Detail Information about cancer of Pancreas

Author : Bhadresh Bundela

Cancer of the pancreas

The vast majority of pancreatic cancers are adenocarcinomas – a term used for cancers arising from glandular linings. Given that the role of the pancreas is to secrete digestive juices/enzymes into the gut, it is not surprising that this is the type of cancer that arises here. There is no useful subtyping of the pancreatic adenocarcinoma into better outlook and worse.
The pancreas is also a hormone gland, secreting most famously: insulin and glucagon. Tumours of these cell types give rise to malignant apudomas.

Symptoms of cancer of the pancreas

Given that the main bile duct that drains the excretions form the liver runs through the head of the pancreas and that the majority of cancers of the pancreas arise in the head of the pancreas (that part that lies in the fold/curvature of the duodenum), it is not surprising that the commonest clinical presentation of this disease is with compression of the bile duct and the development of clinical jaundice.

The silent development of jaundice is always a suspicious sign to the doctor. Weight loss, loss of appetite and lethargy are common accompanying symptoms. Abdominal pain is common and this not infrequently goes through to the back; this last symptom suggests a degreee of spread locally into the surrounding tissues. Sometimes the cancer has spread to the liver at the time of diagnosis and some of the patient’s languor and ill health are due to metastatic cancer. Cancers of the body and tail (those parts away from the duodenum and bile duct system) usually present as larger tuours because obstruction of the bile ducts does not call them to attention sooner.

Causes of cancer of the pancreas

The cause of this disease is not known. There is a statistical association with smoking and the incidence of pancreatic cancer but other putative associations have not been reproducibly found to be associated. The disease is twice as common in men as in women.

Incidence of cancer of the pancreas

The incidence of pancreatic cancer is increasing, and it is currently the fifth leading cause of cancer in the Western world. The incidence rises from 2 per 100,000 in the fourth decade of life to 100 per 100,000 in the ninth decade.

Diagnosis of cancer of the pancreas

The critical test is the abdominal scan – usually an ultrasound scan or CT scan is performed. An ultrasound scan will show the mass/tumour in the pancreas, the dilated bile duct system above the obstruction to its drainage and may be used to perform a diagnostic biopsy via a needle.

CA 19-9 is a cell surface antigen, an oligosaccharide (related to a blood group antigen), and this is expressed particularly in gastrointestinal cells and cancers derived from these cells and secreted into the blood stream where it is measurable; pancreatic cancer cells seem a rich source for CA 19-9. Serum levels of CA 19-9 more than 100 U/ml are rarely found in benign disease (although they may occur in some forms of obstructive jaundice producing a conflict in diagnostic accuracy if the cancer of the pancreas presents with jaundice) and can be used to diagnose and monitor disease activity in pancreatic cancer.

Stages of cancer of the pancreas

The main concern in staging is as to whether the growth is confined to the pancreas or whether it has spread outside the gland and thereby is definitely incurable.

Where the disease is localised sugical removal may be curative in a minority of patients.

Where the disease is metastatic, palliative chemotherapy may be useful.

Where the disease is locally infiltrative but non-metastatic, chemo-radiotherapy is advised.

Where there is bile duct obstruction, stenting may overcome the obstruction.