Pancreatic cancer is a malignant tumor formed from mutated cells of an organ that secretes substances necessary for the process of digestion and regulation of metabolism.
The pancreas is located in the left hypochondrium near the stomach and duodenum. It is penetrated by excretory ducts, vessels and nerves, covered with a connective tissue capsule and consists of three parts: head, body and tail. The excretory duct joins the bile duct at the head of the pancreas and opens into the duodenum.
Cells can mutate as they divide, and some of these mutations can interfere with cell division control. Then the cells begin to divide uncontrollably, and a tumor forms.
Pancreatic cancer is one of the most aggressive types of cancer. It is often asymptomatic until the later stages of the disease, when treatment becomes very difficult. With the bloodstream, cancer cells can spread throughout the body, forming distant secondary tumors (metastases).
The five-year survival rate (the percentage of patients who survive five years after diagnosis) for early-stage pancreatic cancer is up to 15%. This is because the organ is located in a place that is difficult to access for surgical operations and is densely surrounded by other organs. The surgeon requires extensive experience in performing operations to remove a malignant tumor. And the risk of complications after surgery is very high.
Pancreatic cancer is the sixth most common cancer and is responsible for 7% of cancer deaths of all types. It most commonly affects older people of both sexes. In more than half of cases, the tumor develops in the head of the pancreas. And in almost a third of cases, the entire organ is affected.
Pass an examination in our clinic to identify diseases of the pancreas and other organs as soon as possible.
Types of pancreatic cancer
According to its secretory function, the pancreas is divided into exocrine and endocrine parts. The exocrine part secretes digestive enzymes, which are secreted through the ducts into the duodenum. Endocrine tissue secretes hormones that go directly into the blood. According to which of these tissues a tumor has formed, exocrine malignant tumors of the pancreas (the most common) and endocrine ones are distinguished.
The most common endocrine tumor is adenocarcinoma. It can be ductal (formed in the glandular cells of the pancreatic ducts - the most common form of cancer) or acinar cell (from acinus cells - a special structure of the pancreas).
In addition to adenocarcinoma, types of pancreatic cancer include such rare varieties as squamous cell carcinoma, undifferentiated cancer, cystadenocarcinoma, adenosquamous carcinoma, and signet cell carcinoma.
Benign tumors can form in the pancreas, such as intraductal papillary tumor or cystic mucinous tumor. But they can become malignant, so they are often removed surgically, especially if their location interferes with the function of the pancreas. Patients with such diagnoses should be constantly examined.
Endocrine cell tumors occur in less than 5% of cases. They are called neuroendocrine tumors and islet cell tumors. According to the hormone secreted by the cells responsible for the formation of the tumor, neoplasms are called: gastrinoma (a tumor from cells that produce gastrin), insulinoma (insulin), glucagonoma (glucagon), somatostatinoma (somatostatin). These are usually benign tumors of the pancreas, but there are also malignant ones.
In rare cases, malignant tumors in the pancreas are metastases of cancer of another organ - this is metastatic cancer. The primary tumor may be in the gastrointestinal tract, kidneys, lungs, breast, or prostate. Sometimes the pancreas can affect metastases of melanoma (cancer of the skin and mucous membranes), osteosarcoma (bone cancer), leiomyosarcoma (smooth muscle cancer), Merkel cell carcinoma (skin cancer).
Location of pancreatic cancer
As already mentioned, the pancreas anatomically consists of a head (adjacent to the duodenum), which passes into the body (between the duodenum and stomach) and ends with a tail (reaches the spleen). A malignant tumor can form in any of these departments.
Cancer of the head of the pancreas
This is the most common type of pancreatic cancer. The tumors in this part are smaller than in the body and tail, but due to the bile duct that runs through here, even a small tumor can become a serious problem. It can compress the duct, which causes obstructive jaundice. A neoplasm in the head of the pancreas can also lead to narrowing of the lumen (stenosis) of the duodenum. Another complication of malignant tumors of this localization is bleeding due to tumor decay.
Cancer of the body of the pancreas
In terms of the prevalence of pancreatic tumors, her body is in second place. Neoplasms here are larger than in the head. They can lead to inflammation of blood vessels (thrombophlebitis), blockage of the lumen of blood vessels (phlebothrombosis) and even to diabetes. Advanced forms of pancreatic cancer localized in the body of this organ can cause jaundice.
