Pancreatic Cancer Day: Diagnosis, symptoms and treatment

November is Pancreatic Cancer Awareness Month when communities around the globe unite on World Pancreatic Cancer Day on 21 November, to highlight the need for greater awareness, funding and research for pancreatic cancer. Launched in 2014, World Pancreatic Cancer Day quickly became a global success. Each year, outreach, visibility, and engagement continue to grow across the world given the severity of the disease.

“Pancreatic cancer occurs when abnormal cells develop and grow out of control, causing tumours,” says Prof Jose Ramos, Head of HPB Surgery, Wits University Donald Gordon Medical Centre. “Most people know very little about this cancer, which has the lowest survival rate of all major cancers, with just 2 to 9 percent of those diagnosed surviving five years. It’s important to know the symptoms and risks of this disease and to spread the word to help educate your family, friends, and colleagues about the symptoms and risks, and what to do to support earlier diagnosis and treatment.”

One of the major challenges associated with pancreatic cancer is that the condition often goes undetected for a long period of time because signs and symptoms seldom occur until advanced stages. By the time symptoms occur, cancer cells are likely to have spread (metastasised) to other parts of the body, often preventing surgical removal of tumours.

The exact cause of pancreatic cancer is yet to be determined. However, genetics appears to play a large role, as they do with other cancers. People with family members who have been diagnosed with pancreatic cancer are at a greater risk of developing it themselves.

A far greater number of cases develop as a result of environmental and lifestyle factors such as smoking, diet, excessive drinking and chemical exposure. A personal history of chronic pancreatitis is associated with an increased risk of developing pancreatic cancer.

“Pancreatic cancer is often called a silent disease because it’s hard to spot early, at the stage when it’s most treatable. Spread of the cancer occurs early which contributes to the poor outcome,” says Prof Ramos. “Besides knowing the symptoms, knowing the risk factors for pancreatic cancer is your best protection against this disease.”

Risk factors

Risks for pancreatic cancer include:

·         Age. The vast majority of cases of pancreatic cancer occur in people aged 65 years and older.

·         Excessive drinking. People who drink 9 or more alcoholic drinks every day are at increased risk for developing pancreatic cancer.

·         Cigarette smoking. Smokers are 2 to 3 times more likely to develop pancreatic cancer than non-smokers. Smoking is the single greatest risk factor, associated with almost one-third of all cases of pancreatic cancer.

·         Diabetes. Multiple large studies have shown that people diagnosed with diabetes (abnormal glucose metabolism) are at significantly increased risk of developing pancreatic cancer.

·         Weight. Multiple large studies have shown that people who are obese, with a body mass index (BMI) 30 or greater, are at increased risk for developing pancreatic cancer (a large study showed that the risk was 47% greater compared to people who were not obese).

·         Diet. Diets high in animal fats and low in fruits and vegetables are more likely to develop pancreatic cancer. A large study has also shown that consumption of processed meat and red meat is associated with an increased risk of developing pancreatic cancer.

·         Chemical exposure. People working with petroleum agents such as gasoline and fuel oils are at increased risk of developing pancreatic cancer.

Signs and symptoms of pancreatic cancer

Many symptoms of pancreatic cancer are mild at first, so patients may often be unaware of the potential seriousness of them. Due in large part to the position of the pancreas deep in the abdomen, a pancreatic tumour can grow for years before causing pressure, pain, or other signs of illness. This can make it difficult for a patient or doctor to recognise a problem. In many cases, there are no symptoms in pancreatic cancer until its late stages.

Symptoms include the following:

Digestive Difficulties

Digestive difficulties including indigestion, nausea, weight loss, a poor appetite, and diarrhoea, can arise as a result of pressure from a pancreatic cyst or tumour on the stomach or the small intestine, in some cases causing a block in the digestive tract. When a tumour grows, it can wrap around the far end of the stomach or duodenum, causing a partial block. This can cause nausea, vomiting, and pain which may worsen after eating.

