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Pancreatic cancer is cancer that occurs in the pancreas. Cancer is defined as cell growth and division that has gotten out of control. Normal healthy cells commit suicide if they malfunction so that the damaged or unhealthy cell does not adversely affect normal cells. Cancer cells, in contrast, do not commit suicide and continue to grow. Ultimately the cancer cells form tumors, which are collections of cancerous cells. These tumors damage the body by interfering with the functioning of healthy cells and consuming nutrients that would normally go to the healthy cells. Since cancerous cells do not generally perform the same necessary functions as healthy cells, they are useless to the body. As a result, the body has numerous natural defenses against cancer, and small amounts of cancerous cells occur routinely.
The disease referred to as cancer in the medical community arises when the body has lost control of the growth of the cancerous cells, and the cells multiply to the point that they become harmful. There are two essential types of cancer. The less harmful type of cancer is characterized by a relatively small tumor and does not continue to grow past a certain point. These tumors are considered benign.
Benign tumors may or may not require treatment and are usually monitored to see if they continue to grow or change. The more harmful type of cancer occurs when the cancerous cells begin to spread beyond the pancreas to infect other bodily organs. For example, it is common for pancreatic cancer to spread first to other digestive system organs such as the small intestine, gall bladder, and stomach. Cancer may also spread through the lymph nodes or bloodstream and can potentially infect any part of the body with cancer. When cancer spreads, it is considered malignant.
Malignant cancers are especially dangerous and become progressively more difficult to treat as more and more body systems are infected. Cancer is usually named for the first part of the body infected, so any cancer that begins in the pancreas may be considered pancreatic cancer even if it has spread to other organs.
Classifications of Pancreatic Cancer
Pancreatic cancer has several classifications depending on the type of pancreas cells that are affected. There are essentially two types of pancreas cells, the exocrine and endocrine cells. Cancer is by far more common in the exocrine cells at the head of the pancreas. About 70-80 percent of all pancreatic cancers infect these cells near where the pancreas connects to the small intestine.
The much rarer type of cancer occurs in the endocrine cells that are spread throughout the pancreas. These cells are responsible for joining the nervous and endocrine systems, and they can be found throughout the body, including in the pancreas. Since these cells are responsible for many of the body’s hormones and blood secretions, it is often easier to detect endocrine cancers, and they may create more noticeable symptoms early on.
Giovanni Battista Morgagni is noted for having first discovered pancreatic cancer in the 18th century. During this period, however, cancer was not a clearly understood disease, and many prominent physicians of the day questioned its very existence. The identification of pancreatic cancer at that time was further complicated by its close relationship with pancreatitis, which was better understood. Therefore, most cases of pancreatic cancer at this time were likely diagnosed as pancreatitis.
It was not until the 20th century that pancreatic cancer, especially the version located at the head of the pancreas, was a firmly established diagnosis. Early treatment of pancreatic cancer usually involves completely removing large parts of the pancreas and small intestine. It was found that a patient could survive after this procedure, but it was in general quite dangerous.
Even if they survived the surgery, many patients would die within a few years from complications arising from the missing organs. As late as the 1970s, there was still a 25 percent death rate from pancreatic cancer treatment involving surgery. Modern medical technology greatly enhanced detection and accurate treatment for pancreatic cancer. Death rates from surgery have dropped to around 4 percent using modern techniques that were pioneered by the use of imaging technology.
Surgeries today are much more precise at targeting the cancerous cells and may not necessitate the removal of large amounts of healthy organ tissue.
Many risk factors that apply to all cancers will also apply to pancreatic cancer. It is worth noting upfront that pancreatic cancer has a relatively low correlation with known risk facts. This means that avoiding the risk factors does not ensure that cancer will not develop. Many risk factors for pancreatic cancer are within a person’s control, but some are not.
