Pancreatic cancer
Pancreas is an organ of the human body, which is located in the abdomen behind the stomach. It is about 15 cm long and shaped like a chunky pear. It consists of four sections, the head, neck, body and tail. Inside and along the organ passes the pancreatic pore, through which the pancreatic fluid (exocrine fate) is excreted in the intestine. This liquid consists of enzymes that contribute to the absorption of nutrients from the small intestine. The pancreas produces hormones (endocrine fate) important to the human body, mainly insulin and glycagen, which play an important role in regulating sugar.
In Europe, pancreatic cancer is the seventh most common cancer, with an increasing trend. The frequency of new diagnosed cases increases with age, and the majority of cases are diagnosed over the age of 65, while infecting both leaves equally. It's the fifth cause of cancer death. Over 80% of pancreatic cancers occur in the exocrine fate (adenocarcinoma is the most common). 75% of these topographically are found on the head and neck of the organ.
Risk factors
Today, it's not clear why pancreatic cancer develops. Most cases of pancreatic cancer (90%) considered not to be related to any risk factor. However, some risk factors have been identified, but this does not mean that everyone who has them will develop pancreatic cancer.
The most common risk factors for pancreatic cancer are:
- genes,
- smoking,
- age,
- obesity and
- chronic pancreatitis.
There is an association between pancreatic cancer and diabetes mellitus, but diabetes is more likely, in some cases, to be an early manifestation of pancreatic cancer rather than a predisposing factor. It is suspected that alcoholism and high consumption of red and processed meat are combined with an increased risk of developing pancreatic cancer, but the evidence is not strong.
Symptoms
Pancreatic cancer usually remains asymptomatic for some time or the first symptoms are mild and not specific misleading/delaying diagnosis. Thus, early diagnosis of pancreatic cancer is difficult and unusual, which is why it has been named by many silent disease, as it does not cause early symptoms.
The main symptoms are:
- jaundice
- anorexia
- fast saturation with the start of eating
- difficulty digesting food
- bloating of the abdomen
- nausea or vomiting
- unexplained weight loss
- unexplained fatigue
- abdominal pain
- pain in the middle of the back
- pain in the lower back
- faeces floating in the water in the basin like fat
- depression
- onset of diabetes with weight gain-related
Diagnosis
Diagnosis of pancreatic cancer is based on the following tests:
1. Clinical examination
2. Imaging control: Abdominal ultrasound is usually the initial examination when pancreatic cancer is suspected. Endoscopic ultrasound (EUS), polytomic CT using contrast (MD-CT) and MRI are used for further assessment. Holangi – Pancreatic Endoscopic Palindrome (ERCP) is an examination in which an endoscope is used to reach the upper part of the digestive tract, up to the first part of the small intestine. Its purpose is to lift the blockage of the bile duct from the pancreatic tumor. However, in a preoperative period, ERCP and stent placement in the bile ducts should only be performed if surgery cannot be performed rapidly.
3. Laboratory tests: CA 19.9 is a carbohydrate produced by pancreatic cancer cells, found in the blood and can be measured from a blood sample. CA 19.9 levels in the blood are not very useful for diagnosis but are often as a reference point for checking response to treatment and monitoring.
4. Histopathological examination: It is the laboratory examination of tumor cells taken from a sample of the tumor (biopsy). This examination is carried out by a pathologist who will confirm the diagnosis of pancreatic cancer and give more information about the characteristics of the tumor. It is mandatory in cases where the tumor cannot be surgically removed or when other treatment is planned before surgery.
Treatment
The treatment options for pancreatic cancer patients are:
In some cases a combination of the above treatment options is needed. The decision to choose treatment is individualized and depends mainly on the location of the tumor in the pancreas, the spread of the disease, the age and general physical condition of the patient.
Nowadays, pancreatic cancer can be cured, if and when it is found at an early stage (i.e. before it spreads). Only with surgery can a tumor in the pancreas be completely excluded. The other therapeutic approaches for patients who cannot be operated on are aimed at improving the quality of life and increasing survival.
It is a fact that a team of doctors of various specialties is required in order to design the treatment plan for each patient. The oncology boards in the specialized centers where decisions are made to plan a treatment consist of Pathologists Oncologists, Oncologists Surgeons, Gastroenterologists, Radiologists and Pathologists.
The harmonious cooperation of the patient with his physician is fundamental throughout the duration and stages of treatment.
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