Pancreatic cancer

What is a pancreatic cancer?

Pancreatic cancer arises when cells within the pancreas undergo mutations, leading to uncontrolled multiplication and tumour formation. Situated in the abdomen, between the spine and stomach, the pancreas functions as a gland that produces hormones regulating blood sugar levels and enzymes aiding digestion.

Primarily originating in the pancreatic ducts, notably the central pancreatic duct (known as the duct of Wirsung), this cancerous growth often goes undetected in its early stages, evading detection on imaging tests. Consequently, diagnosis frequently occurs after the cancer has already metastasized. Moreover, pancreatic cancer exhibits resistance to many conventional cancer treatments, posing significant challenges in its management.

What are the types of pancreatic cancer?

Pancreatic cancer manifests in various types, primarily distinguished by whether they affect the exocrine or endocrine glands.

Exocrine Pancreatic Cancer:

Exocrine glands produce enzymes vital for digestion, including fats, proteins, and carbohydrates, with most of the pancreas comprising exocrine tissue. Tumours impacting exocrine function encompass:

1. Adenocarcinomas

2. Acinar cell carcinomas

3. Cystic tumours

The majority of pancreatic tumours disrupt exocrine function.

2. Endocrine Pancreatic Cancer:

Endocrine glands, represented by small cell clusters known as the islets of Langerhans, release hormones like insulin and glucagon into the bloodstream, crucial for regulating blood sugar levels. Dysfunction in these glands can precipitate diabetes. The vocabulary of endocrine pancreatic cancer hinges on the type of hormone-producing cell where the tumour originates. Examples include:

1. Insulinomas (affecting insulin production)

2. Glucagonomas (affecting glucagon production)

3. Gastronomes (affecting gastrin production)

4. Somatostatinomas (affecting somatostatin production)

Accurate identification of the specific cancer type enables doctors to tailor the most appropriate treatment regimen for patients.

What are the causes of Pancreatic cancer?

Scientists are still trying to figure out what exactly causes pancreatic cancer, but they have found some things that may make it more likely to happen. Some of these risk factors are smoking and having a family history of pancreatic cancer.

Pancreatic cancer starts when genes in pancreatic cells get changed. Mutations in DNA mess up the normal directions that tell cells how to grow and copy themselves. These messages tell normal cells how to grow and die in a controlled way. However, changes in cancerous cells cause them to multiply out of control and live longer, making too many cells.

These abnormal cells may join together to form a lump called a tumour, which can invade and harm good tissue nearby. Cancerous cells can spread to other body parts after breaking away from the main growth.

Pancreatic cancer usually starts in the ductal cells that line the pancreas. This is called pancreatic ductal adenocarcinoma or pancreatic exocrine cancer. Neuroendocrine or hormone-producing cells can sometimes form tumours. These are called pancreatic neuroendocrine tumours or pancreatic endocrine cancer.

What are the risk factors of pancreatic cancer?

Factors that could elevate the likelihood of pancreatic cancer comprise:

• Tobacco use.

• Presence of type 2 diabetes.

• Persistent pancreas inflammation, known as pancreatitis.

• Familial predisposition to genetic alterations that heighten cancer susceptibility, such as mutations in the BRCA2 gene, Lynch syndrome, and familial atypical multiple mole melanoma (FAMMM) syndrome.

• Family history of pancreatic cancer.

• Obesity.

• Advanced age, with most pancreatic cancer cases occurring in individuals aged 65 and older.

• Excessive alcohol consumption.

What are the symptoms of pancreatic cancer?

Regrettably, early indicators of pancreatic cancer are elusive. Typically, symptoms manifest once the tumour begins affecting other organs within the digestive system.

Potential symptoms of pancreatic cancer encompass:

• Jaundice (yellowing of the skin).

• Darkened urine.

• Light-coloured stool.

• Upper abdominal discomfort.

• Pain in the middle back.

• Fatigue.

• Pruritus (itchy skin).

• Nausea and vomiting.

• Gas or bloating.

• Loss of appetite.

• Formation of blood clots.

• Unexplained weight loss.

• Onset of diabetes.

If you've recently acquired diabetes or pancreatitis, a painful inflammation of the pancreas, your healthcare provider might suspect pancreatic cancer.

Symptoms of pancreatic neuroendocrine cancer may diverge from those of conventional pancreatic cancer, such as jaundice or weight loss. They can vary but might include diarrhoea and anaemia.

What are the complications of pancreatic cancer?

As pancreatic cancer advances, it can lead to various complications, including:

1. Weight loss: Individuals with pancreatic cancer may experience weight loss as the cancer consumes more of the body's energy. Nausea and vomiting induced by cancer treatments or pressure from the tumour on the stomach can hinder eating. Additionally, insufficient production of digestive juices by the pancreas may impede nutrient absorption from food.

2. Jaundice: Blockage of the liver's bile duct by pancreatic cancer can result in jaundice, characterized by yellowing of the skin and the whites of the eyes. Jaundice may also cause darkened urine and pale stools. Often, jaundice occurs independently of abdominal pain.

3. Pain: The growth of a tumour may exert pressure on nerves in the abdomen, resulting in increasingly severe pain. Pain management medications can alleviate discomfort. Radiation and chemotherapy may also help slow tumour progression and relieve pain.

4. Bowel obstruction: Pancreatic cancer may infringe upon or compress the duodenum, the initial segment of the small intestine, leading to a blockage in the passage of digested food from the stomach to the intestines.

When to see a doctor

Schedule a consultation with a healthcare provider if you experience concerning symptoms.