Pancreatic cancer: symptoms, treatment, prognosis
Pancreatic cancer refers to a rather aggressive forms of malignant tumors and is widespread. Any geographical differences in the frequency of its occurrence is not marked, but it is known that inhabitants of the industrialized countries get sick more often.
Among all malignant tumors of the pancreatic cancer is not more than 3%, but mortality this type of tumor has a strong fourth place, making it extremely dangerous. In addition, every year the number of cases in different countries continues to grow steadily.
It is believed that the disease is equally common in men and women, however, some sources indicate that among patients with men slightly more. Perhaps this is due to the greater prevalence of harmful habits (particularly Smoking) among males.
Like many other tumors, pancreatic cancer predominantly affects the elderly part of the population and occurs in patients older than 60 years. By this age, reduced natural mechanisms of antitumor protection, accumulate spontaneous mutations, broken processes of cell division. It is worth noting that most elderly people already have pathological changes in the gland (pancreatitis, cysts), which also contribute to the growth of cancer.
Very often the presence of tumor is not accompanied by any specific symptoms and complaints patients present already in advanced cases of the disease. Partly this is linked with not always good results of the therapy and poor prognosis.
Cancer of the pancreatic head is more than half of all tumors of the specified locale. Up to a third of patients have a total lesion of the pancreas. Manifestations of the tumor are determined by the Department in which it is located, but before symptoms appear when the lesion of the pancreatic head.
Causes of cancer
Causes of pancreatic cancer are diverse, but the contributing factors are quite widely distributed among the population.
The main risk factors of tumors of the pancreas can be considered:
- Features power;
- Diseases of the gland – pancreatitis, cysts, diabetes mellitus;
- Diseases of the biliary tract;
- Hereditary factors and acquired gene mutations.
Smoking causes the development of many types of malignant tumors, including pancreatic cancer. Carcinogenic substances get into the lungs with the inhaled smoke, are carried by the blood throughout the body, realizing its negative effects in various organs. In the pancreas in smokers can be detected hyperplasia of the epithelium of the ducts, which may become source of malignant transformation in the future. Perhaps with more frequent spread of this addiction among men is associated and somewhat greater frequency of disease among them.
Eating habits greatly contribute to the defeat of the parenchyma of the pancreas. The abuse of fatty and fried foods, alcohol provokes excessive secretion of digestive enzymes, dilated bile ducts, stagnation in their secret with inflammation and damage to the glandular tissue.
Chronic diseases of the pancreas, accompanied by its inflammation, atrophy of the islets, the proliferation of connective tissue with compression of the lobules (chronic pancreatitis, diabetes, cysts after acute inflammation, or necrosis, etc.) are conditions that significantly increase the risk of cancer. Meanwhile, chronic pancreatitis is found in most of the older people, and can also be a substrate for diabetes mellitus of the second type, in which the risk of cancer doubles.
Diseases of the biliary tract, for example, the presence of stones in the gallbladder, cirrhosis of the liver prevent the normal emptying of the ducts of the pancreas, which leads to stagnation of secretions, epithelial cell injury, secondary inflammation and sclerosis, and this may be the background to the development of cancer.
The role of hereditary factors and genetic disorders continues to be explored. Known family cases, and more than 90% of patients show p53 gene mutation and K-ras. Study of genetic abnormalities in pancreatic cancer population was not performed, however, soon such an opportunity may appear that will facilitate early diagnosis of the disease, especially in adverse family history.
Because carcinoma occurs generally in the changed fabric, such as adenoma (benign glandular tumor), chronic pancreatitis and pancreatic cyst can be considered precancerous.
As can be seen, a major role in the Genesis of cancer is played by the external shocks, which most of us do not give importance to, while simple rules such as good nutrition, a healthy lifestyle, elimination of bad habits to a considerable extent help to maintain a healthy pancreas, even in old age.
Features classification of tumors of the pancreas
The pancreas is very important not only for proper digestive system. As you know, she carries and endocrine function, producing hormones, particularly insulin, glucagon etc.
The bulk of the organ formed by glandular tissue that produces digestive enzymes and the endocrine function is performed by specialized cells, grouped in the so-called islets of Langerhans.
Since the major part of pancreas is represented exocrine parenchyma, it often becomes a source of cancerous tumors.
