Pancreatic Cancer Treatment
The pancreas is a gland that is about 6 inches long and is pear-shaped lying on its side. The wider end of the pancreas is called the head, the middle section is called the body, and the narrow end is called the tail. The pancreas is located between the stomach and the spine.
The function of the pancreas in the body:
• It produces enzymes that help break down food into substances the body can use.• It produces hormones, such as insulin and glucagon, which help regulate blood glucose levels and assist the body in using and storing energy obtained from food.
Pancreatic cancer can occur in the cells of the pancreas that produce digestive enzymes or in the cells that produce hormones. Approximately 95% of pancreatic cancer cases begin in the cells that secrete digestive enzymes.
Causes of pancreatic cancer:
The causes of pancreatic cancer in men and women are not well known. Generally, pancreatic cancer occurs due to specific changes in how the pancreas cells function, particularly how they grow and divide into new cells.There are many risk factors for developing pancreatic cancer, but many of them do not directly cause cancer. Instead, they increase the likelihood of DNA damage in cells, which may lead to pancreatic cancer.
Risk factors for pancreatic cancer include:
1- Advancing Age:Pancreatic cancer is more common among older individuals. Nearly half of new cases are diagnosed in people aged 75 or older. Pancreatic cancer is rare in individuals under 40.
2- Smoking:
About 20% of pancreatic cancer cases are attributed to smoking. Cigarettes increase the risk of developing pancreatic cancer. Therefore, the best way for smokers to reduce their cancer risk and improve their overall health is to quit smoking entirely. The risk of developing pancreatic cancer for individuals who have quit smoking for 20 years is the same as for those who have never smoked.
3- Overweight or obesity:
More than 10% of pancreatic cancer cases are attributed to being overweight or obese. This increased risk may be due to the pancreas producing more insulin in these individuals.
4- Family cancer syndromes and genetic factors:
Sometimes, pancreatic cancer runs in families. However, only 5 to 10% of those diagnosed with pancreatic cancer have a family history of the disease.
The risk is increased if a first-degree relative has pancreatic cancer. This risk is higher if multiple first-degree relatives are affected or if a first-degree relative was diagnosed at a young age.
5- Exposure to high-energy radiation:
Exposure to high-energy radiation is associated with an increased risk of pancreatic cancer, like exposure to electromagnetic radiation from communication towers on rooftops.
This can occur through medical imaging such as X-rays and CT scans or radiation therapy for cancer. The health risks from radiation exposure due to these tests are very low, and it is important to undergo these tests for accurate diagnosis and appropriate treatment. Doctors keep radiation exposure to the minimum necessary and only perform these procedures when required to ensure that the benefits outweigh the risks of the original cancer treatment.
6- Other medical conditions:
• Chronic Pancreatitis: There is a link between chronic pancreatitis and pancreatic cancer. In rare cases, pancreatitis can run in families (hereditary pancreatitis) and represents about 1% of pancreatitis cases. Individuals with hereditary pancreatitis are at a higher risk of developing pancreatic cancer compared to the general population.
• Diabetes: Diabetes is a condition that affects pancreatic cells that normally produce insulin. People with diabetes have an increased risk of developing pancreatic cancer.
• Gallstones: Gallstones are small, solid lumps (typically made of cholesterol) that form in the gallbladder. People with gallstones are at a higher risk of developing pancreatic cancer compared to those without gallstones. This increased risk is because gallstones can cause chronic pancreatitis, which is a risk factor for pancreatic cancer.
• Metabolic Syndrome: Women with metabolic syndrome have an increased risk of developing pancreatic cancer. Metabolic syndrome is a cluster of conditions including:
o Excess weight around the waist.
o The presence of elevated blood glucose levels is due to the cells not responding properly to insulin (insulin resistance).
o Hypertension.
o High levels of fats in the blood.
Types of pancreatic cancer:
There are different types of cells in the pancreas, so there are various types of pancreatic tumors. Knowing the type of cell and where the cancer starts in the pancreas determines the most effective treatment. Cancer can originate in the head, body, or tail of the pancreas. Between 60% and 70% of pancreatic cancer cases begin in the head of the pancreas.1- Exocrine Pancreatic Cancers:
Most pancreatic cancers are exocrine, meaning they originate in the cells that produce pancreatic digestive enzymes.2- Pancreatic neuroendocrine tumors:
Endocrine tumors are uncommon. The cancer begins in the endocrine glands, where insulin and other hormones are produced and released into the bloodstream.What are the late symptoms of pancreatic cancer?
