Pancreatic Cancer: Causes, Symptoms, Treatments

Pancreatic Cancer: Causes, Symptoms, Treatments

What is pancreatic cancer?

Pancreatic cancer originates in pancreatic cells. The cancerous (malignant) tumor is a group of cancer cells that can invade and destroy nearby tissue. It can also spread (metastasize) to other parts of the body.

Pancreatic cells sometimes undergo changes that make their growth pattern or behavior abnormal. These changes can lead to the formation of non-cancerous (benign) tumors, such as pancreatic pseudo cyst and serous cystic tumor (TKS).

Changes in pancreatic cells can also cause precancerous conditions. This means that the abnormal cells are not yet cancerous, but that they risk becoming so if they are not treated. The most common precancerous conditions of the pancreas are mucinous cystic tumor (TKM), intraductal papillary mucinous tumor (TIPM), and solid and pseudo papillary tumor.

But in some cases, changes that affect pancreatic cells can cause cancer. Most of the time, pancreatic cancer originates in the cells of the pancreatic duct. This type of cancer is called ductal adenocarcinoma of the pancreas. About 95% of all pancreatic cancers are ductal adenocarcinomas.

There are also rare types of pancreatic cancer such as adenosquamous carcinoma.

Another rare type of tumor can originate in the endocrine cells of the pancreas. It is a pancreatic neuroendocrine tumor (TNEp). These tumors are classified as a precancerous tumor or cancerous tumor, known as pancreatic neuroendocrine carcinoma, based on the differences between these cells and normal cells (differentiation) and the rate at which they develop (grade). Learn more about pancreatic neuroendocrine tumors (TNEp).

The pancreas is a pear-shaped flat gland located behind the stomach. It is part of the digestive system. The pancreas is also part of the endocrine system. The endocrine system is a group of glands and cells that make and release hormones into the blood that control many functions such as growth, reproduction, sleep, hunger, and metabolism.

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The pancreas is about 15 cm (6 inches) long. Its widest segment is called head. Its narrowest part is called tail. The central section is called body.

The pancreas has a series of small tubes that open into the pancreatic duct. The pancreatic duct joins the common bile duct to pour into the duodenum. The duodenum is the first segment of the small intestine that receives partially digested food from the stomach, which absorbs nutrients and circulates digested food to the jejunum. The duodenum also receives bile (a greenish-yellow liquid that helps digest fats) from the liver and gallbladder.

The pancreas is made of exocrine cells and endocrine cells. These cells have different functions.

Exocrine cells

Most pancreatic cells are exocrine. They make and release the pancreatic juice. This juice circulates in the pancreatic duct to the duodenum. Enzymes in pancreatic juice help digest fats, carbohydrates and proteins in foods.

Endocrine cells

A small number of pancreatic cells are endocrine. They are grouped in clusters called islets, or islets of Langerhans. These islets make and release insulin and glucagon into the blood. These hormones help control the level of sugar, or glucose, in the blood.

Insulin reduces the amount of sugar in the blood when the sugar level is high. It encourages the liver, muscles and fatty tissues to absorb and store excess sugar.

Glucagon increases the amount of sugar in the blood when the sugar level is low. It causes the liver and other body tissues to release sugar stored in the blood.

Causes of Pancreatic Cancer

Pancreatic cancer is mainly caused by an abnormal multiplication of pancreatic cells.

There are risk factors for cancer of exocrine cells:

the tobacco;

the history of chronic pancreatitis (inflammation of the pancreas due to alcohol, certain tropical diseases, sometimes cystic fibrosis ...);

a genetic component.

Proven risk factors

Tobacco

Sufficient evidence of carcinogenicity in humans (IARC group 1) has been found between smoking and pancreatic cancer (IARC, 2009). Tobacco increases the risk of pancreatic cancer by 3 times and is responsible for 21% of all deaths (Lynch, 2009). The risk of pancreatic cancer increases with tobacco consumption: 2% for one smoked cigarette per day and 62% for 20 smoked cigarettes per day. The duration of smoking also increases the risk, 1% per year of smoking and 16% after 10 years of consumption (Vrieling, 2010). A recent case-control study from the EPIC cohort shows that plasma levels of cotinine, used as a biomarker of tobacco exposure, are found in high concentrations in patients with pancreatic cancer (Leenders, 2012).

Risk factors discussed

Other risk factors are suspected to be related to the risk of pancreatic cancer, but the available scientific data are insufficient to conclude. These are nutritional and professional factors.