Classification of malignant neoplasms of the pancreas based on their histological structure, localization, extent of organ, lymph nodes, etc. On the basis of all these features installed and the stage of the disease.
Depending on histological structure distinguish different types of neoplasia:
These species are characteristic of the exocrine glands, and the most common form is adenocarcinoma of varying degrees of differentiation occurring in more than 90% of cases.
A tumor of the endocrine division is diagnosed much less frequently, and its kind is determined by which type of endocrine cells it originates (insulinoma, glucagonoma, etc.). These tumors usually are not malignant, but due to the hormonal activity and the possibility of growth to a significant size, can cause significant adverse effects.
Traditionally, the cancer classification used is the TNM system, however, it applies only to tumors of the exocrine glands. Based on the data characterizing the tumor (T) nodal involvement (N) and the presence or absence of metastases (M) allocated to the stage of the disease:
- IA – characterizes the tumor up to 2 cm located within the gland, the lymph nodes are not affected, and distant metastases are absent;
- IB – tumor is larger than 2 cm, but still localized in the gland, within its borders; metastases to lymph nodes and distant organs, is not typical;
- IIA – neoplasia extends beyond pancreas, but the large arterial trunks (celiac, superior mesenteric artery) remain intact; metastasis at this stage is not detected;
- IIB – the tumor is 2 cm or more may go beyond the boundaries of the authority, not vrasta into vessels, but revealed metastases in nearby lymph nodes;
- III – the tumor is embedded in the celiac trunk, superior mesenteric artery, a possible regional nodal metastases, but no distant;
- Stage IV – the most severe neoplastic lesions, accompanied by the detection of distant metastases, regardless of the tumor size, the presence or absence of changes in the lymph nodes.
Like any other malignant tumor, a cancer of the pancreas tend to spread throughout the body in the form of metastases. The main way is lymphogenic (lymph flow), and the most commonly affected lymph nodes of the head body, the celiac, mesenteric, retroperitoneal.
Hematogenous route is realized by circulatory system, while metastases can be detected in the lungs, bones and other organs and characterize a far-reaching process. Hepatic metastases are identified in approximately half of patients and can even be mistaken for liver cancer, they are not being.
Because the pancreas is covered on three sides by the peritoneum, when the tumor on its surface, is the dispersal of cancer cells in serous cover abdominal – carcinomatosis, which is the basis of the implant way of dissemination.
Manifestations of tumors of the pancreas
Specific symptoms of pancreatic cancer there, and often the signs of swelling due to lesions of neighboring organs the abdominal cavity during germination and their growth.
Such early symptoms as a change in tastes, loss of appetite, or weakness do not always cause the patient to immediately consult a doctor, as may be characteristic of many other diseases.
Often the tumor grows quite a long time, does not cause any concern to the patient, but on closer questioning will become clear that the gastrointestinal tract is not all right. The fact that most often, cancer affects older people with certain diseases of the digestive system, so the symptoms of the disorders in the abdominal organs is not rare usual and can remain in the early stages without proper attention.
Symptoms of pancreatic cancer depend not only on the stage of the lesion and the tumor in the body. Most often found:
A feature of lesions of the parenchyma of the gland is the propensity of patients to thrombosis of different localization, which is due to hit the bloodstream of excess proteolytic enzymes that violate the coordinated operation of the coagulation and anticoagulation systems.
All manifestations of cancer can be grouped into three phenomena:
- Obturation was associated with the germination of the bile ducts, intestine, duct pancreas, with jaundice, increased pressure in the biliary tract, violation of passage of food mass in the duodenum;
- Intoksikatsii – is associated with tumor progression and highlighting the various products of metabolism, as well as a violation of processes of digestion in the small intestine due to lack of pancreatic enzymes (loss of appetite, weakness, fever, etc.);
- The phenomenon of compression due to compression of nerves by tumor site, accompanied by pain syndrome.
Because the common bile duct and pancreatic duct open together into the duodenum, the cancer is head cancer, squeezing and vrasta in the adjacent tissue, accompanied by obstruction of the outflow of bile from the signs of jaundice. In addition, it is possible to palpate enlarged gall bladder (Courvoisier symptom), pointing to the defeat of the head of the pancreas.
