The pancreas is an organ, located in the back of the abdomen, which has very important functions in the body, and is adjacent to the stomach, duodenum and large intestine, which is about 15 cm long. The pancreas ensures the digestion of the consumed foods and keeping the glucose obtained from these foods at the required levels in the blood. Apart from this, the smallest damage to the pancreas, which has many vital functions, can cause consequences that will affect the whole body.
What is Pancreatic Cancer?
Malignant masses that tend to proliferate in any part of the pancreas are defined as pancreatic cancer. Cancers that occur in this organ spread to all parts of the organ, most commonly to the head. Adenocancer is the most common type of pancreatic cancer. Since it originates from aggressive cells, it can progress rapidly and metastasize to surrounding tissues.
What are the Symptoms of Pancreatic Cancer?
Pancreatic cancer can progress insidiously in its initial stages without any symptoms. However, the most common symptoms of pancreatic cancer, which begin to appear in the later stages, are: weight loss, abdominal pain, jaundice, loss of appetite, nausea-vomiting, weakness, fatigue, diarrhea, indigestion, back pain, glass paste-colored stools, pallor, sudden onset diabetes, depression.
Patients experience rapid weight loss as a result of malnutrition along with indigestion, bloating and loss of appetite. Jaundice is one of the earliest and commonly observed symptoms. It initially appears in the eyes, then turns yellow in the skin, turns into ‘tea-colored urine’ by darkening the urine color, and finally appears as abnormal lightening of the stool color, which is defined as ‘glass paste’. The cause of jaundice is the prevention of the excretion of the bilirubin produced by the liver into the duodenum as a result of the obstruction of the bile duct by pancreatic cancer. The pain is defined as vague abdominal pain at first, in the form of a slight discomfort, later it turns into abdominal pain hitting the back, and is blunt in nature. It is often accompanied by symptoms of indigestion and swelling.
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What are the Causes of Pancreatic Cancer?
Although the cause of the disease is unknown, it is more common in smokers and obese individuals. Smoking is the cause of pancreatic cancer in 30 percent of patients, and pancreatic cancer associated with adult type diabetes is controversial. Having a family history of cancer is also among the causes of pancreatic cancer. The disease is more common in men than women, and the risk of developing this disease increases with age. Worldwide, the average age for pancreatic cancer is 63 for men and 67 for women.
How is Pancreatic Cancer Diagnosed?
Since the disease occurs with insidious symptoms, it is difficult to diagnose, especially in the early stages. It is very important that the patients who apply to the health institution in the early period are examined by the physician and the diagnostic tests required for the diagnosis of the disease are applied.
Ultrasonography: The first examination method to be applied in the suspicion of pancreatic cancer is ultrasonography. The presence of a hard or cystic mass in the pancreas provides information about the size of the mass, its relationship with other surrounding structures, and its proximity to vascular structures.
Laboratory tests: Serum bilirubin, alkaline phosphatase, liver transaminases and values such as CEA, CA19-9 and CA-125 are elevated and bilirubin is positive in the urine.
Computed tomography (CT) and magnetic resonance imaging (MR): When CT is taken orally and intravenously with contrast medication, it gives very important information about pancreatic tumors and has a diagnostic feature of approximately 95 percent or more. MR imaging is also important in the differential diagnosis of the tumor. These two examinations contribute to the correct staging of the tumor and to reach the surgical decision.
Individuals diagnosed with the disease as a result of the tests should be evaluated in detail in terms of pancreatic cancer stages, and the treatment process should be started after the stage is determined.
How is Pancreatic Cancer Treated?
Physical examination, laboratory and radiological examinations reveal the stage of the tumor, its relationship with neighboring organs, especially whether it has spread. The chance of surgical removal is evaluated. Surgery cannot be performed in advanced tumors. Along with chemotherapy, some interventions can be applied to improve the comfort of life by correcting existing jaundice, providing nutritional support, and reducing pain. For this purpose, placing a tube (stent) that provides passage to the biliary tract with endoscopy from the mouth through the stomach, drainage of bile with the help of a catheter inserted through the abdominal skin into the bile ducts inside the liver with the help of a needle, and advanced pain management techniques can be used.
Surgical Treatment: In the examinations, if the tumor is suitable for surgical removal, ‘Whipple surgery’ is performed. In addition, if the tumor is located in the body and tail of the pancreas, relatively easier resection techniques can be applied. Surgical removal of the tumor is the only cure for these patients. In pancreatic head tumors, surgery has become more complicated since it is not possible to surgically remove only the head of the pancreas. In the Whipple surgery, the head of the pancreas, blocked gallbladder, part of the main bile duct, duodenum, part of the stomach and surrounding lymph nodes are removed.
Radiation Therapy: Radiation therapy, also called radiotherapy, is the process of using high-energy rays to kill cancer cells. Radiation therapy only affects cells in the treated area. Radiotherapy is applied alone or in combination with chemotherapy, especially if the location and size of the tumor complicates the surgery or in cases where surgery cannot be performed. It is also possible to use radiotherapy in combination with chemotherapy to shrink the tumor before surgery. In some cases, radiotherapy may be given to prevent recurrences after the operation.
Chemotherapy: In pancreatic cancers, it is possible to apply a drug treatment called chemotherapy, taking into account the general conditions of the patients before or after surgery. Chemotherapy can be used in combination with radiotherapy to shrink the tumor prior to surgery or as a primary treatment in place of surgery. Surgery and radiotherapy are not required in advanced disease. By administering chemotherapy to this group of patients, their quality of life can be significantly improved.
After Treatment
Survival: Anticancer drugs and radiation therapy increase the rate of recovery. However, survival rates are not good after surgeries that leave cancer cells behind or in cases where there is spread to neighboring organs.
Prevention: To prevent pancreatic cancer, tobacco should be avoided, a balanced diet should be exercised, and excess weight should be avoided.
