Pancreatic cancer is one of the most aggressive tumors of the digestive tract. It is not an excessively frequent tumor (2.1% of all tumors), but its incidence has increased steadily since the 1950s.
The incidence in our country can be considered average, but is expected to grow by 40 percent in the next 15 years and in 2030 there will be 9,000 cases per year, according to data from the Spanish Association of Pancreatic Cancer (ACanPan). The problem, as they point out, is that while the mortality rate decreases for many other types of cancer, in the case of the pancreas they are increasing, hence the need to improve the early diagnosis of the disease.
Pancreatic cancer is difficult to discover in its early stages. The pancreas is in a deep region of the body, so tumors can not be seen or felt in their early stages during routine physical exams. The patients usually have no symptoms until the cancer has already spread to other organs.
Currently there are no tests or early detection methods for pancreatic cancer and, although some are being developed, knowing the symptoms remains the key to diagnosis. In fact, research shows that patients diagnosed and operated on time are more likely to live five years or more. In contrast, in patients with metastatic disease the median overall survival from diagnosis is 4.6 months.
The pancreas is composed of two types of tissues according to their functions. The exocrine tissue that has digestive functions and causes the so-called exocrine tumors that are the most frequent and the endocrine tissue that has metabolic functions (control of glycemia) and causes endocrine or neuro-endocrine tumors.
Often, pancreatic cancers in the early stages do not cause any signs or symptoms. For when they cause symptoms, they have often already spread outside the pancreas.
The symptoms of exocrine pancreatic cancers and pancreatic neuroendocrine tumors are often different.
Because of its frequency, we will focus on the symptoms of exocrine tumors, which frequently include:
Jaundice and related symptoms.
Jaundice manifests through the skin and eyes that turn yellow, dark urine, pale or greasy stools, and itchy skin.
Abdominal or back pain.
Cancers that originate in the body or tail of the pancreas can grow significantly and can begin to compress other nearby organs causing pain. The cancer can also spread to the nerves near the pancreas, which often causes back and belt pain.
Weight loss and lack of appetite.
Nausea and vomiting.
Enlargement of the gallbladder or liver.
Sometimes, a doctor can feel this enlargement during a physical examination (such as a large lump under the right ribs). It can also be seen in imaging studies.
Occasionally, pancreatic cancer can also cause an increase in the size of the liver, especially if the cancer has spread to this organ. It is possible that the doctor may realize this by feeling the area below the right ribs, by examining or observing it in imaging studies.
Blood clots.
Occasionally, the first sign that a person has pancreatic cancer is a blood clot (thrombosis) in a large vein, often in a leg. Symptoms may include pain, swelling, redness and warmth in the affected leg. Occasionally, a fragment of clot may be detached and move to the lungs (embolism), which could make breathing difficult and cause chest pain.
The diagnosis in early stages of the disease is sometimes difficult.
When jaundice appears, in addition to blood tests, the most appropriate initial exploration for diagnosis is ultrasound.
In most cases, it will be necessary to perform an abdominal CT (scanner), which allows a correct diagnosis and assess the extent of the disease.
Especially, if it is not possible to operate, a sample must be taken to confirm the diagnosis. This biopsy can be performed through a digestive endoscopy or, where appropriate, eco-endoscopy, or a fine-needle aspiration (FNA), which is directed to the desired area with radiological control.
The only curative treatment for pancreatic cancer is surgery, which involves the removal of the pancreatic head along with the bile duct, the duodenum and, occasionally, part of the stomach. It is a relatively long surgery and with a sometimes complicated postoperative period. Nowadays, the mortality during the intervention, carried out by experts, is practically nil. Chemotherapy and Radiotherapy are complementary to surgery, both before and after the intervention. Both treatments, especially with the incorporation of new drugs have managed to increase the survival of these patients by 3-4 times. As with other tumors, any time that is gained in survival allows the patient to receive new treatments.
Palliative treatment focuses on reducing symptoms to improve quality of life: relieve pain and solve biliary obstruction and digestive case.
The pain is usually controlled in the Pain Units and, sometimes, it may be necessary to resort to procedures of “destruction” of the affected nerves. The palliation of jaundice can be done by placing a prosthesis in the obstructed bile duct.
From HC Marbella we recommend that you consult with your doctor the factors that he or she is taking into account when considering the treatment options and that you value it together.
At HC Marbella we are convinced that listening to patients, understanding their concerns and those of their loved ones, and having a realistic discussion of expectations is essential so that patients can make an informed decision.
Dr. Hernán Cortés-Funes
Director of Oncology Service
May 16, 2018
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