18 Causes and risk factors of pancreatic cancer
The exact cause of pancreatic cancer in an individual is still being researched. However, the most important risk factor for pancreatic cancer is increasing age, with the risk rising to 1 in 61 by the age of 85 years. Other factors that increase the risks may include:
- Smoking (usually considered the most common cause of pancreatic cancer)
- Obesity (body mass index >30 kg/m2)
- Heavy alcohol use (more than four standard drinks/day)
- Long-standing diabetes (>5 years)
- Severe pancreatitis: Patients who have chronic or severe pancreatitis are five times more likely to develop pancreatic cancer.
- Previous surgeries such as gastrectomy or cholecystectomy: People who have had certain types of surgery such as a gastrectomy (a portion of the stomach removed) to treat stomach ulcers or cholecystectomy (gallbladder removal) may be at an increased risk of pancreatic cancer. There is conflicting evidence that specific types of bacteria that can produce carcinogenic chemicals called nitrosamines as a result of these types of surgery may increase the risk of pancreatic cancer.
- Diet: Diets with a high intake of meat and/or saturated fat and a reduced intake of fruits and vegetables can increase the risk of pancreatic cancer.
- People frequently exposed to certain pesticides and petroleum products may have an increased risk of pancreatic cancer. High rates of pancreatic cancer have been noted among industrial workers, for example, those working in chemical manufacturing and metal industries.
- One first-degree relative (FDR) with pancreatic cancer: Approximately, 5-10% of patients with pancreatic cancer have a family history of the pancreatic disease.
- African Americans tend to be more likely to acquire cancer of the pancreas than their Caucasian counterparts. The causes of this are not entirely clear but may have to do with diet, smoking, diabetes rates, and obesity.
- Pancreatic cancer is caused by mutations or changes in a person’s DNA.
- These genetic mutations may be inherited, meaning that we are born with them, or they may be acquired throughout a lifetime.
- In most cases of pancreatic cancer, mutations are caused by environmental, lifestyle, and aging factors.
- Approximately, 5-10% of all pancreatic cancers are the result of inherited changes, which explains why pancreatic cancer appears to run in some families.
- Breast cancer 2 (BRCA2) gene: Mutations in the BRCA2 gene may also account for 6-16% of hereditary pancreatic cancer cases. It is estimated that the lifetime risk of pancreatic cancer for those carrying a BRCA2 gene mutation is 5%.
- Peutz-Jeghers syndrome: This syndrome is caused by mutations in the STK11 gene. It is associated with the growth of polyps (usually benign) in the stomach and intestines and pigmentation on the lips and nose. The lifetime risk of pancreatic cancer is 36%.
- Hereditary pancreatitis: It is rare and can be caused by mutations in the PRSS1 or SPINK1 gene. This condition is characterized by frequent episodes of chronic pancreatitis (long-term inflammation of the pancreas) beginning from a relatively young age. The lifetime risk of pancreatic cancer is estimated to be as high as 40%.
- Familial atypical multiple mole melanomas (FAMMM): FAMMM is caused by mutations in the CDKN2A gene, and affected individuals develop numerous skin moles and melanomas at a young age. They may also be susceptible to cancer of the pancreas.
- Lynch syndrome or hereditary non-polyposis colorectal cancer (HNPCC): It is an inherited predisposition to developing bowel cancer due to mismatch repair gene mutations (MLH1, MSH2, MSH6, and PMS2). It is also associated with an increased risk of pancreas cancer.
- Familial adenomatous polyposis (FAP): It is characterized by multiple colorectal adenomas at a significantly younger age. Benign and malignant tumors can also be found in other sites such as the duodenum, stomach, and skin. FAP is a result of mutations in the APC gene and is associated with an increased risk of pancreatic cancer.
What are the different stages of pancreatic cancer?
Pancreatic cancer staging assists doctors in determining how far the disease has progressed locally and systematically and helps determine the best treatment. Moreover, staging aids in the calculation of survival statistics.
The lower the stage number, the less cancer has spread, with early stages being 0 and the most advanced stage being IV.
Five stages of pancreatic cancer include:
- Stage 0 or carcinoma in situ
- Cancer cells are present in duct cells and have not spread deep into the tissues.
- They have not spread to lymph nodes or distant portions of the body.
- Stage I
- Stage IA:
- A pancreatic tumor is less than 2 cm in size.
- The tumor has not yet gone beyond the pancreas or lymph nodes.
- Stage IB:
- The pancreatic tumor has grown to between 2 and 4 cm in size.
- The tumor is not visible outside of the pancreas.
- Stage IA:
- Stage II
- Stage IIA:
- The tumor has grown to be more than 4 cm in diameter, yet it has not spread to the lymph nodes.
- Stage IIB:
- The tumor has grown to be more than 4 cm in diameter and has migrated to the lymph nodes.