Nutritional factors

Alcohol

An excessive and regular consumption of alcohol would increase the risk of pancreatic cancer by promoting the development of chronic local inflammation (pancreatitis), but the results are currently controversial (Go, 2005, Boffetta, 2006).

Obesity and physical activity

Overweight is associated with an increased risk of pancreatic cancer.

For an increase in BMI (Body Mass Index) of 5 kg / m², the increased risk of pancreatic cancer is estimated at about 14% (RR Men = 1.13, 95% CI (1.04, 22), female RR = 1.10-95% CI (1.04-1.16)). While the increased risk associated with overweight and obesity is considered convincing for pancreatic cancer, evidence for an association with a physical exercise deficit is limited.

Red meat

Numerous studies have examined the link between pancreatic cancer and red meat consumption. The results are contradictory and studies are not unanimous on the existence of a link with a diet rich in red meat.

Food supplemented with folate

The role of folates in DNA synthesis and repair is demonstrated. A recent meta-analysis based on 6 cohort studies and 4 case-control studies supports the hypothesis that dietary folate intake may play a protective role in the development of pancreatic cancer.

Coffee

A relationship with coffee consumption, formerly debated, is considered unlikely in the current state of knowledge.

Diabetes

At the time of diagnosis of pancreatic cancer, diabetes is present in 40 to 60% of patients. Researchers therefore wonder whether there is a link between the two diseases, and whether diabetes is a cause or consequence of pancreatic cancer. Currently, there is insufficient evidence to conclude, but diabetes is a risk factor for pancreatic cancer.

Professional factors

X-rays and g radiation

Studies have shown a positive association between exposure to x-rays and radiation and pancreatic cancer (Preston, 2007). But no significant indication of a dose-response relationship allows the establishment of sufficient evidence.

pesticides

Regarding pesticides, contradictory results have been obtained in agricultural populations. Only one study has found positive associations between pesticide exposure and pancreatic cancer. But these results remain controversial and further studies are needed to validate them (Andreotti, 2009).

Other sources of exposure

Various occupational factors are suspected to play a role in the occurrence of exocrine pancreatic cancer, such as solvents, metals such as nickel or chromium, silica

Genetic factors

In rare cases (5%), there are hereditary predispositions to pancreatic cancers (genes still unidentified). Pancreatic cancer can develop in the setting of predispositions to other tumors such as BRCA2 for hereditary breast and ovarian cancer and p16 for familial multiple melanoma.

Pancreatic Cancer

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Symptoms of Pancreatic Cancer

During adenocarcinoma (cancer of the pancreas affecting exocrine cells), the tumor is often already evolved and the symptoms are:

severe pain in the upper abdomen often spreading to the back and relieved by flexing the body forward;

occurrence of diabetes;

weight loss;

jaundice if the cancer is located in the head of the pancreas, often associated with itching;

enlargement of the spleen, esophageal and gastric varices responsible for gastrointestinal bleeding if the tumor is located in the body and tail of the pancreas.

The symptoms of insulinoma

In the case of cancer of the endocrine cells, the signs are related to the hormone or substance secreted in excess. During insulinoma, we can find:

very fasting hypo glycaemia leading to headaches;

a confusion;

visual disturbances;

a coma.

During a gastrinoma, the symptoms are:

a gastric ulcer, sometimes revealed by complications (hemorrhage, perforation ...);

diarrhea

The symptoms of vipoma

The vipoma is manifested by:

significant diarrhea;

hot flashes

abdominal pain;

 nausea and / or vomiting;

muscle weakness ...

It is imperative to take care of the patient quickly.

Treatments of Pancreatic Cancer

If you have pancreatic cancer, your healthcare team will develop a treatment plan just for you. It will be based on your health and specific information about cancer. When your healthcare team decides what treatments to offer you for pancreatic cancer, it takes into consideration the size and location of the tumor as well as your overall health.

The stage of the cancer, among others if the tumor is resectable, at the limit of respectability or unrespectable (locally advanced or metastatic), determines which treatments can be proposed.

Pancreatic tumors that are resectable can be removed completely by surgery. Stage 1 or 2 tumors are often resectable. They are surgically treated to remove part or all of the pancreas. It is possible that chemotherapy is given after surgery (adjuvant chemotherapy). If cancer cells are observed in the tissue removed with the tumor during surgery, that is, the surgical margins are positive, then radiotherapy or chemo radiotherapy can be given.

