Pancreatic Cancer

The pancreas is an organ located in the posterior part of the abdomen, approximately 15 cm in length, completely covered by the stomach, duodenum and large intestine (colon).

Although it has many important tasks, it plays an important role in the digestion of food and in keeping blood sugar in balance. Although pancreatic cancer develops from every region of the organ, it most often develops from the head region. Again, they originate from the most frequently secreting cells and are called adenocarcinoma.

Pancreatic Cancer Risk Factors

Although the cause of the disease is unknown, it is more common in smokers and obese individuals. In almost 30% of patients, the cause of pancreatic cancer is smoking. Pancreatic cancer associated with adult diabetes is controversial. In a very small number of patients, pancreatic cancer may develop by heredity. Cancer is more common in men than women, and the risk increases with age. The average age is 63 for men and 67 for women.

Symptoms

Pancreatic cancer; It may occur with psychological disorders such as weight loss, abdominal pain, jaundice, loss of appetite, nausea-vomiting, weakness, fatigue, diarrhea, indigestion, back pain, glazing paste-colored stools, pallor, sudden onset diabetes without a family history, depression. .

The patient loses weight as a result of insufficient food intake along with bloating, indigestion and loss of appetite. Jaundice is the most common and earliest symptom. It initially appears in the eyes, then the skin becomes yellow, followed by a darkening of the urine color and turning into ‘tea colored urine’, and finally resulting in a light color of the stool, which is defined as ‘glassmaker’s paste’.

The cause of jaundice is the obstruction of the excretion of bilirubin made in the liver to the duodenum as a result of obstruction of the biliary tract by pancreatic cancer. While the pain is a mild discomfort, which is defined as vague abdominal pain, it takes the form of abdominal pain in the back in the future. It is blunt in nature. It is often associated with symptoms of bloating and indigestion.

Diagnosis of Pancreatic Cancer

Diagnosis of pancreatic cancer can be difficult, as the disease presents with insidious symptoms. In patients who are caught in the early period, it is important that the physician suspects this disease most frequently at the time of application to the physician and conducts research on it.

Laboratory examinations: Serum bilirubin, alkaline phosphatase, liver transaminases, and tumor markers such as CEA, CA 19-9 and CA 125 were elevated.  There is a positive bilirubin in the urine.

Ultrasonography: It is almost always the first examination method to be applied. The presence of a hard or cystic mass in the pancreas gives information about the size of the mass, its relationship with other surrounding structures, and its proximity to vascular structures.

Computed tomography (CT) and magnetic resonance imaging (MR): CT gives very important information about pancreatic tumors when taken orally and intravenously with contrast medication. It has a diagnostic feature of approximately 95% or more.

MR imaging is also important in the differential diagnosis of the tumor. These two examinations are used together when necessary to ensure that the correct results are obtained for the decision of surgery to be given to the patient and the staging of the tumor is performed correctly.

EUS (Endoscopic Ultrasonography): It is one of the most important examinations in the diagnosis and staging of the disease. During the observation, the relationship of the tumor with the vessels and its stage are determined. Pathological diagnosis can be made by taking biopsy during the procedure.

Pancreatic Cancer Treatment

At the beginning of the treatment, at the end of physical examination, laboratory and radiological examinations, the stage of the pancreatic tumor, its relationship with neighboring organs, especially whether it has spread to neighboring vessels and/or distant organs, and the chance of surgical removal are evaluated. Surgery cannot be performed in advanced stage tumors.

Along with the chemotherapy to be applied to these patients, some interventions can be applied to improve the comfort of life by correcting the existing jaundice, providing nutritional support and reducing pain. For this purpose, placing a tube (stent) that provides passage to the biliary tract with endoscopy from the mouth through the stomach, draining the bile out with the help of a needle placed from the abdominal skin to the intrahepatic bile ducts, advanced pain management techniques, in tumors that cause obstruction in the duodenum, this part is orally administered. Methods such as stent insertion by endoscopic method are used.

Surgical Treatment: In the examinations, if the tumor is suitable for surgical removal, classically ‘Whipple surgery’ is applied. In addition, if the tumor is located in the body and tail of the pancreas, relatively easier resection methods are applied. Surgical removal of the tumor is the only cure for these patients.

In pancreatic head tumors, surgery is more complicated since it is not possible to surgically remove only the head of the pancreas. In the applied Whipple surgery; Along with the head of the pancreas, the gallbladder, part of the main bile duct, duodenum, part of the stomach and surrounding lymph nodes are removed as a block.

Surgical Treatment of Pancreatic Cancer (Whipple Surgery) During or shortly after this surgery, in which a wide variety of organs are removed and continuity is ensured for a very long time, the patient’s death (mortality) or bleeding, leakage from the sutures made to ensure the continuity of the digestive system (fistula) conditions (morbidity) may be encountered. The accepted mortality rate in the world is 5% and below. Again, the accepted rate in the world for postoperative complications is 15-20%. In our country, these rates are 5-10% mortality and 20-25% morbidity rates.

Radiation Therapy: Also called radiotherapy. It involves using high-energy rays to kill cancer cells. Radiation therapy only affects cells in the treated area. Radiation is in the form of irradiation from outside by means of a machine. Radiotherapy is used alone or in combination with chemotherapy, especially if the location and size of the tumor complicates the surgery or in cases where surgery cannot be performed. Radiotherapy can be combined with chemotherapy to shrink the tumor before surgery. In some cases, radiotherapy may be given to prevent recurrences after surgery.

Chemotherapy: It is the use of anticancer drugs to kill cancer cells. Taking into account the general conditions of the patients before or after pancreatic cancer surgery, drug treatment called chemotherapy can be applied. Chemotherapy may be used in conjunction with radiotherapy to shrink the tumor prior to surgery or as a primary treatment in place of surgery.

Surgery and radiotherapy have no place in extensive advanced disease. It has been reported that the quality of life of the patients can be significantly improved and their survival may be prolonged by administering chemotherapy to this group of patients.