The symptoms of malignant pancreatic tumors vary depending on the stage of cancer. Generally, early symptoms of pancreatic cancer are not clear, as the disease often does not cause signs or symptoms in its early stages, making it difficult to detect. As the cancer progresses, symptoms become more apparent, and the symptoms of pancreatic cancer do not differ between children and adults or between men and women. Symptoms of late-stage pancreatic cancer include:• Jaundice (yellowing of the skin and the whites of the eyes).
• Light-colored stool.
• Dark urine.
• Abdominal and back pain.
• Abdominal swelling in pancreatic cancer patients.
• Unexplained weight loss.
• Loss of appetite.
• Fatigue.
These symptoms can be caused by many other conditions besides pancreatic cancer. Therefore, it is important to consult with the skilled doctors at Warith International Cancer Institute (WICI) within the Hepatobiliary and Pancreatic Oncological Surgery Clinic.
Is pancreatic cancer serious?
The seriousness of pancreatic cancer lies in its rapid spread and the difficulty of detecting and diagnosing it for the following reasons:• There are no noticeable signs or symptoms in the early stages of pancreatic cancer.
• The signs and symptoms of pancreatic cancer, if present, resemble those of many other diseases.
• The pancreas is hidden behind other organs such as the stomach, small intestine, liver, gallbladder, spleen, and bile ducts.
Tests for Diagnosing and Staging Pancreatic Cancer:
It is important to determine the stage of the disease and whether pancreatic cancer can be removed through surgery to plan for treatment. In addition to asking about personal and family health history and conducting a physical exam, doctors and staff at Warith International Cancer Institute (WICI) in Iraq perform the following tests and procedures:• Blood test: To measure levels of certain substances, such as bilirubin, released by tissues into the blood. Higher or lower levels than normal may indicate disease.
• Pancreatic cancer diagnosing through tumor marker testing: a procedure in which a sample of blood, urine, or tissue is examined to measure the amounts of certain substances produced by cancer cells in the body.
• Magnetic resonance imaging (MRI): It uses magnets, radio waves, and a computer to create detailed images of areas inside the body.
• CT scan: A spiral incisive CT scanner creates three-dimensional images of tissues and organs from different angles. A contrast dye may be injected to help make the organs or tissues more visible.
• Positron emission tomography (PET): A small amount of radioactive glucose is injected into a vein. The scanner then rotates around the body to create detailed images of the areas where the glucose is taken up. Since cancer cells often consume more glucose than normal cells, the images can be used to locate cancer cells in the body.
• Abdominal ultrasound imaging captures images of the inside of the abdomen: An ultrasound transducer is pressed against the skin of the abdomen and directs high-frequency sound waves into the abdomen. The sound waves bounce off the tissues and internal organs, creating echoes. The transducer receives the echoes and sends them to a computer, which uses the echoes to create images known as ultrasounds.
• Endoscopic Ultrasound (EUS): A procedure that uses an endoscope inserted into the body, typically through the mouth or rectum. The endoscope is a thin, tube-like instrument with a light and lens for viewing. A probe at the end of the endoscope emits high-energy sound waves that bounce off internal tissues or organs, creating echoes. These echoes form an image of the pancreas. This procedure is also called endoscopic sonography.
• 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 using X-rays. Sometimes, pancreatic cancer can narrow these ducts, blocking or slowing the flow of bile, which can cause jaundice. The endoscope is passed through the mouth, esophagus, and stomach to the first part of the small intestine. A catheter is then inserted through the endoscope into the pancreatic ducts. A dye is injected through the catheter into the ducts, and X-rays are taken. If the ducts are blocked due to a tumor, a thin tube may be placed in the duct to remove the obstruction. This tube (or stent) may be left to keep the duct open. Tissue samples may also be taken.
• Percutaneous transhepatic cholangiography (PTC): A procedure used to visualize the liver and bile ducts using X-rays. A thin needle is inserted through the skin beneath the ribs and into the liver. A dye is injected into the liver or bile ducts, and X-rays are taken. If an obstruction is found, a thin, flexible tube called a stent may sometimes be left in the liver to drain bile into the small intestine or an external collection bag. This test is performed if ERCP cannot be done.
• Biopsy: This involves removing cells or tissues to be examined under a microscope for signs of cancer. Several methods can be used for a pancreatic biopsy. A thin needle may be inserted into the pancreas during an X-ray or ultrasound to collect cells. Tissue can also be removed during laparoscopic surgery or through a procedure to remove the tumor.
Factors affecting the chances of recovery from pancreatic cancer and treatment options:
The diagnosis and treatment options depend on:• Whether the tumor can be surgically removed.
• The stage of cancer (the size of the pancreatic cancer and whether it has spread beyond the pancreas to nearby tissues, lymph nodes, or other parts of the body).
• The overall health of the patient.
