Pancreatic cancer is a type of cancer that occurs in the pancreas and occurs as a result of growth and out-of-control multiplication of cells which lead to the growth of a tumor. Pancreatic cancer is considered one of the most difficult cancers to detect, which as result ends up being diagnosed in its later stages.

The pancreas is a gland found in the abdomen and lies on the lower part of the stomach near the gall bladder. It releases enzymes that assist in digestion of fats, proteins and carbohydrates, and produces hormones that control the body’s blood sugar(insulin).

The cancer in the pancreas can attack either the exocrine or endocrine glands. The exocrine glands make up the part of the pancreas which releases enzymes and juices, and which assist in the digestion of macronutrients such as fats, proteins and carbohydrates.

Endocrine glands comprise of islet cells (Islets of Langerhans) which produce two hormones, insulin and glucagon, then releases them to the bloodstream. Insulin regulates low blood sugar whiles glucagon regulates high blood sugar.

Types of Pancreatic Cancer

Pancreatic cancer is classified based on whether it has attacked the endocrine or exocrine glands of the pancreas. Each of the two pancreatic cancers has several other subtypes.

Exocrine Pancreatic Tumors

A variety of pancreatic cancers start in the exocrine cells of the pancreas. The cancer can be benign or malignant, but they mostly lean towards malignancy.

The types of exocrine tumors include:

Pancreatic adenocarcinoma: This type of pancreatic cancer starts in the ducts of the pancreas.

Acinar cell carcinoma: This type the pancreas to produce a lot of lipase (an enzyme which digests fats). Lipase is measured in the blood.

Intraductal papillary-mucinous neoplasm (IPMN): This starts as a tumor which spreads from the side branches of the duct in the main pancreatic duct. This type of tumor can be benign but could evolve to become malignant if it starts to spread from the main pancreatic duct.

Mucinous cystic neoplasm: This is a tumor that develops at the tail of the pancreas and it consists of a cyst with thick fluid.

Adenosquamous carcinoma: This is a pancreatic neoplasm which has squamous cells at the surrounding glandular elements.

Pancreatic Neuroendocrine Tumors (PNET)

Tumors in the endocrine are known as neuroendocrine tumors or islet cell tumors. This is because they grow in the islet cells. PNET are either producing or not-producing hormones. The tumors occur with different symptoms and therefore require different modalities of treatment.

The different types of Neuroendocrine tumors are categorized by the hormones they produce, which are:

• Glucagonoma producing glucagon
• Insulinoma – Insulin
• Gastrinoma – gastrin
• VIPoma – vasoactive intestinal peptide
• Somatostatinoma – somatostatin
• Nonfunctional Islet cell tumor – no hormones

Symptoms of Pancreatic Cancer

Pancreatic cancer rarely presents any signs or symptoms until the advanced stages. However, certain symptoms tend to occur when the cancer has progressed. These include:

• Discoloration of the skin and eyes that turns yellow (Jaundice). This could indicate an early sign of pancreatic cancer
• Abdominal pain that spreads to the back
• Loss of appetite
• Fatigue
• Unintentional drastic weight loss
• Pale stool, dark urine and diarrhea
• Nausea and vomiting

Causes and Risk Factors of Pancreatic Cancer

Although there are no known causes of pancreatic cancer, there are factors which can put one at risk of developing it. These include:

Genetic Predisposition

There are individuals who are genetically predisposed to pancreatic cancer. This means that the individual caries the pancreatic cancer gene which increases the risk of him/her developing it. Additionally, certain genetic syndromes such as melanoma and pancreatitis among others may also cause pancreatic cancer.

Environmental Pollution

Chemicals and pesticides are substances that pollute the environment and when transferred to individuals, they can decrease the body’s ability to function normally. This is a risk because these substances produce carcinogens, which can cause cancer in the living tissues of the body.

Lifestyle Factors

Lifestyle aspects that may increase the risk of pancreatic cancer include:

• Being overweight and leading a sedentary lifestyle
• Smoking or passive smoking
• High consumption of alcohol.
• High intake of red meat and fat, and lack of vegetables and fruits in the diet

Gender

Several scientific researches have concluded that men are more susceptible to pancreatic cancer compared to women.

