Welcome to OncMonk | Pancreatic Cancer

Overview

Pancreas is a part of digestive system that is responsible for making insulin and digestive juices. Pancreatic cancer is a disease in which malignant cells form in the tissues of the pancreas. It represents 7.8% of all cancer deaths around the world. The number of deaths estimated in 2020 is 47,050. Pancreatic cancer in India is lower in terms of incidence, mortality, and prevalence compared to pancreatic cancer worldwide.

Types of Pancreatic Cancer

Pancreatic adenocarcinoma

About 95% of cancers of the pancreas are adenocarcinomas. These cancers usually start in the ducts of the pancreas. Less often, they develop from the cells that make the pancreatic enzymes, in which case they are called acinar cell carcinomas.

Ampullary Cancer

This cancer starts in the ampulla of Vater, which is where the bile duct and pancreatic duct come together and empty into the small intestine.

Less common types of exocrine cancer

It includes adenosquamous carcinomas, squamous cell carcinoma, signet ring cell carcinomas, undifferentiated carcinomas, and undifferentiated carcinomas with giant cells. Other rare types of pancreatic cancer are cystic tumors and cancer of the acinar cells.

Causes

Somatic mutations in pancreatic cancer have changes in the p16 and TP53 genes, which can be part of some genetic syndromes. Many pancreatic cancers also have somatic mutations in genes such as KRAS, BRAF, and DPC4 (SMAD4)- not part of inherited syndromes.

Risk Factors

Smoking

There are higher chances of developing pancreatic cancer in people who smoke.

Obesity

The risk of pancreatic cancer is associated with people who are obese because the pancreas produces more insulin in obese people.

Other associations for pancreatic cancers are

History of diabetes or chronic pancreatitis.
Family history of pancreatic cancer or pancreatitis.
Certain hereditary conditions, such as:
- Hereditary nonpolyposis colon cancer (HNPCC; Lynch syndrome).
- Hippel-Lindau syndrome.
- Peutz-Jeghers syndrome.
- Hereditary breast and ovarian cancer syndrome.
- Familial atypical multiple mole melanoma (FAMMM) syndrome.
- Ataxia-telangiectasia.

Signs & symptoms

Jaundice

Light-colored stools

Dark urine

Pain in the upper or middle abdomen and back

Loss of appetite

Feeling very tired

High temperature of the body

Diarrhea or constipation

Diagnosis

Endoscopic retrograde cholangiopancreatography (ERCP)

A procedure used to visualize the ducts that carry bile from the liver to the gallbladder and from the gallbladder to the small intestine. Sometimes pancreatic cancer causes these ducts to narrow down and block or slow the flow of bile, causing jaundice.

Percutaneous transhepatic cholangiography (PTC)

A procedure used to image the liver and bile ducts. If a blockage is found, a thin, flexible tube called a stent is sometimes left in the liver to drain bile into the small intestine or a collection bag outside the body. This test is done only if ERCP cannot be done.

Laparoscopy

A surgical procedure explore for any disease inside the abdomen. The laparoscope may have an ultrasound probe at the end to bounce high-energy sound waves off the pancreas. This is called a laparoscopic ultrasound.

Biopsy

There are several ways to do a biopsy for pancreatic cancer. A fine needle or a thick (core) needle may be inserted into the pancreas during an x-ray or ultrasound to remove cells. Tissue may also be removed during a laparoscopy or surgery to remove the tumor.

Pancreatic Cancer