• Whether the cancer is newly diagnosed or has returned after prior treatment.
Pancreatic cancer can only be managed if detected before it has spread, as it can then be completely removed through surgery. If the cancer has spread, supportive treatment can improve the patient's quality of life by managing symptoms and complications.
Stages of pancreatic cancer:
The stage of cancer describes how far the cancer has spread in the body, including the size of the tumor, whether it has spread, and the extent of its spread from its original location. Knowing the stage of pancreatic cancer is crucial for planning the most effective treatment.The following stages are used for pancreatic cancer:
• Stage 0 of pancreatic cancer is characterized by the presence of abnormal cells in the lining of the pancreas. These abnormal cells may turn into cancer and spread to nearby healthy tissues. Stage 0 is also called carcinoma in situ.• Stage 1 of pancreatic cancer means that the cancer is present only in the pancreas. Stage 1 is divided into stages IA and IB, depending on the tumor size.
o Stage IA: The tumor is 2 cm or smaller.
o Stage IB: The tumor is larger than 2 cm but no more than 4 cm.
• Stage 2 of pancreatic cancer is divided into stages IIA and IIB, depending on the size of the tumor and how far the cancer has spread.
o Stage IIA: The tumor is larger than 4 cm.
o Stage IIB: The tumor can be any size, and the cancer has spread to 1 to 3 nearby lymph nodes.
• Stage 3 of pancreatic cancer, means the tumor can be any size, and the cancer has spread to:
o Four or more nearby lymph nodes, or
o Major blood vessels near the pancreas.
• Stage 4 of pancreatic cancer, where the tumor can be any size, and the cancer has spread to other parts of the body, such as the liver, lungs, or the peritoneal cavity, which contains most of the organs in the abdomen.
Stage 4 pancreatic cancer is also called metastatic pancreatic cancer. Metastatic cancer occurs when cancer cells travel through the lymphatic system or blood and form tumors in other body parts. For example, if pancreatic cancer spreads to the liver, the cancer cells in the liver are pancreatic cancer cells.
Methods for determining pancreatic cancer treatment in Iraq:
1- Resectable pancreatic cancer:Resectable pancreatic cancer can be removed through surgery because it has not grown into major blood vessels near the growth.
2- Borderline resectable pancreatic cancer:
Borderline resectable pancreatic cancer has grown into a major blood vessel or surrounding tissues or organs. It may be possible to remove the growth, but there is a significant risk that not all cancer cells will be removed with surgery.
3- Advanced pancreatic cancer:
Advanced pancreatic cancer grows into nearby lymph nodes or blood vessels. Therefore, surgery cannot completely remove the growth.
4- Metastatic pancreatic cancer:
Metastatic pancreatic cancer has spread to other organs, so surgery cannot remove all the cancer.
5- Recurrent pancreatic cancer:
Recurrent pancreatic cancer is cancer that returns after treatment. It may come back in the pancreas or other parts of the body.
Treatment options for pancreatic cancer:
1- Surgical treatment for pancreatic cancer:
One of the following types of surgery may be used to remove the tumor:• Surgery to remove the head of the pancreas, the gallbladder, part of the stomach, part of the small intestine, and the bile duct. Enough of the pancreas remains to produce digestive enzymes and insulin.
• Total Pancreatectomy removes the entire pancreas, part of the stomach, part of the small intestine, the common bile duct, the gallbladder, the spleen, and nearby lymph nodes.
• Distal Pancreatectomy is a surgical procedure to remove the body and tail of the pancreas. The spleen may also be removed if the patient has cancer in both the spleen and pancreas.
If the cancer has spread and cannot be removed, the following types of surgery may be performed to relieve symptoms and improve quality of life:
• Biliary Bypass: If the cancer obstructs the bile duct, leading to a buildup of bile in the gallbladder, a biliary bypass may be performed. During this procedure, doctors at Warith International Cancer Institute (WICI) cut the bile duct or gallbladder above the obstruction and sew it to the small intestine to create a new pathway around the blocked area.
• Endoscopic Stent Placement: If the growth obstructs the bile duct, a procedure may be performed to place a stent to drain the accumulated bile. Top cancer doctors in Iraq may place the stent using a catheter that drains the bile into a bag outside the body, or the stent may be placed around the blocked area to drain the bile into the small intestine.
• Gastric Bypass: If the tumor obstructs the flow of food from the stomach, the stomach may be sewn directly to the small intestine so the patient can continue to eat normally.
