CT scan takes three dimensional pictures of the abnormal tissues from different angles.

Magnetic Resonance Imaging:

A MRI scan uses the combination of the magnetic and radiowave frequency to view the abnormal tissues.

An dye is injected in the vein or the patient is asked to swallow the dye and the results are observed.

Ultrasound:

A sound waves to create the picture of the internal organs to find out if the cancer is spread or not.

Abdominal ultrasound:  with the patient symptoms it can be used to view the pancreas. But it cannot reveal the spread of pancreas.

Endoscopic ultrasound: in this method the doctor uses an ultrasound probe, and with the guidance of endoscope it is passed in to the small intestine and then into the pancreas to view the structures.

Endoscopic retrograde cholangiopancreatography: The physiscian uses the endoscope which is the thin, flexible tube with a tiny camera is placed down the small intestine and through the pancreas. The is mainly used when the doctor wants to view the ampulla of vater where the common bile ducts empties in to the small intestine.

If X rays are taken at this time it might show some blockages in the stomach.

Positron emission tomography (PET) or PET-CT scan.:

A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. However, the amount of radiation in the substance is too low to be harmful. A scanner then detects this substance to produce images of the inside of the body. With the help of the PET scan one can be able to find out the stage of cancer.

Liver function test:

              The bilirubin levels and the level of other digestive enzymes and liver enzymes such as Alanine transaminase, Aspartate transaminase and Alkaline phosphatase should be checked.

Tumour marker:

  • CA 19-9
  • Carcinoembryonic antigen (CEA)
  • Stages:
  • Stage 0:
  • The cancer is not spread but has potential development of the cancer in the future which is termed as carcinoma insitu.
  • Stage 1:
  • The cancer cells are consider to the localized area. This is also called the early stage cancer
  • Stage 2 and Stage 3:
  • It indicates that the cancer cell has spread to the nearby lymphnodes or tissues.


TREATMENT AND PROGNOSIS :

Laproscopy:

During this method, several small holes are made in the abdomen and a tiny camera is passed into the body and the patient is administered with anesthesia during this procedure. During this surgery the surgeon can find out if the cancer has spread to other parts of the abdomen.

Surgery to remove the tumour:

 The following are the surgeries used to remove the tumour.

 Whipple procedure:

This procedure is done only when the tumour is present in the head of the pancreas. In this surgery the head of the pancreas along with part of the small intestine called the duodenum as well as the bile duct and the stomach. After these surgery the physician connects the bile system with the digestive system.

Distal Pancreatectomy:

This surgery is mainly indicated if the cancer is present in the tail of the pancreas. During this surgery the surgeon might remove the tail, body and the spleen.

Total Pancreatectomy:

When the cancer is located at the multiple sites in the pancreas it might results in the total pancreatectomy.

During this procedure an entire pancreas, a part of the small  intestine that is the duodenum, a common bile duct, the gall bladder and the spleen are removed.

Chemotherapy:

 chemotherapy is after the sugery or before the surgery to shrink the cancer cells. A chemotherapy is nothing but the delivery of drug intravenously

Radiation therapy:

It uses powerful x rays or emission of protons to destroy the cells. The radiation therapy also aids  in shrinkage of the cells and also relief the symptoms caused by the cancer.

Immunotherapy

it is a drug treatment that uses your immune system to fight cancer. Your body's disease-fighting immune system may not attack your cancer because the cancer cells produce proteins that blind the immune system cells from recognizing the cancer cells. This immunotherapy boos those cells and helps the body to fight against it.

    • Targeted therapy: This treatment uses drugs that are focused on a specific features of pancreatic causing cancer cells such as the specific genes, proteins and tissue environment which favours the cancer growth. Targeted therapies work by blocking the ability of pancreatic cancer cells to multiply and divide, cutting off the blood supply needed for the cells to live, or killing the cells directly. Targeted therapy is less likely to harm normal cells.
  • Drugs: Olaparib, Erlotinib

Palliative therapy:

 During this therapy the patient is given the moral support and mainly this therapy encourages to deteriorate the symptoms in the patients.

  Since digestive enzymes are dysfunctioned adjuvant support of these enzymes are given orally.


PROGNOSIS :

The 5 year survival rate :

 Stage 0,1,2 is 34%

Stage 3 – 12%

Stage 4- 3%


PREVENTION :

Avoid alcohol consumption

Check the blood sugar regularly

Follow the healthy diet

Be physicaly active

Don’t neglect the initial symptoms and have the proper treatment

 


Medicines used in the Treatment :

  • Cisplatin
  • Paclitaxel
  • Capecitabine
  • Fluorouracil (5-FU)
  • Irinotecan
  • Leucovorin
  • Nab-paclitaxel
  • Nanoliposomal irinotecan
  • Oxaliplatin
  • Gemcitabin


REFERENCE :

https://www.cancer.org/cancer/pancreatic-cancer/about/what-is.html

https://www.cancer.org/cancer/pancreatic-cancer/detection-diagnosis-staging/how-diagnosed.html

https://www.cancer.org/cancer/pancreatic-cancer/detection-diagnosis-staging/survival-rates.html

https://www.medicalnewstoday.com/articles/323423

https://www.cancer.gov/types/pancreatic/patient/pancreatic-treatment-pdq