One of the strongest risk factors associated with pancreatic cancer is smoking. Smoking is observed in 20-30 percent of all pancreatic cancer cases. This risk includes smokeless tobacco as well. Since pancreatic cancer primarily involves the digestive system, health is a strong risk factor. This includes diet and obesity problems.
Diets that are low in fruits and vegetables and higher in red meat strongly correlate with the development of pancreatic cancer and other cancers. Obesity and lack of exercise is also strong risk factor. Risk factors that are not within a person’s control primarily include genetics and age. Some people seem to have a genetic predisposition to certain cancers. This may be because cancer is strongly associated with DNA. It is usually an error in the DNA sequence, such as damage or a mutation, that causes the cell malfunction leading to cancer. Those with a family history of cancers to the pancreas, stomach, liver, or intestine may be especially at risk for developing pancreatic cancer. In addition, as the body ages, its ability to properly replicate DNA naturally decreases.
Body cells and DNA strands simply wear out and are more prone to breakage or malfunction. While age does not in any way guarantee that cancer will develop, the likelihood of developing any cancer, including pancreatic cancer, increases remarkably after the age of 60. It is even more important to control the other risk factors for cancer at this age. The weakening of a body’s immune system due to age may also contribute to cancer because the body will be less able to deal with cancerous cells that do occur. Finally, certain medical risk factors are associated with pancreatic cancer. Certain diseases such as cirrhosis of the liver or infection with helicobacter pylori have been connected with cancer.
Diabetes, pancreatitis, and periodontal disease have also shown a correlation. This is likely due to these diseases’ close association with the digestive system. The more strain is put on the digestive organs due to poor diet or infection, the more likely it is that cancer will develop.
Unfortunately, there is no effective or reliable screening method that is currently available to pancreatic cancer patients. This is especially troubling because the disease is difficult to detect through symptoms alone. Johns Hopkins University is leading current research to develop a more effective and reliable screening method for this cancer. The University has one lab fully dedicated to developing an effective screening test and acknowledges the incredible need the medical community has for an effective and reliable test.
Endoscopic ultrasound is currently one of the most effective and reliable options, but it is not an expedient or inexpensive procedure, and it is often performed to help with diagnosis rather than actual screening. According to the University, a reliable screening method would need to be inexpensive, safe, and highly accurate. In addition, there are tumor markers available that will track the progression of cancer and may eventually be usable as a screening tool.
Currently, the markers are not accurate enough to be considered a screening tool because they correctly identify cancer only about 80 percent of the time. Some researchers, however, are still pursuing various tumor markers as a means of screening for cancer.
Short of actual and effective screening procedures, most physicians will use the greatly enhanced modern understanding of genetic risk factors associated with pancreatic cancer. Specific gene abnormalities and cellular changes in the pancreas are general precursors to cancer development. If a person has many risk factors for pancreatic cancer, then they may undergo more thorough imaging tests to help identify cancer as early as possible. Medical researchers and oncologists all agree that early detection is especially critical for pancreatic cancer.
The best screening tool will be able to identify cancer in a stage so early that imaging devices cannot detect it. By the time the cancer is detectable by imaging, it is often already at risk of spreading to other organs.
Pancreatic cancer is known as a silent killer because symptoms of the disease are often not apparent until cancer has spread or reached a very late stage. Cancer becomes progressively more difficult to treat as it grows and spreads, and many stage 4 cancers that have spread throughout the body are essentially not treatable. Significant and inexplicable weight loss and digestive problems are among the first signs of pancreatic cancer. This can include a loss of appetite, vomiting, and nausea. In addition, the stool may become gray because food is not being digested properly.
The pancreas releases many of the critical enzymes that digest food. If its function is disrupted by cancer, then it will not release these enzymes, and food will not be adequately digested. In a broad sense, a person with advanced pancreatic cancer is starving no matter how much food they eat. Pancreatic tumors often interfere with the functioning of the bile duct. This is a tube leading from the liver to the small intestine. It delivers bile, which is produced by the liver to aid in the digestion of fat.
