Pancreatic Cancer

Pancreatic Cancer

Pancreatic cancer is one of the most feared of all gastrointestinal neoplasms, because it typically presents at an advanced stage and is very difficult to treat.  The most common form of pancreatic cancer known as adenocarcinomas arise from the cells that line the pancreatic duct and as the tumors grow can lead to a number of different problems, which will be discussed below.

The causes of pancreatic cancer are not exactly clear, but some of the risk factors are thought to be smoking, alcohol consumption, a diet rich in animal fat and chronic pancreatitis itself.  As in many cancers in the human body, chronic forms of inflammation seem to be a risk factor for the development of different types of tumors.

What are the symptoms of pancreatic cancer?: Unfortunately, pancreatic cancer very often has no symptomatology, but as the tumor gets larger, it can impinge on neighboring organs and start to cause different types of problems.  If the tumor obstructs the common bile duct, which is the major path where bile exits into the intestine, patients can become jaundice.  This typically presents with yellowing of the eyes and darkening of the urine.  Abdominal pain is another typical presentation, which may radiate into the back and typically is made worse by eating or lying down.  Patients sometimes complain of nausea, decreased appetite and weight loss.

Diagnosis of pancreatic cancer:  Aside from a careful history and physical, which would arouse a physician’s suspicion, various tests are used to try to make this diagnosis as accurately as possible.  Ultrasounds are sometimes used to evaluate the pancreas, but they are typically somewhat limited.  A CAT scan is the most common tool used to evaluate the pancreas and other examinations might include MRI, an endoscopic ultrasound and an ERCP.

Endoscopic ultrasounds use an ultrasound probe at the tip of an endoscopic to obtain ultrasound images internally, close to the actual pancreas itself.  Endoscopic ultrasounds are very useful to look for the nature of any growth in the pancreas, adjacent suspicious lymph nodes and can allow for actual biopsy of abnormal-appearing tissue by inserting a needle through the scope into the suspicious area.

The endoscopic test referred to as ERCP is sometimes helpful for investigating the pancreatic duct and the common bile duct and in the case of obstruction of the common bile duct by a tumor, sometimes an ERCP is used to place a tube known as a stent to open up passage of bile through the obstructed area into the small intestine.  A brush can also be passed through the scope into the pancreatic duct to obtain tissue samples.

Even with these tools, it is sometimes very difficult to accurately stage pancreatic cancer and ultimately, exploratory surgery is very often needed to definitively look for a curable tumor.

Treatment of cancer of the pancreas:  Like many types of gastrointestinal cancers, cure is truly achieved only when lesions are found at an early enough stage so that complete surgical removal is possible.  Unfortunately, with pancreatic cancer that is less common and other additional forms of treatment often need to be considered.  These include radiation and chemotherapy, which often will slow the growth of a tumor and is sometimes used in addition to an attempt at surgical excision.

Unfortunately, pain management in patients with pancreatic cancer can often be a problem and may need to be formally addressed through pain management specialists for adequate treatment.