Medical Conditions

Diseases such as liver cirrhosis, inflammation of the pancreas (Pancreatitis), Helicobacter pylori (H. Pylori) and Diabetes are also associated with pancreatic cancer.

Diagnosis of Pancreatic Cancer

Early diagnosis of pancreatic cancer can lead to a possible successful treatment, however, since the disease does not present any obvious symptoms, it is rare to catch it at an early stage. If you notice any of the symptoms listed above and you are at risk of developing pancreatic cancer, then it is recommended to seek medical help for a diagnosis.

Pancreatic cancer is diagnosed through:

Imagining tests, which are done to reveal the cancer and how it has spread. These include

• X-rays with a barium meal to detect the abnormalities
• Endoscopic ultrasound or ultrasound
• MRI, PET scans and CT scans
• An angiogram. A catheter contrasted with a dye is inserted in the groin and X-ray of the blood vessels is taken.

Biopsy, whereby a sample is taken out of the tissue for examination

Laboratory tests: These are blood, stool and urine tests done to examine the chemicals release from pancreatic cells to the blood.

Pancreatic Cancer Treatment

Pancreatic cancer treatment is usually dependent on:

• The aggressiveness of the cancer
• Type of the cancer
• Stage of the cancer
• Size and location of the tumour
• Age and overall health of the patient
• History of thyroid cancer in the family
• Gene mutation test results

However, the goal of pancreatic cancer treatment is to control symptoms and remove the cancerous cells. The treatment options include:

Surgery

Surgical treatment of pancreatic cancer in its early stage as compared to when it’s in the advanced stage is considered to have a more positive outcome. For pancreatic cancer there are three surgical procedures used. These are;

Total pancreatectomy: This is the removal of the entire pancreas if it is fully damaged. Even though a person can live without the pancreas, chances of developing diabetes are high as insulin is not produced.

Distal pancreatectomy: This procedure is for treating neuroendocrine tumors and it involves cutting the tail of the pancreas. Other areas such as the spleen can be removed together with the tail if they are affected.

Whipple procedure: This is the riskiest procedure for pancreatic cancer treatment as the head together with lymph nodes, duodenum and parts of the stomach are removed. Possible risks include bleeding, leakage, and stomach infection.

Radiation

Radiation therapy is used to destroy the cancer cells by focusing high energy rays on the affected area. This procedure shrinks or destroys the cancer cells, and it can be combined with surgery for a more positive outcome. The possible side effects are fatigue, loss of appetite, weight loss, nausea, vomiting, and diarrhea.

Chemotherapy

Chemotherapy involves the use of anti-cancer drugs to destroy any fast-growing cancer cells in the pancreas. This is done in cycles of a weekly basis and the drug used for treatment of pancreatic cancer is gemcitabine (gemzar). Fatigue, nausea, vomiting and hair loss are the possible side effects of chemotherapy.

Palliative Treatment

Palliative treatment is considered when there’s no possibility of removing the pancreatic cancer. A diversion is created to remove blockage in the duodenum or bile duct so that bile can continue circulation from the liver. Alternatively, a small stent is inserted in the duct to open the blockage by using an endoscope. This procedure is efficient as is reduces pain and resolves digestion problem.

Targeted Treatment

• Palliative chemotherapy – done in later stages of cancer
• Adjuvant chemotherapy -done after surgery
• Biologics – target the cancer cells and do not affect the whole body

Next Step

At King’s College Hospital Dubai, we focus on offering an exemplary service. From initial consultation through to final diagnosis, treatment and beyond. Our multidisciplinary team of expert doctors and nurses, and technologists led by Dr Hassan Ghazal – an American triple board-certified Consultant Medical Oncologist and a Consultant Clinical Hematologist with more than 3 decades of clinical experience, are here to offer tailored management and treatment of your condition, and to answer any questions that you may have throughout your time with us. Whatever you need us for, we’re only a phone-call away.