When cancer interferes with the bile duct and liver function, there may be a distinct yellowing of the skin called jaundice. It may also result in excessive amounts of fat being found in the stool because the fat cannot be properly digested without bile.
Finally, if pancreatic tumors have progressed to an advanced stage and have grown large enough to press on the nerves surrounding the pancreas and stomach, pain in the upper abdomen may result. One of the greatest problems with pancreatic cancer symptoms is that they may be caused by a wide variety of much more common diseases. This means that the misdiagnosis of pancreatic cancer is relatively common. Furthermore, the risk of misdiagnosis is increased due to the lack of an effective screening method.
Certain symptoms for pancreatic cancer may vary depending on the type of pancreatic cancer present. If endocrine cells are affected, hormone imbalance is the most common symptom. The pancreas may release far more insulin or other hormones than it should. This is because cancerous endocrine cells typically continue to produce hormones, but unlike healthy cells, they do not stop producing the hormone when the body signals them to do so.
As cancer progresses, more cancerous cells produce hormones, leading to an even stronger imbalance. Insulin and hormone imbalance may cause dizziness, muscle spasms, chills, and diarrhea. The symptoms themselves may be especially noticeable or harmful if the person already has diabetes or a hormone imbalance. Advanced stage cancers that have spread to other body systems and organs may also produce widespread non-specific symptoms. As tumors spread and grow in other organs and organ systems, those parts of the body will also produce symptoms unique to them. These symptoms will likely be completed differently than those associated with the pancreas or digestive system.
While it is hoped that cancer will be discovered long before it reaches such an advanced stage, a person may begin to suffer widespread symptoms as cancer spreads through the body.
There are several ways that a physician may approach the diagnosis of pancreatic cancer. This approach is usually broad and thorough because the symptoms are common to many diseases. The doctor will use a combination of medical history and the presence of certain signaling diseases as a sort of preliminary diagnosis. A person with a combined history of cancer, various symptoms, and the onset of certain diseases such as diabetes, Trousseau’s sign, or recent pancreatitis is much more likely to receive a positive preliminary diagnosis.
From there, the physician will conduct more definitive tests to diagnose cancer’s presence accurately. Again, modern medical imaging is front and center here. It may include ultrasounds, CT scans, MRIs, or x-rays of the abdominal area.
These images will be able to detect the presence of tumors if they have grown to a moderate size. It is worth noting that these diagnostics are not effective at the earliest stages of cancer before the tumors have grown. However, preliminary symptoms are also extremely unlikely to be noticed at such an early stage.
Since advanced-stage cancers often spread, a doctor may order a PET scan be performed to determine if cancer has spread beyond the pancreas and immediate area of the digestive system. If there is some question about the presence of cancer or the results of the scans, a physician may go one step further to diagnose the presence of cancerous cells definitely. The most definitive cancer test involves taking a sample of the tissue and looking for cancerous cells under the microscope. A doctor will most often use a fine needle aspiration biopsy to obtain the tissue sample. This minimally invasive procedure involves inserting a small needle into the pancreas to collect cells.
Stages of Pancreatic Cancer
The stage of cancer is a measure of the disease’s severity. This is determined by the overall growth and spread of cancer throughout the body. Therefore, determining cancer’s stage is important for deciding on treatments and giving the patient an overall condition prognosis. Most pancreatic cancer stages are reported using the Tumor Node Metastasis system or TNM.
Each of the three letters is then given a number indicating the severity of that portion of the diagnosis, ranging from 0 to 4. The Tumor part of the system indicates the size of the primary tumor located on the pancreas itself.
The Node part of the system is a measure of how much cancer has spread to nearby lymph nodes. This indicates cancer has reached a more severe stage and is beginning to spread beyond the pancreas.
