I have been channelling my posts towards cancerand tumor, and I have done well to explain a few type of tumors and cancers in the past. You can read through my post, and enjoy the properly served post which I took time to write. Today, I will be discussing Pancreatic cancer, so let's jump straight to it.
Pancreatic cancer is a type of cancer that affects the pancreas. The Pancrease is a gland located behind the stomach that plays a role in digesting food and regulating blood sugar in the body. Pancreatic cancer is often diagnose late, and has a poor prognosis. The mvast majority of pancreatic cancer is known as adenocarcinoma, which occurs in the head of the pancrease. which are the cells that produce the enzymes needed for digestion, and then begin to compress the bile duct causing Obstructive jaundice (symptoms similar to pancreatic cancer). They can metastasise early to other organs which includes the liver, lung, bones and the peritoneum (The peritoneum is a thin, transparent membrane that lines the abdominal cavity, coverering most of the abdominal organs).
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Pancreatic cancer is the 14th most common cancer, having the 7th highest cancer caused mortality in the world, and it is predicted at pancreatic cancer would be the second most caused cancer-related death in the United States by the year 2030. Currently, the average survival of 6 months when diagnosed with advanced level of the cancer. When it is caught early, and quickly noticed and surgery done quickly, there is a 25% or less chance of survival. According to GLOBOCAN, in 2012 pancreatic cancer killed more than 331,000 people anually, and in 2018 about 460 thousand people were diagnosed with over 432000 death.
Pancreatic cancer can present in numerous way but majorly, patients with pancreatic cancer usually present with painless, and patients with such panceratic cancer are diagnosed with cholangiocarcinoma. Painless obstructive jaundice occur when the tumor at the pancrease compresses the bile ducts causing the disruption of Bile flowing to the liver causing yellowing of the skin and yellowing of the sclera (Jaundice). Patients suffering of pancreatic cancer would present with dark Urine, Pale Stool, and Itching generally. Other presentations include upper abdominal pain, back pain, weight loss, palpable mass in the gastric area, changes in bowel habits, diabetes type 1 and 2, nausea, and vomiting.
Courvoisier's law states that if a patient presents with a palpable gallbladder and painless jaundice (yellowing of the skin and eyes), the cause is likely to be gallbladder cancer, Cholangiocarcinoma, and pancreatic cancer rather than obstruction of the common bile duct by a gallstone.
Risk factors associated with pancreatic cancer can vary, and this is because some are non-modifiable while some are modifiable. These risk factors include;
- Age
Actually, pancreatic cancer is a disease associated with the elderly, and it is very rare to see patients who are diagnosed before the age of 30 years. It is prevalent in patients above the age of 50 years with patients in their 70s and 80s being the majority of patients who suffer from this disease although this can vary depending on the country.
- Sex
Being male is one risk factor for having pancreatic cancer and this does not mean that there are no incidents in females but males have a higher incidence than females.
- Blood group
Blood groups are another risk factor for pancreatic cancer. Studies using the ABO blood grouping show that some blood groups are more likely to have pancreatic adenocarcinoma than others. The study shows that patients with the O blood group are less to develop pancreatic cancer compared to other blood groups with blood group A (HR: 1.32, 95%CI: 1.02-1.72), blood group AB (HR: 1.51, 95%CI: 1.02-2.23), and blood group B (HR: 1.72, 95%CI: 1.25-2.38)
- Ethnicity
There is a 50 to 90 percent increased risk of Pancreatic cancer in African-Americans compared to Caucasians, while Asian-American has the least incidence rate.
- Family history and genetic susceptibility
There is a high risk of developing pancreatic cancer if there are two or more first-degree relatives who have been diagnosed with Pancreatic cancer previously.
- Diabetes
Patients who previously developed diabetes or have been diagnosed with diabetes are at a high risk of developing pancreatic cancer, and the risk is higher if the patient is diagnosed with type 2 Diabetes
There can be modifiable risk factors for pancreatic cancers which include; Alcohol, Smoking, Chronic pancreatitis, Obesity, Infections (such as Helicobacter pylori), and Dietary factors.
When investigating or Diagnosis pancreatic Cancer, it is based on imaging and histology. Imaging can be done with CT scan, while histology has to do with the Biopsy of the lesion. The CT of the Abdomen, Thorax, and Pelvis is done to check for metastases, as well as other cancerous growth. Using Carbohydrate Antigen 19-9 (CA 19-9) is a marker used to identify tumors, and it is used to identify cholangiocarcinoma. Magnetic Resonance Cholangiopancreatography (MRCP) can be done to access the Biliary system in detail, looking for obstruction in the Biliary system. The use of Endoscopic Retrograde Cholangiopancreatography (ERCP) to put a stent and obtain a Biopsy is welcomed. A biopsy can also be taken through the skin through Ultrasound or CT guidance, or during an endoscopy procedure.
Management of pancreatic cancer would include Surgery for smaller, isolated tumors in the pancrease, Surgery includes total pancreatectomy, distal pancreatectomy, Dylorus-preserving pancreaticoduobenectomy, and Radical pancreaticoduobenectomy. Palliative treatments such as the insertion of a stent to relieve the biliary obstruction, bypassing the biliary system, palliative chemotherapy, palliative radiotherapy, and supportive care.
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