Pancreatic cancer, a silent killer affects several million people worldwide where most cases end in fatalities. The most challenging problem facing the treatment of pancreatic cancer is its diagnosis only in the later stages of the disease. The early stages of the disease do not cause any serious symptoms thereby causing patients to ignore the probability of their symptoms. Pancreatic cancer thus needs to be assessed and diagnosed early for timely treatment.

Pancreatic Cancer Prevalence

Pancreatic cancer is the 12th most common cancer and the fourth largest cancer killer in the world after lung, colorectal, and prostate cancer.  According to statistics, in 2020, an estimated 95,773 people were diagnosed with pancreatic cancer where 90% of pancreatic cancers are exocrine adenocarcinoma. The negative aspect of pancreatic cancer is the lack of success in diagnosing the disease in early stages where surgery could be a lifesaver for patients. It isn’t easy to diagnose pancreatic cancer simply because there are no specific screening tests that are reliable enough to find out the disease in its early stages.

People with the disease don’t even experience identifiable symptoms in the early stages. Up to 10 percent of patients with an early diagnosis can become disease-free after treatment. For patients who are diagnosed before the tumor grows much or spreads, the average pancreatic cancer survival rate is 3 to 3.5 years. For the 52% of people who are diagnosed after the cancer has spread to a distant part of the body, the 5-year relative survival rate is 3%. While pancreas cancer is a highly prevalent disease in the US, in India it is comparatively low affecting just 0.5-2.4 per 100,000 men and 0.2-1.8 per 100,000 women in most parts of the country. It is important to note that statistics on the survival rates for people with pancreatic cancer are only an estimate. Whether pancreatic cancer will shorten or not the life of someone will depend on their  medical condition.

The Origin of Pancreatic Cancer

Pancreas cancer occurs when pancreatic cells mutate and multiply causing tumors. The pancreas is a gland in your abdomen located between your stomach and spine. The pancreas main role is hormone production namely insulin to regulate sugar in the body and aiding in digestion through enzyme regulation. Most cancers will begin in the pancreas ducts or the duct of Wirsun which connects the pancreas to the common bile duct.

The origin of pancreatic cancer  lies in the anatomy of the pancreas itself. Digestion, hormones like secretin and cholecystokinin, within the small intestine, stimulate exocrine cells within the pancreas thereby producing carbonate ions and digestive enzymes. These pass through the pancreas to the duodenum for digestion of lipids and proteins.  Contributing negative factors may cause these exocrine cells cause possible tumors thus obstructing the functioning of the pancreas to produce enzymes. The problem with such a scenario is that these exocrine tumors do not secrete hormones and do not display symptoms making it hard for cancer diagnosis. Moreover, pancreatic cancer is so notorious, it is drug resistant making it extremely difficult to treat the disease. Only management medication is usually administered to improve the quality of life.

There Are Two Types of Pancreatic Cancer:

• Exocrine tumors: 90% of all pancreatic tumors are exocrine tumors. The most common type of pancreatic cancer is adenocarcinoma, which begins in the cells that line your organs.
• Neuroendocrine tumors: Less than 10% of pancreatic tumors are neuroendocrine tumors also called Islet cell carcinoma. The extent of pancreatic cancer stages is usually divided depending on extent of affliction

The Various Stages of Pancreatic Cancer

Primary stage and stage 1 and 2

Most pancreatic cancers usually obstruct the drainage of bile produced by the liver thus causing a discoloration of the skin to a yellow shade. The primary pancreatic cancer stages commence with abnormal cells found in the pancreatic lining, spreading to other adjacent tissue. During the first and second stages, cancerous cells developed into tumors averaging 2 centimeters or larger. In the second stage, the cancer usually spreads to connecting tissue, organs and then possibly to lymph nodes. In some cases, the lymph nodes may not be affected.

Stages 3 and 4

The cancer will have metastasized and spread to blood vessels near the pancreas and the lymph nodes and tissues present in the area. This progresses to tumors of varied sizes, soon affecting nearby organs like the liver, peritoneum and even the lungs.

Summary of Progression of Pancreatic Cancer

• Stage 0: This stage is also known as carcinoma in situ or pancreatic intraepithelial neoplasia (PanIN). At this stage, abnormal cells are found only in the top layers of pancreatic duct cells and have not spread to nearby tissues or organs.
• Stage I: At this stage, the cancer is confined to the pancreas and has not spread beyond the organ. It may be further divided into IA and IB based on the size of the tumor.
• Stage II: In this stage, the cancer may have spread beyond the pancreas to nearby tissues or organs, such as the bile ducts, but has not yet metastasized to distant sites. It may be further divided into IIA and IIB based on the extent of local spread.
• Stage III: At this stage, the cancer has typically spread to nearby lymph nodes and may involve major blood vessels near the pancreas. It has not spread to distant sites.
• Stage IV: This is the most advanced stage of pancreatic cancer, where the cancer has spread to distant organs or tissues, such as the liver, lungs, or peritoneum (the lining of the abdominal cavity).

