Emilie Meyer
Pancreatic cancer is a rare but deadly form of cancer that affects the pancreas, a gland located deep in the abdomen, between the stomach and spine. It involves the formation of tumours, which can be either benign or malignant. Malignant tumours, or cancer, occur when cells in the pancreas mutate and multiply out of control, forming a tumour that can spread to other parts of the body. Treatment options for pancreatic cancer include surgery, chemotherapy, and radiation therapy, often used in combination. However, pancreatic cancer is notoriously difficult to treat due to the dense tissue layer surrounding the tumours, which makes it challenging for treatments to reach them effectively.
| Characteristics | Values |
|---|---|
| Cause | Cells in the pancreas mutate and multiply out of control, forming a tumour. |
| Symptoms | Nausea, bloating, fatigue, jaundice, lack of appetite, abdominal pain, weight loss, skin rashes, joint pain, weakness, pruritus from bile salts in the skin, anorexia, distended gallbladder, alcoholic stools, dark urine, recurrent deep vein thrombosis, recent-onset diabetes. |
| Diagnosis | CT scans, multidetector computed tomography (MDCT), magnetic resonance imaging (MRI), endoscopic ultrasound (EUS). |
| Treatment | Surgery, chemotherapy, radiation therapy, targeted therapy, mRNA vaccines. |
| Types | Exocrine (adenocarcinoma, cystadenocarcinoma, acinar cell carcinoma, adenosquamous carcinoma, colloid carcinomas) and neuroendocrine (endocrine, islet cell tumours, pancreatic NETs or PNETs). |
| Tumour Markers | CEA and CA 19-9. |
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What You'll Learn
Tumour detection and diagnosis
Pancreatic cancer occurs when cells in the pancreas mutate and multiply out of control, forming a tumour. Tumours in the pancreas often don't show up on imaging tests, making diagnosis difficult.
When it comes to tumour detection and diagnosis, there is no single test that can diagnose cancer. Doctors employ a variety of methods to determine the presence of cancer.
Medical history and physical exam
Doctors will typically start by asking about the patient's personal and family medical history and performing a physical examination.
Imaging tests
Imaging tests such as CT scans can be used to help detect tumours, although they may not always be effective in determining whether a tumour can be fully removed.
Lab tests
Lab tests on blood, urine, and other body fluids can help detect abnormal levels of certain substances, which may indicate the presence of cancer. These tests include blood chemistry tests, which measure substances such as metabolites, electrolytes, fats, sugars, and proteins, and complete blood counts (CBC), which measure red blood cells, white blood cells, platelets, and haemoglobin levels. However, abnormal lab results are not conclusive evidence of cancer and must be considered alongside other tests.
Biopsies
A biopsy, which involves taking a sample of tissue or cells from the body, is often necessary to confirm a cancer diagnosis.
In the case of brain tumours, Magnetic Resonance Imaging (MRI) combined with deep learning approaches has shown promising results in accurately identifying the presence and location of tumours. This technology has achieved 99.5% accuracy in brain tumour detection, outperforming standard techniques.
For pancreatic cancer, individuals with hereditary pancreatitis may be offered screening for early detection. Additionally, surgery may be performed with the intention of a cure, but this is only possible in about 20% of new cases.
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Tumour removal surgery
Pancreatic cancer occurs when cells in the pancreas mutate and multiply out of control, forming a tumour. The pancreas is a gland in the abdomen that helps with digestion and controls blood sugar levels.
Surgery is the only realistic chance to cure pancreatic cancer, but it does not always lead to a cure. Surgery with curative intent is only possible in about 20% of new cases. The type of surgery performed depends on the location of the tumour in the pancreas.
If the cancer is in the head of the pancreas, the surgeon removes the head of the pancreas and sometimes the body of the pancreas as well. Nearby structures, such as part of the small intestine, part of the bile duct, the gallbladder, lymph nodes near the pancreas, and sometimes part of the stomach, are also removed. The remaining bile duct and pancreas are then attached to the small intestine so that bile and digestive enzymes can still enter the small intestine. This procedure is called a pylorus-preserving pancreaticoduodenectomy (PPPD).