- Tumors are seen in no more than three lymph nodes at this stage.
- It has not spread to other organs.
- Stage IIA:
- Stage III
- The tumor has progressed to four or more regional lymph nodes or adjacent arteries and veins. It is not found in any other organ.
- Stage IV
Each stage of pancreatic cancer requires a unique approach or combination of different treatments. The most difficult stage of pancreatic cancer to treat is stage IV. For patients who can be treated by removing pancreatic tumors, the amount of resection is a significant consideration for staging, that is, whether the tumor has been eliminated.
The staging is divided into three groups according to whether the tumor can be resected:
- If cancer is limited to the pancreas and the tumor can be removed, it is said to be resectable. In the TNM system, this encompasses IA, IB, and IIA.
- Borderline resectable:
- This occurs when cancer has only recently gone to the blood vessels, yet it may still be removed surgically.
- These malignancies cannot be removed surgically. Cancer that has spread or is locally progressed is among them.
What are the treatment options for pancreatic cancer?
There are several types of treatment for pancreatic cancer. Physicians determine the best approach for treatment based on the type and stage of cancer, as well as the molecular and genetic makeup of your disease. Pancreatic cancer is often diagnosed when it is in a more advanced stage, and patients may require a combination of treatments.
Pancreatic cancer treatment may include:
To remove pancreatic cancer, a surgeon may undertake one of the following procedures:
- Whipple procedure or pancreatoduodenectomy
- Many types of exocrine pancreatic cancer and certain neuroendocrine pancreatic tumors are treated with Whipple surgery.
- A section of the pancreas, the gallbladder, a portion of the stomach and small intestine, and the bile duct will be removed by the surgeon.
- A part of the pancreas is preserved for the production of insulin and digestive juices.
- Distal pancreatectomy
- Patients with pancreatic neuroendocrine carcinoma are frequently treated with this procedure.
- The surgeon removes parts of the pancreas and, in certain cases, the spleen.
- Total pancreatectomy
- A complete pancreatectomy involves the removal of the whole pancreas and sections of the small intestine and stomach.
- The gallbladder, common bile duct, spleen, and lymph nodes in the vicinity are removed.
Surgery may be recommended to ease symptoms in advanced pancreatic cancer that have become too big to be removed or have spread to distant organs. These techniques, sometimes known as palliative surgery, include:
- Biliary bypass
- Some pancreatic tumors prevent bile (a digestive fluid produced by the liver) from flowing from the common bile duct to the small intestine, causing bile to accumulate in the gallbladder.
- By cutting into the gallbladder or bile duct and creating a new channel to the small intestine, the surgeon can circumvent the obstruction.
- Gastric bypass
- To avoid a second operation if the tumor continues to develop, the surgeon may establish a new pathway from the stomach to the small intestine at the same time as the biliary bypass.
- In other instances, the tumor has already blocked the passage of food from the stomach, necessitating the creation of a direct route from the stomach to the small intestine.
- Endoscopic stent placement
- A doctor may be able to unblock an obstructed bile duct by inserting a stent, which is a thin flexible tube, into the clogged location.
- Endoscopy is a technique in which a thin, flexible tube is inserted into the beginning of the small intestine while the patient is anesthetized.
Surgery for pancreatic neuroendocrine tumors
Pancreatic neuroendocrine tumor surgeries are conducted to remove the tumor. Aside from the Whipple technique and distal pancreatectomy surgery, the following are performed:
- Enucleation: When endocrine cancer arises in only one area in the pancreas, the tumor can be removed surgically.
- Total gastrectomy: Surgery involves removing the patient’s stomach.
- Parietal cell vagotomy: The surgeon involves cutting the nerve that causes acid to be made in the stomach.
- Liver resection: The surgeon involves removing a portion of the liver or the entire liver.
- Radiation therapy is a cancer treatment that uses high-energy X-rays to kill or slow the development of cancer cells.
- Radiation therapy can be used before or after surgery to help reduce a pancreatic tumor or to eradicate any cancer cells that remain after a tumor is removed.
- Most pancreatic neuroendocrine tumors are not treatable with radiation.
It is used to treat pancreatic neuroendocrine cancer that has progressed to the liver or other organs, as well as exocrine pancreatic cancer metastases. Different types include:
- Cryoablation or cryosurgery:
- This freezes cancer cells and the surrounding tissue using a probe introduced into the tissue and filled with liquid nitrogen or liquid carbon dioxide.
- Ablation can be performed by a doctor during surgery or laparoscopy.
- Radiofrequency ablation:
- In radiofrequency ablation, a probe is introduced into malignant tissue.
- The probe emits high-frequency radio waves that heat and kill the tumor.
- Microwave thermotherapy is a related approach that uses microwaves rather than radiofrequency radiation.
- Embolization is a procedure used to limit cancer development by cutting off the tumor's blood supply.
