Pancreatic cancer is a dangerous illness peculiar with a severe clinical course and negative prognosis. Majority of patients die within a year after the diagnosis is confirmed. Incidence of the disease is approximately equal in different countries and counts for about 7 cases per 100 thousands of population a year.
Men are more prone to suffer from this disease than women. People of around 60-70 years old are a likely candidates for this illness. 75% of all the patients that have pancreatic cancer are people over 50 years of age.
Causes of pancreatic cancer
Key risk factors of pancreatic cancer arising:
- Meat based diet. A large amount of fat food in the ration of animal content contributes to the production of pancreozymin enzyme in the intestine. Pancreozymin triggers the development of pancreas hyperplasia. This increases the risk of the malformation arising.
- Smoking increases the doubles the risk of the illness. Carcinogens of tobacco smoke enter the bile, and then get into the pancreatic ducts during the metabolism process.
- Alcohol addiction increases the risk of pancreatic cancer two fold if a person consumes alcohol every day.
- Diabetes increases the probability of the illness because of the developing pancreatic ducts hyperplasia.
- Chronic pancreatitis is found in half of patients with pancreatic cancer. Increase in the risk of malformation is associated to stasis of secretion and narrowing of the ducts. As a result, the time of exposure of pancreas to carcinogens entering the body from food increases.
- Gallbladder pathology increases the risk of pancreatic cancer. In women, the likelihood of the disease also increases after the resection of the gallbladder.
Symptoms of pancreatic cancer
Early symptoms of pancreatic cancer are:
- Pain is the main clinical sign of the illness that is observed in 80% of patients. Pain is located in the epigastrium or the right hypochondrium with paid radiating into the back.
- Weight loss. A patient loses weight despite of still having an appetite, because food is not digested properly. The tumour covers the ducts through which the pancreatic juice enters the intestine.
- Dyspeptic disorders. Most of the fat and a certain amount of protein comes out with faeces in the uncleaved form. This can be accompanied by diarrhea, flatulence, polyfecalia (increased fecal volume), the presence of fat in the faeces. Depending on the location of the tumour, constipation, diarrhea, belching, heaviness in the abdomen, nausea, deterioration of appetite is also possible.
Late pancreatic cancer symptoms can differ and depends on the character of the tumour growth. Most common clinical signs are:
- Jaundice. Skin and sclera (whites of the eyes) turn yellow. Jaundice appears several weeks or months after the pain. It is associated with the overlap of the bile ducts by a tumour. According to the mechanism of development it is obstructive jaundice, which is accompanied by the following symptoms: fecal discoloration, darkening of urine, itching of the skin.
- Increased gallbladder (symptom of Courvosier syndrom). In some patients, it is also possible to detect the enlarged liver.
All the rest of the symptoms are only experienced at the advanced stages or among the limited number of patients:
- Ascites (accumulation of fluid in the abdominal cavity)
- Bleeding from the intestine (clinically manifested by the dark colour of the stool, pain in the abdomen)
- Thrombosis of leg vessels (accompanied by pain and swelling in the lower extremities)
Pancreatic cancer penetrates the neighbouring organs rapidly enough and metastases form in the regional, sometimes, distant lymph nodes.
Diagnostics of pancreatic cancer
Pancreatic cancer diagnostics is tough because of the non-specific symptoms of the illness that could warn a family doctor.
To establish and confirm a diagnosis it’s necessary to apply the following tests:
- Methods of visualization. One can observe voluminous formations in the pancreas (from 2 cm), the expansion of the ducts, presence of metastases in the liver with the help of ultrasound or computed tomography. It is possible to carry out endoscopic ultrasound (endosonography), when the sensor is inserted into the stomach and duodenum. So the pancreas is visualized much better, and the probability of a diagnostic error is reduced.
- Targeted biopsy. A fragment of pancreas tissues is obtained for analysis. The procedure is conducted under the ultrasound for monitoring. It helps to establish a diagnosis in 60-90% of cases if a person suffers from pancreatic cancer.
- ERCPG (endoscopic retrograde cholangiopancreatography) assumes the penetration of the instrument into the ducts of the pancreas. Meanwhile, a doctor can perform a biopsy to confirm the diagnosis, get the juice of the pancreas, and expand the pancreatic ducts if there is such a need.
- Duodenum X-ray. As far as this organ is in close proximity to the pancreas head, the cancer very quickly penetrates into this part of the intestine. X-rays are performed using drugs that reduce the tone of smooth muscles. So the doctor has the opportunity to assess the degree of compression (squeezing) and invasion (germination) of tumour into the duodenum.
- Laparoscopy assumes penetration into the patient's abdominal cavity and is used to detect metastases. This is necessary to determine the possibility and feasibility of surgical intervention, as well as to select an appropriate operation.
- Angiography is a type of an X-ray examination, during which a contrast agent is introduced into the vessels. It assesses the condition of the hepatic artery, portal vein, intrahepatic branches. The diagnostic method is used to assess the resectability of pancreatic cancer.
Treatment of pancreatic cancer abroad
Surgical treatment in most cases is not appropriate and does not necessarily prolong the life of a patient. Only 10% of patients can undergo surgery. In others, the tumour either penetrates into the neighbouring organs, or gives distant metastases.
If diagnostics has proven that radical surgical treatment is possible, then various types of procedures are done aimed at the resection of the damaged parts of the pancreas, duodenum, gallbladder and lymph nodes. The Whipple surgery is most often used (pancreatoduodenal resection).
Also, palliative operations are carried out, the purpose of which is to eliminate certain symptoms of pancreatic cancer and restore the digestive function. They can be aimed at:
- Elimination of jaundice
- Elimination of the duodenum compression and restoration of the food lump passage
- Reduction of pain
- Restoration of pancreatic juice access into the intestines
Radiation therapy is done before as well as after the surgery if a tumour is not resectable. Chemotherapy is administered as a part of treatment combination.
Prognosis for pancreatic cancer
Unfortunately, prognosis is not favourable for pancreatic cancer. 5-year survival of the patients is only 1-1,5%. In the case of radical treatment, prognosis depends on metastases presence:
- If there are metastases; then 5-year survival is 8% and average life expectancy is 11 months
- If there aren’t any metastases, then 5-year survival reaches 50% and average life expectance is 40 months
The basic cause of such a poor prognosis is a highly aggressive tumour, its late detection, rapid metastases penetration by hematogenous (through the blood) way.
Latest (innovative) pancreatic cancer treatment and diagnostics techniques
Irreversible Electroporation (NanoKnife®) is a way of treating malformations located in hard-to-reach places of the body, one of which is the pancreas. The essence of the technique is in the local impact at the cell structures of the malignant tumour by a non-thermal method. The impact is due to short-time impulses with the creation of a high voltage electric field.
Microscopic pores are formed in the cell membrane, which disrupt the normal metabolism of the cancer cell. As a result of such damage, they die by apoptosis, and not necrosis, as during treatment with low or high temperatures. In the case of the pancreas, this remains critical because of the structural integrity of the vessels, nerves and other tissues surrounding the organ preservation.
Proton therapy is a technique based on focused irradiation of the affected pancreas tissues with a proton beam. It is a subspecies of corpuscular therapy (Particle therapy), when other particles are used for treatment. Due to the ability to control the proton beam, which is irradiated at the cancer cells, the method remains safe for surrounding tissues, which affects purely the pathological focus. The DNA of cancer cells is damaged under the influence of protons, which leads to their death without necrosis. The remains of atypical structures are destroyed by the immune cells of the human body.