Pancreatic tumors that are at the limit of respectability are treated, if possible, in clinical trials. They could be treated before surgery by chemotherapy and chemo radiotherapy (neoadjuvant treatments).

The locally advanced pancreatic tumors (stage 3) are treated by chemotherapy, radiotherapy or chemo radiotherapy. In some cases, surgery is done to relieve the symptoms of advanced cancer, which is palliative surgery, but it is not used to try to remove the entire tumor.

Metastatic pancreatic tumors (stage 4) are treated with chemotherapy, with or without targeted therapy. You may be offered surgery, radiation therapy or both to relieve symptoms and control pain, which is a palliative treatment.

You may be offered one or more of the following treatments for pancreatic cancer.

Surgery

Depending on the stage, size and location of the tumor, you may experience one of the following types of surgery.

Whipple's operation, also known as pancreatoduodenectomy, is used to remove tumors located in the head of the pancreas or in the opening of the pancreatic duct. The head of the pancreas is removed along with the duodenum (first segment of the small intestine), the gallbladder, part of the common bile duct, the pylorus (the lower section of the stomach that is connected to the duodenum), and the lymph nodes near the head of the pancreas.

A modified Whipple operation, also known as pyloric pancreatoduodenectomy, can be used to remove tumors located in the pancreas head that are not large or bulky and have not expanded to the duodenum or spread to the lymph nodes. lymphatics surrounding the pylorus. This is a modified version of Whipple's intervention in which the pylorus is not removed. Since the modified Whipple operation does not affect the normal functioning of the stomach, the possible nutritional disorders after the Whipple operation are avoided.

Distal pancreatectomy is used to remove tumors from the body or tail of the pancreas. The tail of the pancreas, or the tail and part of the body of the pancreas, and the neighboring lymph nodes are removed. The spleen is removed only if the tumor has spread to the spleen or blood vessels supplying the spleen. Distal pancreatectomy is often not used because cancer that has originated in the body or tail of the pancreas has often spread when diagnosed.

A total pancreatectomy is done, if necessary, to completely remove the tumor. It is very difficult to recover from this surgery, so it is not as often used as the Whipple operation or the modified Whipple operation. Total pancreatectomy removes all the pancreas as well as the duodenum, pylorus, part of the common bile duct, gallbladder, sometimes the spleen and neighboring lymph nodes.

Palliative surgery is used to relieve the symptoms of advanced cancer. Possible types of surgeries are stent placement and surgical derivation. These interventions may help clear blockage in the common bile duct or duodenum.

Chemotherapy

In chemotherapy, anti-cancer drugs (cytotoxic drugs) are used to destroy cancer cells. Some chemotherapeutic agents are administered alone. But it happens more often that we associate several.

The chemotherapeutic agents often used to treat pancreatic cancer include:

gemcitabine (Gemzar)

5-fluorouracil (Adrucil, 5-FU)

nab-paclitaxel (Abraxane)

FOLFIRINOX - folinic acid (leucovorin), irinotecan (Camptosar), oxaliplatin (Eloxatin) and 5-fluorouracil

Radiotherapy

In radiotherapy, high-energy rays or particles, such as X-rays and gamma rays, are used to destroy cancer cells.

Pancreatic cancer is usually treated by external beam radiotherapy. A device emits radiation through the skin to the tumor and some of the surrounding tissue.

chemo radiotherapy

Chemo radiotherapy combines chemotherapy with radiotherapy. Both are given during the same period. Some types of chemotherapy make radiotherapy more effective.

If you cannot or do not want to receive cancer treatment

You may want to consider care that is designed to make you feel better without treating the cancer itself, perhaps because cancer treatments no longer work, are no longer likely to improve your condition, or their side effects are hard to tolerate. Other reasons may explain why you cannot or do not want to receive cancer treatment.

Discuss with members of your care team. They can help you choose care and treatment for advanced cancer.

Followed

Post-treatment follow-up is an important component of caring for people with cancer. You will need regular follow-up visits, especially during the first 2 to 3 years after treatment. These visits allow the care team to monitor your progress and find out how you are recovering from the treatment.

Clinical tests

Some clinical trials on pancreatic cancer are underway in Canada and accept participants. Clinical trials aim to find new ways to prevent, detect and treat cancer. Learn more about clinical trials

Questions to ask about treatment

In order to make the right decisions for you, ask questions about treatment to your healthcare team.

Pancreatic Cancer

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