- A tiny tube called a catheter is guided through the artery near the tumor, and if necessary, a dye is injected to highlight the blood vessels and arteries.
- The doctor then injects a particular substance into the conduit to halt blood flow to that specific location.
- Transarterial embolization:
- It involves the insertion of tiny radioactive microspheres in the arteries supplying the affected parts of the pancreas.
- Certain chemotherapeutic drugs can be prescribed by the doctor.
- Hepatic arterial occlusion:
- Embolization distributes microscopic particles or particular medications to the liver through the hepatic artery, a blood vessel that provides blood to the liver.
- Blocking blood flow can prevent oxygen and nutrients from reaching the tumor, hence halting tumor development.
- Using embolization to deliver chemotherapy medications to a liver tumor concentrates the majority of the drugs in the tumor.
- Chemotherapy uses medications to either eliminate or slow the development of cancer cells.
- Medications can be administered orally or intravenously to patients.
- These medications enter the patient's circulation and reach cancer cells throughout the body.
- Other medications are injected directly into a bodily organ or area, such as the abdominal cavity. Combination chemotherapy treats a patient's cancer with more than one medicine.
- Hormone treatment may be used to inhibit or eliminate hormones that govern the proliferation of cancer cells in patients with pancreatic neuroendocrine carcinoma.
- Targeted treatments are medications that attack cancer cells while leaving healthy cells alone. They disrupt the signals of certain enzymes that cancer cells need to quickly divide and proliferate.
- Targeted medications are those that are specially developed to attack pancreatic neuroendocrine cancer cells.
Immunotherapy or biologic therapy
- Immunotherapy combats cancer by using the patient's immune system.
- Substances produced by the body or created in a laboratory are used to augment, enhance or restore the body's natural anti-cancer defenses.
- Pancreatic cancer affects your digestive tract in various ways.
- Furthermore, surgery and other pancreatic cancer therapies interfere with the natural synthesis of enzymes that aid in digestion.
- Many patients require assistance with diet and weight management.
- Clinical trials represent hope for patients with cancer—hope for a cancer-free planet, as well as improved, more focused methods of preventing, detecting, treating, and curing particular tumors.
- Patients can enroll in clinical trials before, during, or after beginning cancer therapy.
Pain control and palliative care
Most people with advanced pancreatic cancer have pain because the pancreas is placed near multiple key organs and a complicated network of nerves. Pancreatic tumors can induce gastrointestinal difficulties and other issues that may necessitate extra therapy. Doctors collaborate with patients to ensure that they have the highest possible quality of life while combating this condition.
- Pain medication: Pain management and palliative care professionals are committed to identifying the most effective pain management options.
- Pain medicine is provided in a variety of ways, including:
- Intravenous (through injection into a vein)
- Orally (by mouth)
- Peripheral (through injection into spinal fluid or tissue near the spinal cord)
- Cutaneous (through the skin, via pain patches or creams)
- Portable and implanted infusion devices that are used as needed to maintain quality of life while minimizing pain-related consequences
- Pain medicine is provided in a variety of ways, including:
- Powerful nerve blocks:
- The neurolytic celiac plexus block (NCPB) is a highly efficient pain treatment therapy.
- NCPB entails directly injecting medicine into the neurological system to suppress pain signals delivered by the pancreas to the brain.
- Anesthesiologists use sophisticated X-ray technology to execute this treatment. In most individuals, pain can be significantly decreased while simultaneously reducing the number of drugs given to the patient by 50 to 70 percent.
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What are the survival rates of patients with pancreatic cancer?
Early identification and preventative efforts may improve pancreatic cancer survival rates.
Although pancreatic cancer is uncommon, it is one of the types of cancer that are more difficult to treat. This is because symptoms generally do not appear until the malignancy is advanced, making treatment difficult.
Aside from being difficult to detect early, pancreatic cancer is lethal because it is difficult to cure. This is because pancreatic cancer tumors do not react as effectively to standard cancer therapy as other, less fatal types of cancer. However, there are therapeutic options available, including surgery, chemotherapy, and radiation.
Treatment is usually a mix of these three treatments, depending on the type of pancreatic cancer and when it is diagnosed. A novel chemotherapy treatment combination has recently shown promise for patients with pancreatic cancer that has metastasized or spread to other areas of the body.
- Pancreatic cancer is the third highest cause of cancer mortality in the United States.
- The total five-year survival rate is only nine percent.
- Pancreatic cancer is the 9th most prevalent cancer in women and the 10th most common cancer in men.
According to the American Cancer Society, the five-year survival rate per stage includes:
|Stage||Survival rate percentage|
|Stage IIB and Stage III||12%|
According to 2017 research published in the Annals of Surgical Oncology, the five-year survival percentage for patients with tumors smaller than 2 cm in size and removed surgically is more than 40 percent.
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