Pancreatic cancer: when pancreas' cells grow out of control

Pancreatic cancer is a type of cancer that begins in the pancreas (a glandular organ within both the digestive and endocrine systems).

The pancreas is located in the abdominal cavity behind the stomach. It has a dual function: producing several important hormones, such as insulin, glucagon, somatostatin, and pancreatic polypeptide, while also secreting pancreatic juice containing digestive enzymes. These enzymes aid in the digestion and absorption of nutrients in the small intestine, primarily helping to break down carbohydrates, proteins, and lipids in the duodenum.

Most cases of pancreatic cancer begin in the cells lining the exocrine functions of the pancreas, though cancer can also originate in the endocrine portion of the organ.

Doctors classify pancreatic cancer into two main types based on the nature of the affected cells:

• Exocrine pancreatic cancers: this is by far the most common type of pancreatic cancer. Approximately 95% of exocrine cancers are adenocarcinomas. Less common exocrine cancers include adenosquamous carcinomas, squamous cell carcinomas, signet ring cell carcinomas, undifferentiated carcinomas, and undifferentiated carcinomas with giant cells
• Endocrine pancreatic cancers: as a group, these are often referred to as pancreatic neuroendocrine tumors (PNETs) or islet cell tumors. They account for less than 5% of all pancreatic cancers. About half of PNETs produce hormones that are released into the bloodstream and cause symptoms. Examples include gastrinomas, glucagonomas, and somatostatinomas

Several factors can increase the risk of developing pancreatic cancer. Some risk factors, such as quitting smoking, are manageable, while others, like family history, are not.

Risk factors for pancreatic cancer include:

• Age
• Higher risk for men than women
• African American ethnicity
• Family history
• Hereditary genetic syndromes
• Diabetes
• Chronic pancreatitis
• Liver cirrhosis
• Smoking
• Excess body weight

Pancreatic cancer is challenging to detect early. Because the pancreas is located deep within the body, healthcare providers cannot see or feel early tumors during routine physical exams. Patients often do not exhibit symptoms until the cancer has spread to other organs.

Signs and symptoms of pancreatic cancer include:

• Upper abdominal pain that may radiate to the back
• Yellowing of the skin and whites of the eyes (jaundice)
• Loss of appetite
• Weight loss
• Depression
• Blood clots

Since the pancreas is an endocrine organ responsible for regulating vital functions such as blood sugar levels, survival rates are very low. For this reason, early diagnosis is critical.

If the cancer has not spread beyond the pancreas and surgery is possible, 7 to 25 out of 100 people survive for five years or more.

For locally advanced disease (Stage III) that cannot be removed surgically, the median survival is approximately 6 to 11 months.

For pancreatic cancer that has spread to other parts of the body (Stage IV), the median survival is only 2 to 6 months. However, survival can vary depending on how much the cancer has grown and where it has spread.

IMPORTANT: EARLY DIAGNOSIS IS CRUCIAL BECAUSE CANCERS DETECTED AT AN EARLY STAGE, —BEFORE SIGNIFICANT GROWTH OR SPREAD— HAVE A MUCH HIGHER CHANCE OF SUCCESSFUL TREATMENT. CONVERSELY, IF THE CANCER HAS METASTASIZED TO OTHER ORGANS, TREATMENT BECOMES MORE DIFFICULT, AND SURVIVAL RATES ARE SIGNIFICANTLY LOWER.

For years, imaging techniques and biopsies have been at the forefront of cancer diagnosis. Pancreatic cancer diagnosis involves some specialized procedures due to the importance of early detection. An endoscope is often used to apply ultrasound and inject dye into the pancreatic ducts, which is later detected using X-rays. However, these procedures can be harmful to organs and tissues due to their invasive nature. Additionally, the stress associated with a biopsy can be difficult for patients. It is also worth noting that these diagnostic procedures add significant costs throughout the course of treatment.