The Metastasis part of the system measures how far the tumors have spread to other major organs throughout the body. For example, a rating of T1, N0, M0 indicates that a small tumor has developed on the pancreas but that no cancer is detectable beyond the pancreas.
Cancer may also be said to have a stage of 0 if the detectable tumors can only be spotted on the surface cells of the pancreas and have not yet spread to cells deeper in. A stage of 0 is often easier to cure because most or all of the cancerous cells can be surgically removed from the surface of the panacea. A physician may also use a simpler staging method that only identifies how easily the tumor could be removed surgically. Resectable cancers represent those that can be easily removed with surgery. This is the preferred stage because it means that surgery is likely to provide a viable cure for cancer by removing all cancerous cells.
If cancer has spread to deeper tissues or to areas of the body where surgery is not possible, then the cancer is considered unresectable. Surgery may still be performed on accessible tumors, but cancer will require further treatment.
The final stage is metastatic. This indicates that cancer has spread liberally throughout the body and is infecting many tissues and organs. At this stage, surgery is unlikely to contribute much to recovery and can only be used for symptom relief.
Treatments and Drugs
Treatment methods for pancreatic cancer are similar to those used for other types of cancer. The exact form of treatment used will depend on various factors. They include especially the patient’s overall health condition, cancer stage, the patient’s ability to tolerate certain medications, and the patient’s own wishes. Cancer is notoriously difficult to fully treat, especially in the later stages. Cancer treatments are not easy on the body and often come with numerous, sometimes serious negative side effects. Cancer treatment, however, is subject to serious ongoing research, and less harmful ways are being found to deal with pancreatic cancer and other types of cancers.
Treatment with Surgery
Surgical treatment is a preferred way to deal with pancreatic cancer if possible. The pancreas is relatively easy to operate on so long as the tumors are confined to the surface of the organ. Surgical treatment that is able to completely remove the tumors is the only effective means of curing cancer. Surgery typically involves the removal of the cancerous portion of the pancreas. This could include the removal of the tail or head of the pancreas and the spleen and parts of the small intestines or lymph nodes.
In some cases, the entire pancreas must be removed. How much tissue is removed is largely dependent on the extent to which cancer has spread throughout the local organs? It is possible to live without a pancreas, spleen, portion of the small intestine, or lymph nodes. However, there are likely to be numerous complications, including infections, bleeding, and leakage. Removal of most of the organs, called the Whipple procedure, is also a risky surgery. If most or all of the pancreas is removed, diabetes will likely result because the body will no longer produce insulin.
Unfortunately, surgery is also the least likely to be used effectively because it will only work if done at the earlier stages. For example, most pancreatic cancers are not discovered or diagnosed until reaching a stage where surgery alone is insufficient to remove all the cancerous cells. However, even at the more advanced stages, surgery may still be used as part of a broader treatment plan to remove the most sizable and dangerous tumors, undo blockages to the bile duct or intestines, and provide general relief.
Certain surgeries may also be used to relieve the symptoms of pancreatic cancer, even if cancer itself is not removed. For example, a common procedure involves rerouting the bile duct or small intestine around the tumors, blocking them so that digestive juices may continue to flow unimpeded.
Treatment with Chemotherapy
Certain drugs may be administered to a patient in an attempt to kill the cancerous cells throughout the body. This is commonly referred to as chemotherapy. The drugs involved cause damage to the cancerous cells, forcing them to commit cell suicide or apoptosis. The drugs may also be directly toxic to the cells, killing them.
This is one of the only treatments that are useful against later stages of cancer that have spread throughout the body and are infecting multiple organs or organ systems. The greatest downside to chemotherapy drugs is that they do not target only cancer cells. While healthy cells are more resistant to the effects of the drugs than are cancerous cells, they are not immune.
Death and dysfunction of healthy cells and tissues are common in chemotherapy. This often results in many undesirable side effects, including hair loss, nausea, weakness, and other symptoms. Two specific chemotherapy drugs are often used for pancreatic cancer.