Symptoms of Pancreatic Cancer

Pancreatic cancer often remains asymptomatic in its early stages, making it difficult to diagnose. However, some subtle signs and symptoms may indicate its presence, including:

Abdominal Pain: Persistent pain in the abdomen, which may radiate to the back, is a common symptom.

Unexplained Weight Loss: Sudden and unexplained weight loss, even without changes in diet or physical activity, could signal pancreatic cancer.

Jaundice: Yellowing of the skin and whites of the eyes due to the buildup of bilirubin can occur when the cancer obstructs the bile duct.

Changes in Stool and Urine Color: Light-colored stools and dark urine may indicate a blockage in the bile duct caused by pancreatic cancer.

Loss of Appetite: A decreased appetite, along with feelings of nausea and vomiting, may develop as the cancer progresses.

Other common Symptoms

• Fatigue
• Itchy skin
• Gas and bloating
• Blood clots

It should be noted that several of these symptoms are also indicative of pancreatitis which is why a careful diagnosis and tests should be carried for such conditions that are treatable. Moreover, as mentioned, there are no identifiable symptoms of pancreatic cancer with some people developing vague symptoms a year before being diagnosed.

Many people report that their first pancreatic cancer symptoms were back pain or stomach pain. These symptoms can come and go at first, but may get worse after meals or when you lie down.

Advanced Symptoms:

As pancreatic cancer advances, symptoms become more pronounced and may include:

• Digestive Issues: Difficulty in digesting fatty foods, diarrhea, or indigestion may occur due to impaired pancreatic function.
• Blood Clotting Abnormalities: Pancreatic cancer can lead to blood clotting abnormalities, resulting in symptoms such as deep vein thrombosis (DVT) or pulmonary embolism.
• Diabetes: New-onset diabetes or worsening of existing Various treatment techniques of pancreatic cancer

Causes of Pancreatic cancer

There is no definite answer to what causes the disease, but the most compelling risk factors likely to cause the issue are:

• Smoking
• Excessive alcohol consumption
• Excessive red meat consumption
• Obesity
• Diabetes, especially Type 2 diabetes.
• Chemical exposure like pesticides and petrochemicals.
• Chronic pancreatitis, a permanent inflammation of your pancreas.
• Hereditary chronic pancreatitis

Diagnosis of Pancreatic Cancer

As mentioned, pancreatic cancer isn’t usually diagnosed in early stages. A suspicion of pancreatic cancer might warrant a combination of pancreatic tests such as:

• CT (computed tomography) scans.
• MRI (magnetic resonance imaging).
• PET (positron emission tomography).
• Endoscopic ultrasound (EUS).
• Pancreas blood test to detect tumor biomarkers like carbohydrate antigen (CA) 19-9 and enzymes lipase (helps digest fats) and amylase (helps digests carbs)
• Staging Laparoscopy to detect the extent of cancer and removal possibility

Treatment

Even though pancreatic cancer has a poor survival rate, complete remission is possible with early detection and treatment. The only way to realistically cure pancreatic cancer is total surgical removal of the cancer. Specific treatment depends on certain factors, including:

• Tumor location
• The stage
• Health condition
• The spread of the cancer

Treatments often included in Pancreatic cancer

Palliative surgery:  Basically, surgery on incurable disease simply to lessen pain, facilitate smoother bodily function and improve the quality of daily life.

Stent replacements:  To facilitate smooth passage of obstructed fluid like bile.

Gemcitabine based chemotherapy: Gemcitabine-based chemotherapy is an approved therapy for treatment-naïve metastatic pancreatic ductal adenocarcinoma (PDAC). Inherent resistance to gemcitabine inevitably leads to cancer progression and shorter survival.

Total pancreatectomy: The whole pancreas is removed or distal pancreatectomy, where only the body and tail of the pancreas is removed along with the spleen. However, when the cancer is too far spread, palliative procedures are the only option for controlling discomfort and pain.

Palliative treatments: To ease pain and discomfort, using nerve blockers and supportive procedures.

How To Prevent Pancreatic Cancer

Pancreatic cancer is a negative scenario because of the organ existing deep within the body. Tumors cannot be detected even by any routine exam.  The above symptoms mentioned are general indicators associated with the disease but by and large there are no specific symptoms of the disease until it has spread to other organs.

Medical experts do not recommend screening those at average risk of pancreatic cancer simply because a screening test is no guarantee that decreases the fatality of pancreatic cancer. It is only a blood test of certain protein indicators called tumor markers in the blood that can indicate a person is suffering from pancreatic cancer by which time the cancer is already in an advanced stage. Sometimes such markers show up even when you may not have pancreatic cancer.

The only way to be safe from pancreatic cancer is to avoid and decrease the influence of the factors contributing to the disease. A healthy lifestyle with adequate exercise, no smoking, a diet rich in fruit and vegetables and limiting the consumption of those items that increases the risk is the best possible way to stay safe from pancreatic cancer.