2- Radiation therapy for pancreatic cancer:
Radiation therapy uses high-energy X-rays or other types of radiation to kill cancer cells or prevent them from growing. Pancreatic cancer is sometimes treated with external beam radiation therapy. This type of radiation therapy uses a machine outside the body to direct radiation to the area affected by cancer.3- Chemotherapy for pancreatic cancer:
Pancreatic cancer treatment with chemotherapy relies on drugs to stop the growth of cancer cells, either by killing them or preventing them from dividing. Chemotherapy for pancreatic cancer is typically administered through injection into a vein or taken orally, allowing the drugs to enter the bloodstream and reach cancer cells throughout the body.The number of chemotherapy doses for pancreatic cancer is precisely determined at the Warith International Cancer Institute (WICI), which is considered the best institution in Iraq for cancer treatment. Chemotherapy can also be combined with other types of treatment. For example, it may be combined with radiation therapy or targeted therapy.
4- Targeted therapy for pancreatic cancer:
Targeted therapy is the latest treatment for pancreatic cancer, using drugs or other substances to identify and attack specific cancer cells. Erlotinib is a targeted therapy drug used to treat pancreatic cancer.5- Immunotherapy for pancreatic cancer:
Immunotherapy relies on immune-boosting drugs to help the immune system recognize and effectively destroy cancer cells. Specific types of immunotherapies can be applied to treat pancreatic cancer.Pancreatic cancer pain treatments:
Pain can occur when the tumor presses on nerves or nearby organs around the pancreas. When pain medications are insufficient, treatments targeting the abdominal nerves can help relieve pain. Doctors at the Warith International Cancer Institute (WICI) may inject medication into the area surrounding the affected nerves or may cut the nerves to block pain sensation. Radiation therapy, with or without chemotherapy, can also help alleviate pain by shrinking the tumor.Suitable food for pancreatic cancer patients:
Surgery to remove the pancreas may affect its ability to produce enzymes that help digest food. As a result, patients may experience difficulties digesting food and absorbing nutrients. To prevent malnutrition, the staff at the best cancer treatment hospital in Iraq may prescribe medications to replace these enzymes.The importance of follow-up after pancreatic cancer treatment:
During treatment, follow-up tests or examinations will be conducted. Some tests performed to diagnose the cancer or determine its stages may be repeated to assess the effectiveness of the treatment. Decisions regarding continuing, changing, or stopping treatment may depend on the results of these tests. Certain tests will continue to be done periodically after the therapy ends to evaluate changes in the condition and check for disease recurrence.The lifespan of a pancreatic cancer patient:
Each patient is different, and what works for one person may not work for another, and vice versa. Overall survival rates are still much lower than those for other types of cancer.Can pancreatic cancer be cured?
Long-term recovery from pancreatic cancer depends on the size of the tumor, its type, lymph node involvement, and the extent of spread at the time of diagnosis. The earlier pancreatic cancer is diagnosed and treated, the better the outcomes.Unfortunately, pancreatic cancer often shows few or no symptoms until it advances and spreads. As a result, most cases (up to 80%) are diagnosed at later stages.
The survival rate for pancreatic cancer:
Compared to many other types of cancer, the five-year survival rate for pancreatic cancer is low, usually not exceeding 5 to 10%. Many individuals are diagnosed at stage four when the disease has spread. Up to 10% of patients who receive an early diagnosis become disease-free after treatment. For patients diagnosed before the tumor has grown significantly or spread, the average survival time for pancreatic cancer is 3 to 3.5 years.The prognosis for advanced stages of pancreatic cancer:
The five-year survival rate for advanced pancreatic cancer is 1%. A patient diagnosed with late-stage pancreatic cancer lives for about one year after diagnosis.Does pancreatic cancer lead to death?
Patients whose tumors are detected before they spread or become advanced have longer survival rates because their tumors can usually be surgically removed.About 15 to 20% of all pancreatic tumors are resectable. These include stage one and stage two tumors.However, tumors can still recur in many patients. Therefore, on average, patients who have had their tumors resected live for two and a half years after diagnosis, with a five-year survival rate ranging from 20 to 30%.
Factors affecting the success rate of pancreatic cancer treatment:
1- Appropriate treatment for the tumor:
Obtaining the right treatment for the specific type of tumor can significantly impact patient survival. The Warith International Cancer Institute (WICI) relies on a pathology team to identify the tumor subtype and analyze the patient's genetic history. Some chemotherapy and immunotherapy drugs may be particularly effective for certain types of tumors but could be completely ineffective for others.2- Physical condition after treatment:
Obtaining proper nutrition and maintaining physical activity as much as possible can affect how well patients tolerate the side effects of treatment and symptoms of pancreatic cancer.Younger patients tend to achieve better recovery because they have fewer comorbidities that may limit healing. However, even older patients can positively influence their recovery by focusing on nutrition and exercise.