Pancreatic cancer

The pancreas it is a glandular organ that you have two functions, endocrine secretion and exocrine secretion.

• Endocrine function consists of the production of different hormones such as insulin, glucagon, gastrin, vasoactive intestinal peptide (VIP) or somatostatin.
• The exocrine function of the pancreas consists in the secretion of pancreatic juice to the duodenum, a liquid with numerous enzymes such as lipase, amylase or trypsin, which are involved in the digestion of food.

When the cells that produce these substances (which are part of the pancreatic juice) become malignant, that is, they lose the control mechanisms that allow them to reproduce and die normally, a neoplasm or exocrine pancreatic cancer occurs.

How is it produced?

These tumors can occur in three different areas: the head of the gland (60% and 70% of cases), body or tail of the pancreas (20% and 25% of cases) or affect the entire gland and be multifocal (15% of cases). It has been proven that up to 70% of pancreatic cancers have a alteration of a gene called ras and approximately 60% present mutations in the p53 gene.

This type of cancer spreads locally with ease, especially at the retroperitoneal level, so that they infiltrate the fat that surrounds and protects the gland, as well as the nerves. 70% spread through the lymphatic route and half also do so through the venous route. The liver It is the main organ where the metastasis, although they can also do it in the peritoneum or lungs.

Pancreatic cancer Symptoms

Abdominal pain

Abdominal pain is the most common clinical manifestation of pancreatic cancer. It is usually a constant dull ache, located in the left and upper abdomen, which extends towards the back as if it were a belt. It is a predominantly nocturnal pain, which prevents sleep and worsens with eating and being stretched, but improves when bending forward. This sign is the main one in pancreatic tumors that affect the body or the tail of the gland.

Jaundice

When the head of the pancreas is affected, in addition to the pain, jaundice usually occurs due to obstruction of the bile duct. In body and tail tumors, if there is jaundice, it is usually due to the presence of liver metastases.

Weightloss

weight loss is usually the earliest symptom in pancreatic cancer patients due to a decrease in caloric intake. By not being able to carry out their exocrine function, proteins and fats are not digested correctly, which is why diarrhea and steatorrhea, with the consequent weight loss and asthenia. In a third of the cases, as the pancreatic tissue is destroyed, a impaired glucose tolerance leading to diabetes.

Other symptoms

The patient may have a enlarged gallbladder of size that is palpable on examination, as well as hepatomegaly, splenomegaly, edema, ascites or portal hypertension, with the consequent appearance of esophageal varices.

How is it diagnosed?

Pancreatic cancer will be suspected in any patient with a picture of abdominal pain as described above and associated with weight loss, jaundice, diarrhea or steatorrhea. Thanks to theblood test the following values ​​may be altered:

• Decreasing lipase and amylase levels.
• Alteration of bilirubin levels and liver enzymes in cases of advanced disease.
• Alteration of glucose levels in case of involvement of insulin-producing cells.
• Elevation of tumor markers (CEA and CA 19.9) but they are not very specific.

Other essential tests to detect pancreatic cancer, especially imaging, are:

• Ultrasound: It is reliable, but its performance is poor when tumors are less than 2 cm in diameter.
• CT: it can be more precise in these cases and also allows an extension study to be carried out, evaluating the involvement of the liver, biliary and surrounding tissues of the pancreas.
• Endoscopic retrograde cholangiopancreatography (ERCP): allows to assess well lesions of the head of the pancreas and differentiate between chronic and pancreatic cancer.
• Nuclear magnetic resonance.
• Endoscopic ultrasound.

One time localized lesion it is essential to carry out a fine needle aspiration puncture (FNA) to be able to take a sample of the suspicious tissue (biopsy) and analyze it, which will give us the diagnosis of certainty.

Treatment and life expectancy

Unfortunately only between 10% and 20% of pancreatic cancers can be operated at the time of diagnosis. For this, there must be no metastasis, the tumor must be localized and the vascular structures must not be affected; in that case surgical intervention is possible. Depending on the location of the tumor, a partial pancreatectomy or a total resection of the pancreas will be performed if the involvement is diffuse.

When tumors they cannot be intervened, which occurs between 80% and 90% of the cases, the surgical options will be palliative, especially aimed at avoiding gastroduodenal and bile duct obstruction, either through shunts or stent placement.

The radiotherapy and they can alleviate the pain and increase patient survival if they are used as complementary treatments to surgery. However, pancreatic cancer is one of those worse prognosis they present; only about 5% of patients survive 5 years after diagnosis (most die within one year).

Precautionary measures

This cancer has been associated with tobacco, the high-fat and high-protein diets, the chronic pancreatitis, the diabetes and the cholecystectomy. On the contrary, neither alcohol nor coffee consumption has been associated with an increased risk of pancreatic cancer. Therefore, the main preventive measures consist of avoiding risk factors (smoking and fat and protein diets). It is also recommended to carry out moderate physical activity and avoid a sedentary lifestyle.