Cancer of the body of the pancreas is characterized mainly by pain, when the pain is localized in the epigastrium, lumbar region, left hypochondrium and increases with the adoption of a patient lying position.
Cancer of the tail of the pancreas is diagnosed relatively rarely, and the symptoms appear only in advanced stages. As a rule, severe pain, and during germination tumor of the splenic vein possible thrombosis, increased pressure in the portal system, which is fraught with enlargement of the spleen and varicose veins of the esophagus.
The first symptoms of cancer are reduced to the appearance of pain, and after a few weeks the accession of the jaundice.
Pain is the most frequent and the most characteristic feature, regardless of the place of growth of the neoplasia. High intensity accompanied by the swelling of the body, as well as possible at growing tumors in the nervous plexus, and vessels. Patients describe pain in different ways: dull constant or occurring acute and intense, localized in the epigastrium, right or left upper quadrant, radiating to the interscapular region surrounding. Often the pains are aggravated by errors in diet (fried, spicy, fatty foods, alcohol), as well as evening and night-time, then the patients take a forced position – sitting, some bending forward.
Pain in pancreatic cancer are similar to those of acute or exacerbation of chronic pancreatitis, degenerative disc disease or a herniated disc, so there may be cases of delayed diagnosis of cancer.
A very significant manifestation of pancreatic cancer is jaundice diagnosed in 80% of patients with cancer head-on. Reasons it is a germination by the tumor of the common bile duct or increased compression due to metastasis in lymph nodes. Violation of passage of bile in the 12-duodenum leads to an increase in the gall bladder, absorption through the wall of the bile pigment bilirubin back into the blood, and skin and mucous membranes thus acquires a yellow tint. The accumulation in the skin of bile acids causes intense itching and promotes scratching, and patients prone to irritability, anxiety, sleep disturbance.
Equally important symptoms of neoplasia of the pancreas are weight loss and dyspepsia: vomiting, nausea, diarrhea, appetite loss etc. a violation of the digestive processes due to lack of enzymes normally produced by the exocrine unit of the pancreas and obstruction of the outflow of bile. In addition, changing the nature of the stool – steatorrhea when stool contain significant amounts of unsplit fat.
Similar symptoms of dyspepsia may occur in gastric cancer, especially when cancer spreads to the pancreas. There’s also the reverse situation: pancreatic cancer grows into the wall of the stomach, leading to disruption of the passage content, the narrowing of the antrum, etc., Such cases require a thorough diagnosis and determine the source of the growth of tumors, as this will determine the future tactics of treatment and prognosis.
Result from destruction of the islets of Langerhans to the described characteristics of the tumor may be added the symptoms of diabetes due to lack of insulin.
As the progression of the tumor is increasing General intoxication symptoms, there is fever, aggravated by digestive disorders and reduces weight. In such cases already diagnosed a severe degree of damage of the pancreas.
Rare forms of endocrine tumors of the prostate are manifested by symptoms characteristic of disorders of level of a hormone. So, insulinoma accompanied by hypoglycemia, anxiety, sweating, fainting. Gastrinomas tend to the formation of ulcers in the stomach due to the increased production of gastrin. Glucagonoma manifested by diarrhea, thirst and increased urine output.
How to detect a tumor?
Identification of pancreatic cancer – not an easy task. In the early stages of discovery it is very difficult due to scarce symptomatology and few and nonspecific complaints. Often patients themselves postpone visit to the doctor. Suffering a long time with chronic pancreatitis, inflammation of the stomach or intestine, patients attributed the symptoms of indigestion or pain on the already existing pathology.
Diagnosis of the disease begins with a visit to a doctor who will examine, propellerom abdomen, detail to find out the nature of complaints and symptoms. After that will be assigned to laboratory and instrumental examination.
General and biochemical blood tests are mandatory in case of suspected cancer of the pancreas, and to identify possible changes such as:
- Anemia, leukocytosis, increased ESR;
- The reduction in the amount of total protein and albumin, increase in bilirubin, liver enzymes (AST, ALT), alkaline phosphatase, amylase etc.
A special place is the definition of tumor markers, particularly CA-19-9, however, this figure increases significantly only in case of massive tumor, while the early phase of the tumor may not change at all.