If the cancer is in the tail of the pancreas, the surgeon removes the tail and sometimes a portion of the body of the pancreas. The spleen is usually removed as well, which is called a splenectomy. The spleen helps the body fight infections, so patients will be at increased risk of infection after surgery. This procedure is called a distal pancreatectomy.
In some cases, the entire pancreas may be removed. This procedure is called a total pancreatectomy. The gallbladder, common bile duct, spleen, and portions of the small intestine and stomach are also removed.
Laparoscopic surgery is a minimally invasive technique that can be used for tumour removal in pancreatic cancer. It involves making small incisions in the abdomen and inserting telescope-guided instruments. Laparoscopic surgery may cause less pain and have a quicker recovery time compared to open surgery.
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Tumour treatment options
Pancreatic cancer occurs when cells in the pancreas mutate and multiply out of control, forming a tumour. Treatment options for tumours depend on the type of cancer, how advanced it is, and what treatments are available. Here are some standard treatment options for tumours:
Surgery
Surgery is a local treatment option used to treat a specific tumour or area of the body. It is often the first option considered for tumour treatment. However, surgery with the intention of a cure is only possible in around 20% of new cases of pancreatic cancer. Determining whether a tumour can be fully removed can be challenging, and it may only become apparent during surgery that removing the tumour without damaging other vital tissues is impossible.
Chemotherapy
Chemotherapy is a systemic treatment that can be used before or after surgery. It involves administering drugs that kill or stop the growth of cancer and other fast-growing cells. Chemotherapy can shrink tumours and kill any remaining cancer cells. However, pancreatic cancer is resistant to many common chemotherapy drugs, making it challenging to treat.
Radiation Therapy
Radiation therapy, also known as radiotherapy, is another local treatment option. It uses high-energy X-rays to kill cancer cells and shrink tumours. Radiation therapy is often combined with chemotherapy to enhance its effectiveness. However, its use on unresectable tumours is controversial due to conflicting results from clinical trials.
Targeted Therapy
Targeted therapy is a systemic treatment that focuses on targeting specific changes in cancer cells that help them grow, divide, and spread. These treatments can include small molecule targeted agents, antibody-drug conjugates (ADCs), cell-based therapies, and gene therapy. Targeted therapy offers personalised and precise tumour targeting, improving patient comfort and potentially impeding disease progression.
Immunotherapy
Immunotherapy is a systemic treatment that helps the immune system recognise and fight cancer cells. It includes treatments such as CAR-T cell therapy, which involves extracting the patient's T cells, modifying them, and infusing them back into the patient. Immunotherapy has shown promising results in treating various cancers, including melanoma and malignant glioma.
It is important to note that these treatment options are not exclusive, and a combination of treatments may be recommended based on the specific circumstances of each patient.
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Tumour microenvironment
Pancreatic cancer occurs when cells in the pancreas mutate and multiply out of control, forming a tumour. Tumours are composed of cancerous cells and a multitude of non-cancerous cells, all embedded in an altered extracellular matrix. This ecosystem surrounding a tumour is known as the tumour microenvironment (TME).
The TME is composed of immune cells, stromal cells, blood vessels, and the extracellular matrix. The TME interacts with the tumour, providing it with nutrients and space to expand. The TME also influences how the tumour interacts with the rest of the body, impacting the growth and spread of the tumour. For example, the TME of pancreatic tumours is hypovascular, meaning it has a low number of blood vessels, which makes it difficult for chemotherapy drugs to reach the tumour.
The cellular composition of the TME varies depending on the organ, the intrinsic features of cancer cells, the tumour stage, and patient characteristics. For instance, the microenvironment of many cancer types is very fibrotic or stiff, which hinders drugs from reaching the core of the tumour. The TME can also be hypoxic and acidic, triggering a program that promotes angiogenesis to restore oxygen and nutrient supply.
The role of immune cells within the TME is critical and dichotomous. Immune cells can either suppress tumour formation (anti-tumour microenvironment) or promote tumour growth (immune-suppressive microenvironment). For example, natural killer (NK) cells are highly efficient at killing tumour cells within the bloodstream but are less efficient within the TME. