What is pancreatic cancer?
The pancreas has both endocrine and exocrine functions and is the second-largest gland in the digestive system, following the liver. In its endocrine function, the pancreas produces hormones like insulin and glucagon. Its exocrine function is crucial for digestion. It manufactures enzymes necessary for breaking down sugars, fats, and proteins. Additionally, it plays a vital role in regulating blood sugar levels.
Pancreatic cancer is a general term for malignant tumors that occur in the pancreas.
What are the symptoms of pancreatic cancer?
Pancreatic cancer often does not manifest noticeable symptoms; because of its location amidst other organs in the body. As a result, it cannot be diagnosed through physical examination or routine check-up tests. It is known for its insidious progression and tends to show symptoms in advanced stages.
Symptoms of it:
- Prolonged back and abdominal pain
- Weight loss
- Jaundice
- Loss of appetite
- Fever
- Difficulty in digestion
- Pale-colored feces
- Depression
- Sudden diabetes
- Darkening of urine color
- Greasy feces
What is the cause of pancreatic cancer?
The factors that cause pancreatic cancer are not fully known. However, mutations in the cells formed in the pancreatic duct or “acinus” cells, defined as “self-pancreatic cells”, are linked to pancreatic cancer. Although there are studies supporting these theories, a clear cause that causes pancreatic cancer has not yet been revealed.
What are the types of pancreatic cancer?
Pancreatic cancer is divided into two types and four stages as “metastatic and non-metastatic”. Different methods are followed in the treatment of these two types.
How is pancreatic cancer staged?
Staging pancreatic cancer is different from other cancer types. Normally, cancer is staged based on the size of the tumor. However, in pancreatic cancer, even a very small tumor can have already metastasized to blood vessels and other organs. Therefore, a small tumor can still be in stage 4 of the disease.
In the 1st stage of the disease, tumors are prepared for surgical removal. Staging in stages 2 and 3 is based on how far the tumor has spread to nearby organs and blood vessels. In these stages, tumors are often reduced through personalized chemotherapy treatment plans, followed by surgical intervention.
If cancer has spread to organs outside the pancreas, it’s considered stage 4. In this case, surgical treatment is often replaced by chemotherapy. Personalized chemotherapy treatment plans are designed for these patients.
What is the incidence of pancreatic cancer?
The incidence of pancreatic cancer is approximately one in ten thousand. Although it is not among the 10 most common cancers, pancreatic cancer is among the top cancers that cause death. Its incidence is increasing every year. For this reason, it is one of the most dangerous types of cancer.
In whom and in what age group is pancreatic cancer more common? Does the incidence differ in men and women?
Pancreatic cancer occurs mostly between the ages of 60-65. There is no change in the incidence in women and men; however, genetic predisposition may cause pancreatic cancer to occur in young patients between the ages of 30-45.
People with a family history of pancreatic cancer at a young age are in the risk group. Therefore, it is important to monitor health data with special screening programs.
What are the screening and examination methods for pancreatic cancer? What should people with genetic predisposition especially pay attention to?
Today, there are very good screening methods for early diagnosis and treatment of colon, breast and prostate cancer; however, unfortunately, there is no specific screening and examination method for pancreatic cancer. For this reason, patients need to undergo various screening methods, taking into account complaints such as abdominal pain and lower back pain that last more than a week. Ultrasound alone is not sufficient in imaging methods. For this reason, imaging methods such as CT (computed tomography) and MRI (magnetic resonance) should be preferred.
In addition, high levels of C19-9 and CEA, known as “tumor markers” in the patient’s blood, are also a condition that should be monitored.
How does pancreatic cancer start and progress?
This type of cancer starts primarily in the pancreas and spreads very quickly. This type of cancer does not only progress through vascular access; It spreads to the nerves inside and outside the pancreas and from there it quickly surrounds the vessels. For this reason, the disease often cannot be diagnosed at the initial stage. Cancer cells that spread to the nerves around the vessels in the pancreas enter the lymphatic pathways and vascular pathways and progress to other organs. In the first stage, it metastasizes to the liver, and in the second stage, it usually metastasizes to the lungs. Pancreatic cancer rarely spreads to the brain and bone.
What is the survival rate of pancreatic cancer patients?
In general, survival rates of cancer patients are considered according to a five-year parameter. 25 years ago, the five-year survival rate for pancreatic cancer was around 15-20 percent. Today, with radical surgery and neoadjuvant (before and after surgery) chemotherapy treatment agents, the survival rate has reached 51 percent.
How is pancreatic cancer treated?
Pancreatic cancer treatment is planned with a multidisciplinary approach, together with experts from different medical branches. In cases where the disease has spread to the vessels, neoadjuvant treatment (chemotherapy, radiation therapy or hormone treatments applied in the first stage to reduce tumor sizes before surgical treatment) is applied.
When there is artery involvement, radiation therapy is added to the treatment plan together with radiation and medical oncology specialists to shrink the tumor and then the patient is operated on. After the tumor is removed surgically, the treatment plan is continued with chemotherapy to prevent cancer recurrence and to ensure the survival of the patient.
How is the surgical method determined in the treatment of pancreatic cancer?
The surgery method is determined according to the region and stage of the tumor in the pancreas. Most often, the tumor is located in the head region of the pancreas, in which case it is necessary to perform the Whipple procedure.
What is the Whipple procedure, what is its place and importance in the treatment of pancreatic cancer?
The Whipple procedure, which was first performed by Professor Allen Whipple and named after him, is used especially in cancers of the head of the pancreas, duodenum and bile duct. Since these all occur in the same area, the same technique is used.
In this surgery, the head of the pancreas and the duodenum are removed together; this means eliminating three important pathways for digestion. At this point, when the duodenum and pancreatic head are removed in the Whipple procedure, three new pathways for digestion are built. During the operation, the small intestine is pulled up from where the duodenum is cut. A new connection is established between the intestinal system and the pancreas, bile duct and stomach and connected to the patient’s normal digestive system.
What methods can be applied in pancreatic cancer surgery?
Laparoscopic, robotic or open surgery techniques are used in pancreatic cancer surgery. Which method to apply is decided by the surgeon according to the location and stage of the cancer.
How to live without a pancreas after Whipple surgery?
The pancreas has two main functions. The first of these is the production of the hormone insulin, which regulates the level of sugar in the blood. When the pancreas is completely removed, insulin is given externally to these patients.
The second function of the pancreas is the enzymes it produces for digestion. Postoperatively, patients overcome digestive enzyme problems with tablet-shaped medications taken during meals.
What is the recovery process like after Whipple surgery?
After Whipple surgery to remove the tumor causing pancreatic cancer, the patient stays in intensive care for one night. If there are no complications after the surgery, the patient goes directly to the service room and starts drinking water and eating from the first day. Patients who are planned to consume more water and food every day are generally discharged between the 7th and 10th days after the surgery. Discharged patients return to their normal eating and digestive routine. Following the discharge process, the patient is expected to be checked one week later.
What is the neoadjuvant treatment process for tumor shrinkage?
Pancreatic cancer treatment is team work and the patient is a very important part of this team. The treatment process, which is handled with a multidisciplinary approach, is explained to the patient in detail. Thanks to new developments, neoadjuvant treatment is applied to patients who cannot undergo surgery in the initial stages due to the location and stage of the pancreatic cancer tumor, and the tumor is first reduced. It is then made removable by surgery.
In neoadjuvant treatment, patients receive chemotherapy treatment in the first stage. In cases where vascular involvement is high, radiation therapy is also added to the planning. In cases where only chemotherapy is given, patients become operable after 2.5-3 months of chemotherapy treatment; However, in cases where radiation therapy is used along with chemotherapy, the process may take a little longer.
