What is pancreatic cancer
The pancreas is the organ responsible for releasing enzymes that aid in the digestion process and for producing hormones that help maintain blood sugar control. It is composed of three parts: the head (right side), the body (center), and the tail (left side).
The most common type of pancreatic cancer is adenocarcinoma, accounting for 90% of diagnosed cases, with the majority of them located in the head of the organ.
According to the Union for International Cancer Control (UICC), cases of pancreatic cancer increase with age: from 10/100,000 inhabitants between 40 and 50 years old to 116/100,000 inhabitants between 80 and 85 years old. In Brazil, it accounts for about 2% of all diagnosed cancer types and for 4% of total deaths caused by the disease.
Risk factors for pancreatic cancer
Some risk factors contribute to the development of pancreatic cancer, including:
Smoking;
Overweight or obesity;
Diabetes;
Chronic pancreatitis; and
Occupational exposure to certain chemicals.
The non-modifiable risk factors include:
- Age;
- Male sex;
- African descent;
- Family history;
- Hereditary genetic syndromes (hereditary breast and ovarian cancer syndrome, caused by mutations in the BRCA1 or BRCA2 genes; hereditary breast cancer; familial atypical multiple mole melanoma syndrome (FAMMM); hereditary pancreatitis; Lynch syndrome; and Peutz-Jeghers syndrome); and
- Chronic pancreatitis triggered by genetic alteration.
Remembering that through treatment and lifestyle changes, some are modifiable by
Symptoms and signs of pancreatic cancer
Pancreatic cancer often does not cause signs or symptoms in the very early stages – they usually occur when the tumor is already quite large or when the cancer has spread to other parts of the body. It is important to be aware of some signs and symptoms, such as
- Weakness;
- Weight loss;
- Loss of appetite;
- Abdominal pain;
- Back pain;
- Dark urine;
- Jaundice (yellowing of the eyes and skin);
- Nausea;
- Back pain;
- Deep vein thrombosis (identification of a blood clot, usually in a major vein, such as in the leg);
- Recent-onset diabetes; and
- Abrupt worsening of long-standing diabetes.
Although these symptoms are not exclusive to pancreatic cancer, they can provide clues to the doctor. It is also important to be alert to diabetes, which can be both a risk factor for pancreatic cancer and a clinical manifestation that precedes its discovery. Some studies indicate that in 74% to 88% of individuals with pancreatic cancer and diabetes, the diagnosis of diabetes occurs within a 24-month window before the identification of the neoplasm.
Diagnosis of pancreatic cancer
Pancreatic cancer is rarely diagnosed in its early stages, when the chances of cure are higher. This results in the discovery of a more aggressive cancer, with a high mortality rate.
The first diagnostic step is to perform a physical exam and collect data about the patient’s personal and family history. Some of this information can provide important clues to the doctor.
In the next phase, the individual undergoes additional tests, such as:
- Laboratory tests (blood tests that assess liver function or tumor markers, such as CA 19-9 or carcinoembryonic antigen – CEA);
- Imaging tests (such as computed tomography, magnetic resonance imaging, and PET Scan, which allow visualization of the tumor, its extent, and whether it has spread to other parts of the body);
- Cholangiopancreatography (evaluates whether the bile ducts and pancreatic ducts are blocked, narrowed, or dilated);
- Angiography (a specific imaging test for visualizing blood vessels);
- Biopsy (can be done percutaneously, where the doctor inserts a thin needle through the abdomen and removes a small sample of the tumor; endoscopically, where the sample is collected during an endoscopy exam; guided by computed tomography; or surgically).
Treatment of pancreatic cancer
Once the diagnosis is made and the type of tumor and stage of cancer are determined (tumor staging), the specialist doctor and his multidisciplinary team develop a treatment plan.
Surgery is the only approach that can offer a chance of cure. However, it is an option only in the minority of cases, as most of the time the diagnosis is made when the disease is in an advanced stage.
Other treatment options include radiotherapy and chemotherapy, which can be used alone or in combination, to shrink the tumor and/or to eliminate any cancer cells that may remain after surgery.
When pancreatic cancer is in a very advanced stage, the likelihood of cure with these treatments is very low. In this case, the goal becomes the comfort of the patient and the relief of symptoms through palliative care.
Prevention of pancreatic cancer
It is possible to reduce the risk of developing pancreatic cancer by:
- Quit smoking;
- Maintain a healthy weight;
- Adopt healthy lifestyle habits, including a balanced diet rich in vegetables, fruits, and whole grains, as well as reducing portion sizes;
- Engage in regular physical activity; and
- Avoid the consumption of alcoholic beverages.
