Pancreatic cancer stands out as a highly lethal disease with the poorest likelihood of survival among all cancers. It accounts for only 2% of newly diagnosed cancers but 5% of all cancer deaths. Risk factors for pancreatic cancer are people over age 60, family history of the disease and/or colon or ovarian cancer, being male, high fat dietary intake, smoking, diabetes and chronic pancreatitis.
November is a month when awareness about pancreatic cancer is promoted through numerous events taking place around the world.
Pancreatic Cancer Action Network - http://www.pancan.org
WHAT IS THE PANCREAS?
The pancreas is a gland, about six inches long, located in the abdomen. It is surrounded by the stomach, small intestine, liver, spleen and gallbladder. It is shaped like a flat pear. The wide end of the pancreas on the right side of the body is called the head. The middle sections are the neck and body. The thin end of the pancreas on the left side of the body is called the tail. The uncinate process is the part of the gland that bends backwards and underneath the head of the pancreas. Two very important blood vessels, the superior mesenteric artery and superior mesenteric vein, cross behind the neck of the pancreas and in front of the uncinate process.
The pancreatic duct runs the length of the pancreas and delivers pancreatic secretions to the first portion of the small intestine called the duodenum. The common bile duct runs from the gallbladder behind the head of the pancreas to the point where it joins the pancreatic duct and forms the ampulla of Vater at the duodenum.
The pancreas has two main functions, the exocrine and endocrine functions. Exocrine cells of the pancreas produce enzymes that help with digestion. When food enters the stomach, exocrine cells release digestive enzymes into a system of ducts which lead to the main pancreatic duct. The pancreatic duct empties the enzymes into the first portion of the small intestine called the duodenum, where the enzymes aid in the digestion of fats, carbohydrates and proteins in foods.
The second function of the pancreas is the endocrine function, which involves the production of hormones. Hormones are substances that are made in one part of the body and circulate in the bloodstream to influence a different part of the body. The two main pancreatic hormones are insulin and glucagon. Islet cells (endocrine cells) within the pancreas produce and secrete insulin and glucagon into the bloodstream. Insulin serves to lower blood sugar levels while glucagon raises blood sugar levels. Together, these two main hormones work to maintain the proper level of sugar in the blood.
TYPES OF PANCREATIC CANCER
- All types of pancreatic cancer begin when abnormal cells grow out of control within the pancreas. There are two types of cells in the pancreas, the exocrine cells and endocrine cells. These cells also have different functions.
- 95% of pancreatic cancers are classified as exocrine tumors because they begin in the exocrine cells that produce enzymes to aid in digestion.
- Accounting for less than 5% of all pancreatic tumors are endocrine tumors, also called neuroendocrine or islet cell tumors. Islet cells of the pancreas produce hormones including insulin, glucagon and somatostatin. A major function of these hormones is to control the amount of sugar in the blood. Endocrine tumors may be benign or malignant and tend to be slower growing than exocrine tumors. In addition, these tumors are categorized as functional (produce hormones) or nonfunctional (produce no hormones). The majority of functional endocrine tumors are benign. However, 90% of nonfunctional endocrine tumors are malignant, or cancerous.
SYMPTOMS OF PANCREATIC CANCER
Cancer of the pancreas is sometimes called a “silent” disease because symptoms are not usually present in early stages. Many patients have advanced disease by the time it becomes noticeable to the patient and the doctors. Symptoms that do develop are often vague. Individuals may experience different symptoms depending on the location, type and stage of the tumor. Symptoms that commonly lead to diagnosis include: jaundice, abdominal and/or back pain, unexplained weight loss and loss of appetite. A person with advanced pancreatic cancer may experience all of these symptoms and others including ascites and blood clots. Ascites is the abnormal buildup of fluid in the abdominal cavity. Blood clots most often form in the legs and may easily go unnoticed. Symptoms such as fatigue, weakness, digestive difficulties and depression may occur at any time.
If someone is experiencing one or more of the symptoms mentioned in this section, it does not mean that he or she has pancreatic cancer. There are other medical problems or conditions that may also cause these or similar symptoms. Therefore, anyone experiencing these symptoms should consult with his or her doctor. Only a doctor can diagnose the cause of an individual’s symptoms.
Smoking is a significant risk factor and is the cause of about 25% of all pancreatic cancer cases. People who smoke cigarettes are 2 times more likely to develop pancreatic cancer than people who do not smoke.
The chance of developing pancreatic cancer increases with age. Most people diagnosed with pancreatic cancer are over the age of 60.