Cancer of the tail of the pancreas
This is the rarest type of pancreatic cancer in terms of localization. But it is more difficult to diagnose with an ultrasound examination.
Stages of pancreatic cancer
According to the international TNM system, pancreatic cancer is divided into stages depending on the characteristics of three indicators:
- T is the degree of growth of the primary tumor: T1 is a tumor that affected only the tissues of the pancreas up to its capsule, T2 and T3 are tumors at different stages of germination into the capsule and surrounding tissues and organs.
- N - the number of affected lymph nodes: N0 - lymph nodes are not affected by the tumor process, N1, N2 and N3 - cancer has affected a different (increasing) number of lymph nodes.
- M - the presence of distant metastases: M0 - they are absent, M1 - they are.
According to these indicators and their values, four stages of pancreatic cancer can be distinguished:
- Stage 1 - T1N0M0;
- Stage 2 - T1N1M0;
- Stage 3 - T1N2M0, T2N0M0, T2N1M0;
- 4th stage - any value of T or N, but always M1.
Metastases of pancreatic cancer
Approximately half of patients with pancreatic cancer have metastases, which corresponds to stage 4 of the disease. These tumor foci are located in different organs of the abdominal cavity. They can be in the liver or lungs and even in the bones. Unfortunately, there is no effective treatment for pancreatic cancer with metastases. In such cases, palliative care is provided, i.e. treatment is aimed at reducing pain, containing tumor processes and prolonging the life of the patient.
Causes of pancreatic cancer
The causes of any cancer are mutations in cells. There are many risk factors that can cause these mutations. The most common risk factors for pancreatic cancer are:
- type 2 diabetes;
- chronic pancreatitis - various inflammatory processes in the pancreas;
- cholelithiasis;
- cirrhosis of the liver;
- cysts or adenomas in the prostate gland;
- smoking and drinking;
- the predominance of fatty and spicy foods in the diet;
- burdened heredity;
- overweight, especially excess fat around the waist;
- age - the risk increases after age 45, and most often the disease occurs at the age of 70 years.
Symptoms of pancreatic cancer
It should be noted that at the initial stages, the signs of the disease are almost invisible, most often the tumor begins to give symptoms only when it has grown and begun to spread in the body. The following symptoms may signal the presence of the disease:
- pain in the abdomen (in the upper part) that radiates to the back;
- pain while eating, in a horizontal position;
- loss of appetite;
- bloating and discomfort in the abdomen;
- unexplained weight loss;
- yellowing of the skin and whites of the eyes.
- light colored stools, dark colored urine;
- skin itching;
- temperature, chills;
- deterioration due to existing diabetes or diagnosis of diabetes;
- thrombosis;
- tired.
These symptoms should cause anxiety and be a reason to see a doctor.
Pain is the main and first sign of pancreatic cancer. It can be paroxysmal, strong or weak, and occurs when the tumor has affected the nerves. Depending on the location of the malignant tumor of the pancreas, pain can be in the right hypochondrium if the head of the organ is affected, in the upper abdomen on the left if the tumor is in the body of the gland, or girdle pain if the entire pancreas is affected by cancer.
Pain in pancreatic cancer increases when the patient takes a horizontal position, as well as after eating, especially fatty and spicy, after drinking alcohol. Often these symptoms are ignored or attributed to manifestations of other diseases, the result of an improper diet, and they do not seek medical help.
In some cases, pancreatic cancer can present with leg vein thrombosis, which causes pain, redness, and swelling.
If a tumor of the pancreas squeezes the bile duct, this disrupts the outflow of bile and causes a complication - obstructive jaundice. At the same time, the urine darkens, and the stool brightens, the skin, mucous membranes and sclera of the eyes acquire a yellowish tint, the liver and gallbladder increase in size, which causes the stomach to increase, and skin itching appears. In advanced cases, jaundice can lead to liver or kidney failure, internal bleeding, and even death.
If a malignant tumor decays, substances from cancer cells enter the patient's blood, which lead to intoxication. This causes a decrease in appetite, sudden weight loss, weakness, lethargy, depression, apathy.
In some patients, a pancreatic tumor grows into the intestinal tissue. This leads to intestinal obstruction. If the splenic veins are compressed, this leads to an enlargement of the spleen. Damage to the endocrine functions of the pancreas can also lead to diabetes mellitus. And if the tumor grows into other organs, it can cause them to bleed.