Among the instrumental methods of identifying pancreatic cancer have a high diagnostic value of ultrasound, CT with contrast, MRI, biopsy with morphological verification of the diagnosis.
Currently, the usual ultrasound endoscopic prefer when the sensor is within the lumen of the stomach or duodenum. Such a short distance to the pancreas allows to suspect a tumor, even of small size.
Among radiographic methods the use of CT and retrograde cholangiopancreatography enables the use of a contrast agent to visualize the excretory duct of the gland, which, when the tumors will be narrowed down or do not pass in some areas.
The most accurate method of diagnosis can be considered fine-needle puncture biopsy is the sampling of a fragment of the tumor for histological examination. Possible biopsy during diagnostic laparoscopy.
To detect lesions of the stomach or intestines possible introduction of a radiopaque substance followed by x-ray, fibrogastroduodenoscopy.
In some cases to help the doctors comes radionuclide study (scintigraphy), as well as surgical techniques up to a laparoscopy.
Even when using the whole Arsenal of modern methods of research, diagnosis of pancreatic adenocarcinoma is highly complex, and scientists are constantly finding simple and affordable ways, which can be screening.
Interestingly, the real breakthrough in this direction was made 15-year-old student D. Andraka from the United States, a close family friend who was suffering from pancreatic cancer. Andraka invented a simple test for cancer with the use of paper, reminiscent of such for the diagnosis of diabetes. Using a special paper impregnated with antibodies to mesothelin secreted by tumor cells, we can assume the existence of tumors with a probability of over 90%.
The treatment of pancreatic cancer represents a challenge for oncologists. This is because the majority of patients being in old age suffer from various other diseases, complicating the operation or use of other methods. In addition, the tumor is detected, usually in advanced stages, when the germination of her major blood vessels and other organs makes impossible the complete removal of the tumor.
Postoperative mortality is, according to various estimates, up to 30-40% due to high risk of developing complications. Traumatic in its volume of operation, the removal of fragments of the intestine, bile duct and bladder, as well as products affected gland of various enzymes predispose to poor regeneration, failure of sutures, the possibility of development of hemorrhage, necrosis of the parenchyma of the gland, etc.
The main and most effective is the surgical removal of the tumor, however, even in this case, under the most favorable circumstances, patients live for about a year. With the combination of surgery, chemotherapy and radiotherapy, the life expectancy may increase to one and a half years.
The main types of surgery are considered radical surgery and palliative. Radical treatment involves removal of the affected part of the gland along with the tumor, fragment of the duodenum and jejunum of the intestine, antrum, gallbladder, and distal portion of the common bile duct. Naturally, the lymph nodes and fiber also should be removed. In the case of cancer of body and tail of the gland in the scope of the intervention included even and spleen. It is clear that such an operation is difficult to count on good health and a full recovery, but it prolongs life.
In rare cases of total cancer removes the whole pancreas, however, subsequently developing severe diabetes, poorly amenable to correction by insulin, significantly aggravates the prognosis. Five-year survival of operated patients with advanced forms of cancer do not exceed 10%.
Such treatments as chemotherapy and radiation are often used in combination with surgery, and isolated their purpose is only possible in cases of contraindications for surgery.
During chemotherapy with multiple drugs simultaneously can create some regression of the tumor, but relapse is still inevitable.
Radiation exposure is carried out before the surgery and during or after it, and the survival rate of patients is about one year. There is a high probability of radiation induced reactions in elderly patients.
Diet for pancreatic cancer involves the use of easily digestible food that does not require the generation of a large number of enzymes. Should the exclusion from the diet of fatty, fried or spicy foods, smoked meats, canned food and any alcohol, strong tea and coffee. In the case of diabetes have to give up carbohydrates (pastries, cakes, sweet fruits, etc.).
Many patients who have been diagnosed with cancer of the pancreas, tend to self-medicate with folk remedies, however, under such severe forms of malignant tumors are unlikely to be effective, so you should prefer the traditional medicine, which, if not healed, then at least prolong life and ease suffering.
Pancreatic cancer is an insidious tumor, a long time hiding under the «mask» of pancreatitis or even asymptomatic. To prevent cancer it is impossible, but to warn him with the help of preventive measures for everyone, and this requires proper nutrition, healthy lifestyle and regular visits to the doctor when there are any signs of damage to the pancreas.