Gemzar is the most common and is delivered intravenously weekly. The second common drug, 5-fluorouracil, is commonly used as an additional treatment to surgery. If most of the cancer is removed surgically, then this drug may be administered to clean up the remaining cancer. As a last resort, chemotherapy may be administered to improve the quality of life if the cancer is deemed incurable. However, due to side effects, some patients in this condition prefer to leave cancer untreated or seek alternative treatments.
Treatment with Radiation
The final form of treatment for pancreatic cancer involves using radiation to kill cancerous cells. Radiotherapy is highly effective at killing cells, but it is more limiting than chemotherapy on the areas that can be treated. Radiation therapy is usually delivered five days a week for five to six weeks. Radiation may be delivered via high-energy gamma rays derived from radium or high-energy x-rays delivered from specialized machinery.
The cancer stage is then reevaluated, and additional treatments may be recommended. Radiation is commonly used in conjunction with chemotherapy, especially if cancer has spread throughout the body. However, since radiation is a targeted procedure, it may not completely remove the cancerous cells. The greatest downsides to radiation treatment are the serious side effects associated with it. Like chemotherapy, radiation almost always causes collateral damage to surrounding tissues and cells. The radiation passes through the targeted organ and irradiates all of the tissues in front of, behind, and around the targeted location. This means that healthy cells in a large area around the treatment site may be damaged or destroyed by the procedure.
Ironically, radiation may cause DNA damage to healthy cells, leading to cancer recurrence in those cells.
Due to these problems, researchers are constantly looking for ways to increase the accuracy of radiation exposure and reduce the possibility that healthy cells are affected.
One promising procedure for pancreatic cancer involves using radioactive bacteria that carry the cell, destroying radiation directly to the cancerous cells. While this procedure is currently still in animal-testing stages, it may provide a way to target cancer cells while leaving healthy cells untouched directly.
Coping and Support
Dealing with pancreatic cancer can be extremely difficult and emotionally, mentally, and physically exhausting. Cancer is essentially a systemic disease, a war the body is fighting with itself. Many cancer experts share that keeping up one’s overall physical and emotional health is just as critical to recovery as chemotherapy or surgery. The human body is constantly fighting against cancer, and the more a person can bolster their own ability to resist cancer, the better chance they have of successful treatment. When battling pancreatic cancer, it is important to think beyond just the medical procedures and treatments that will be required.
Surviving a serious bout with cancer is as much about making necessary lifestyle changes and gathering around the right supports. A patient will need to be able to relax and rest often, and they will likely need a lengthy recovery between rounds of chemotherapy or radiation. Therefore, they will want to maintain a healthy diet as much as possible and will need to eliminate as many sources of stress as they can.
A person dealing with rigorous cancer treatment will likely be unable to work or adequately support themselves, so they may need family and friends to step up both directly and financially. In addition, many cancer patients do not remain at the hospital and will only stay during rounds of treatment. Sometimes they may be treated at specialized cancer centers that provide a complete treatment environment.
Since this is not always possible, families should do their best to support the person when they are at home and allow them to focus on recovery. A cancer patient is also likely to need counseling or some other form of emotional and mental support.
There is no question that pancreatic cancer is a life-threatening illness that is very likely to become terminal if it reaches later stages. The latest stages of this cancer are often unrecoverable, and doctors will only be able to offer treatment for symptoms and pain. Dealing with a terminal illness is something that many late-stage cancer patients may face. It is good for those around them to be prepared mentally for that possibility and have the necessary support in place.
Pancreatic cancer remains one of the most serious types of cancer. Early diagnosis, the correct treatment, and a healthy lifestyle all contribute to preventing this cancer from becoming serious. It is important that cancer not be ignored and that those at greater risk are knowledgeable of the symptoms and diligent in communicating with their doctor. Early detection is often the difference between life and death with this form of cancer.
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