Pancreatic Cancer: Symptoms, Diagnosis, & Prognosis

Pancreatic cancer ranks, as the fourth leading cause of cancer deaths in males and females alike. It affects men and women equally and annually at a rate of 48,960 victims, with most cases ending in death. It is estimated that only around 8,000 of these individuals will survive the disease. This low percentile is most likely linked to the difficulty of detecting the cancer, until it is in the later or terminal stages (cancer.net).

Pancreas

The pancreas is part of the digestive system and sits directly behind the stomach, within the abdominal cavity. It is a glandular organ (endocrine gland), which is capable of producing hormones including glucagon, somatostatin, insulin, and polypeptide. It aids in digestive, as it is capable of secreting digestive enzymes and absorbing important nutrients from food.

Pancreatic Cancer Stages

In most pancreatic malignancy cases, the cancer will first appear, as an exocrine tumor, but neuroendocrine and islet cell tumors have also been noted in a lower number of the cases. The TNM system is used to stage the cancer, as the time of diagnosis and throughout its development.

  • T – The initial malignant tumor
  • N – Metastasized to the nearby lymph nodes
  • M – Metastasized to the nearby organs (lungs, liver, and peritoneum)

It is also categorized by the innumerable findings during examination and testing.

  • TX – Unable to access tumor
  • T0 – No initial tumor can be found
  • T1 – No metastasizes and no larger than 2 cm in size
  • T2 – No metastasizes, but larger than 2 cm in size
  • T3 – Metastasized to nearby tissue, but avoiding major blood vessels
  • T4 – Metastasized to nearby tissues and major blood vessels
  • N0 – No metastasizes to lymph nodes
  • N1 – Metastasizes to lymph nodes

Pancreatic cancer is also staged from 0-IV according to size and metastasizes findings.

Symptom Onset

Pancreatic cancer symptoms will normally occur during the later stages and may or may not include all of the following:

  • Unexplained weight loss
  • Thrombosis
  • Decreased appetite
  • Jaundice (yellowing pigment of the skin and sclera), which is due to liver damage
  • Nausea 7 vomiting
  • Diarrhea
  • Upper abdominal pain, which will potentially radiate to the upper back area
  • Light colored stools

Diagnosis

  • Abdominal x-ray
  • 4D Ultrasound
  • Magnetic resonance cholangiopancreatography (MRCP) (noninvasive)
  • Endoscopic retrograde cholangiopancreaticography (ERCP) (noninvasive)
  • Computed tomography with or without needle biopsy
  • Percutaneous transphepatic cholangiography (PTC) (invasive)
  • Somatostatin receptor scintigraphy (SRS) (invasive)
  • Angiography (invasive)

Blood Tests

  • CEA is a tumor marker (substance found in blood, when cancer is present)
  • CA 19-9 excreted into the blood, by exocrine cancer cells

While these tumor markers are not very reliable in helping the detection of pancreatic cancer cells, they are often utilized to determine if cancer is present.

Treatment

Treatment will be determined, by the stage of the pancreatic cancer.

  • Whipple surgery- involves the removal of the gallbladder, portion of stomach and small colon, bile ducts, and head of the pancreas. This will leave a small portion of the pancreas, which be capable of producing digestive juices and insulin.
  • Pancreatectomy – involves the full removal of the pancreas, bile duct, spleen, gallbladder, lymph nodes, and a portion of the stomach and small colon.
  • Radiation may be used in conjunction with chemotherapy
  • Chemotherapy

Prognosis

Prognosis will depend on the individuals overall general health and whether or not the tumor can be excised with surgery. Since pancreatic cancer is most often not diagnosed until the later stages will decrease the change of survival.

Causes

  • Smoking
  • History of pancreatitis, diabetes
  • Obesity
  • Family history of pancreatic cancer, pancreatitis, and atypical multiple mole melanoma