If a person’s mother, father, sibling, or child had pancreatic cancer, then that person’s risk for developing the disease increases by 2-3 times. The risk increases if a greater number of family members are affected. Also, the risk of pancreatic cancer increases if there is a history of familial breast or colon cancer, familial melanoma, or hereditary pancreatitis. Approximately 10% of pancreatic cancer cases are related to a family history of the disease. Individuals who smoke and have a family history of pancreatic cancer are at risk of developing pancreatic cancer up to 10 years earlier than their previously diagnosed family member(s).
Chronic Pancreatitis and Hereditary Pancreatitis
A person who has been diagnosed with chronic pancreatitis, particularly at a younger age, has an increased risk of developing pancreatic cancer. Chronic pancreatitis is usually diagnosed in individuals 35-45 years old and often in individuals who consume large amounts of alcohol for many years. In addition, the mumps virus and various autoimmune disorders can cause chronic pancreatitis, which may lead to pancreatic cancer.
African-Americans have a higher incidence of pancreatic cancer compared to individuals of Asian, Hispanic or Caucasian descent. There is also a higher incidence of pancreatic cancer among Ashkenazi Jews, possibly due to a mutation involving the breast cancer (BRCA2) gene that is found in about 1% of individuals of this background.
Slightly more men are diagnosed with pancreatic cancer than women. This may be linked to higher smoking rates in men. With increasing smoking rates in women, the incidence of pancreatic cancer in women may soon equal that in men.
Pancreatic cancer is 2 times more likely to occur in people who have diabetes than in people who do not have diabetes. In pancreatic cancer patients who have had diabetes for less than five years, it is unclear if the diabetes contributed to the cancer or if the precancerous cells caused the diabetes.
The association of diet and the development of pancreatic cancer is still unclear. A diet high in red meats, animal fats, processed meats, and carbohydrates is thought to increase the risk of developing pancreatic cancer. A diet high in fruits and vegetables may decrease the risk. There may also be a risk associated with eating meats that are very well-cooked, especially those that are charred, foods that are high in salt and refined sugar, or foods that have been smoked, dehydrated or fried.
For people who are considered clinically obese, there may be a significantly increased risk of developing pancreatic cancer. In those who are overweight, the risk may decrease with increased physical activity.
Lack of physical activity or exercise has been associated with increased risk of pancreatic cancer in a large epidemiologic study. This is independent of the effects of obesity, as obese patients who exercise regularly have a lower risk than those who do not.
Diagnosing pancreatic cancer can be difficult. Symptoms are not always obvious and usually develop gradually. If an individual has symptoms that suggest pancreatic cancer, a variety of tests may be performed to make an accurate diagnosis. However, there is no standard diagnostic test for pancreatic cancer.
First, the doctor will ask about medical and family history and will perform a physical exam. The doctor will examine the patient’s body, including skin and eyes, and feel the abdomen to check for changes in the area near the pancreas, liver and gallbladder. Blood, urine and stool tests may be ordered. The visual information of a pancreatic tumor is often first noted on a radiographic study such as a computed tomography (CT) scan or magnetic resonance imaging (MRI).
There are several methods of treatment for people with pancreatic cancer, depending on the type and stage of the cancer. The patient may be treated with surgery, radiation therapy, chemotherapy, biological therapies and/or complementary and alternative therapies. Some patients may receive one or more of these treatments. Clinical trials in pancreatic cancer are also available and should also be considered when selecting a treatment option.
Patients should seek care from hospitals and/or doctors that provide the best quality care. In many cases, this care can be obtained through hospitals or doctors that care for large numbers of people with pancreatic cancer. With more experience, hospitals or doctors may have greater knowledge of the disease and treatment options.
DIET AND NUTRITION
Many people with pancreatic cancer experience significant challenges in the area of diet and nutrition. With the diagnosis of pancreatic cancer, patients should incorporate a healthy diet and nutritional plan, developed together with a doctor or registered dietitian.
The patient's nutritional goal should be to consume an adequate amount of fluids, calories, protein and vitamins each day to maintain a desirable weight and activity level. Small, frequent meals throughout the day (five to six meals/snacks total), with each having a rich source of protein, are usually best tolerated.
The primary nutrition goals of changes in diet are to:
- Prevent or reverse poor nutrition.
- Maintain dose and schedule of cancer treatments.
- Manage symptoms.
- Maintain or improve weight and strength.
Before making changes in diet or using nutritional supplements, it is important to discuss these topics with a doctor or registered dietitian.