Diarrhoea results when the nutrients in food are not absorbed properly. When this occurs, stool can become loose, watery, oily and foul-smelling. Pancreatic enzymes are responsible for digesting fatty foods. If a tumour blocks the pancreatic duct, insufficient pancreatic juices in the intestines can lead to poor absorption and diarrhoea, as the undigested food passes quickly through the digestive tract. If this happens, stool may float due to the higher fat content, appear bulky, greasy, and unusually pale.

Unexplained Weight Loss

This is a common symptom in many cancers and is often accompanied by general loss of appetite and fatigue. The weight loss can be caused by cancerous cells that deprive healthy cells of required nutrients. Prof Ramos says: “Weight loss due to pancreatic cancer can be caused by a lack of functional pancreatic enzymes with consequent malabsorption of food. Eating may aggravate pain in patients with pancreas cancer leading to inadequate intake of calories.”

Jaundice

Jaundice is identified primarily by the skin and the whites of the eyes becoming yellow or greenish yellow. However, Prof Ramos says that dark urine and light or clay-coloured stools are usually the first symptoms of this type of jaundice occurring before the skin and eye changes are noted. Jaundice occurs when bilirubin, a component of bile, builds up in your blood. It typically occurs in pancreatic cancer when a tumour in the head of the pancreas first narrows, then obstructs the common bile duct, blocking the flow of bile into the duodenum. “The presence of jaundice can be easily determined with simple blood tests,” says Prof Ramos.

Upper Abdominal Pain

“Abdominal pain is a common symptom of pancreatic cancer,” says Prof Ramos. “It is usually felt in the upper central or upper left abdomen and often radiates to the middle or upper back and worsens after eating or when lying down. Abdominal pain commonly occurs with advanced pancreatic cancer and can be difficult to control.” Pain can occur when a tumour, typically originating in the body or the tail of the pancreas, grows to put pressure on surrounding abdominal organs or invades surrounding nerves.

New Onset Diabetes

Sudden onset of diabetes in people with normal body mass index is often a warning sign of pancreatic abnormalities and can be a symptom of pancreatic cancer. Additionally, when well-controlled diabetes suddenly becomes brittle or poorly controlled, this change can also be a warning sign for pancreatic cancer.

Treatment

Options for treating pancreatic cancer include surgery, chemotherapy, radiation therapy, and palliative care, depending on the specific characteristics of cancer.

“Unfortunately, pancreas cancer tends to spread to surrounding structures and lymph glands quite early and the majority of patients diagnosed with this disease are no longer candidates for surgical removal. Surgery is thus reserved only for early cases which constitute less than 10-15% of all patients with this cancer,” says Prof Ramos. “The natural evolution of the cancer is progressive spread to the liver, lungs, abdominal cavity and other areas of the body. The majority of patients with this cancer will survive less than one year from the time of diagnosis”.

“Ideally, patients with pancreatic cancer should be treated in units with the necessary experience and expertise in dealing with this complex disease. These units will utilise a multidisciplinary team consisting of surgeons, oncologists, radiologists, radiotherapists, physicians, pain specialists, dieticians and others in order to achieve the best possible outcomes. Even if cure is not possible, modern chemotherapy and radiotherapy may be able to prolong life and maintain quality of life,” says Prof Ramos.

Consequences of pancreas cancer

“Pancreatic cancer leads to permanent damage of the pancreas, eventually impairing the person’s ability to digest food and make pancreatic hormones,” says Prof Ramos. “Malnutrition can be avoided with pancreatic enzyme replacement therapy (PERT), which involves taking the digestive enzymes you need in the form of a capsule to assist the digestion of fat, carbohydrates and proteins. PERT can also help to stop diarrhoea, which contributes significantly to poor quality of life for patients. Diabetes is common due to damage to the pancreas and must be properly controlled to maintain health and well-being”.

Consult your physician as soon as possible if you are experiencing these symptoms. If you are diagnosed with pancreatic cancer, discuss your treatment options carefully and thoroughly with your physician.

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Image source iStock/ @PORNCHAI SODA

Article source: Mantis Communications.