Pancreatic cancer

Pancreatic cancer is the uncontrolled growth of malignant cells in the pancreas.

Pancreatic cancer represents 3% of all cancers, but it has the highest mortality rate of all major cancers and it is the cause of 5% of all cancer deaths.

The pancreas is an organ located in the abdomen, behind the stomach, with two main roles:

• Exocrine function: The pancreas produces enzymes essentials for digestion.
• Endocrine function: The pancreas produces and releases hormones directly into the bloodstream. The most important hormones released are insulin and glucagon, produced in the islets of Langerhans, that regulate the level of blood glucose.

Pancreatic cancer can be classified according to the altered function:

• Exocrine tumors
  • Pancreatic ductal adenocarcinoma.
  • Ampullary cancer (carcinoma of the ampulla of Vater)
  • Other less frequent types: Acinar cell carcinoma, adenosquamous carcinoma, etc.
• Endocrine tumors
  • Insulinoma
  • Gastrinoma or Zollinger-Ellison syndrome
  • Glucagonoma
  • Other less frequent types: VIPoma, somatostatinoma, GRFoma, ACTHoma, etc.

The most common form of pancreatic cancer is pancreatic ductal adenocarcinoma accounting for more than 95% of all pancreatic cancers.

The lifetime risk of developing pancreatic cancer in developed countries is around 1%.

Pancreatic cancer mainly affects people between 60 and 80 years old.

The main risk factors for suffering pancreatic cancer are:

• Tobacco: Accounts for approximately 30% of all cases.
• Diabetes mellitus.
• Chronic pancreatitis.

The symptoms of pancreatic cancer depend on the type:

• Exocrine tumor
  • Obstructive jaundice (a yellow color of the skin and eyes)
  • Weight loss
  • Epigastric pain that radiates to the middle of the back
• Endocrine tumors
  • Insulinoma: Fatigue, weakness, rapid heartbeat (tachycardia), sweating, tremors and confusion after meals.
  • Gastrinoma (Zollinger-Ellison syndrome)
    • Stomach pain that relieves with food and antacids, but may become severe over weeks or months.
    • Watery diarrhea.
  • Glucagonoma
    • Skin spots or patches
    • Sore tongue
    • Weight loss

Chemotherapy and radiotherapy are not usually effective in any stage of the disease.

Surgery, except when the tumor is confined, is not either effective. A tumor is considered confined when its size is less than 2 cm, there is no metastasis to the lymph nodes and it does not exceed the capsule that covers the pancreas. When the tumor is confined, a surgical removal of the affected tissue is the best treatment.

However, surgery may be used as a palliative care in order to improve the quality of life and to avoid obstructions of the bile ducts or the digestive tract.

In any case, it is important to treat both the physical pain and the psychological consequences of the patients and their families.

In the case of the pancreatic cancer, the problem is more severe because this type of cancer usually brings on depression and mood swings. This is a fact to be considered when dealing with these type of patients in order to provide them relief from their suffering.

Pancreatic cancer has a high death rate.

The cases with the best five-year survival rate are the ones of confined tumors. In confined cases, after the surgical procedure, the estimation is a five-year survival rate between 18 and 24%.

If the cancer is extensive or widespread, the survival rate is very low. In general, most patients die in the first year after the diagnosis of the disease.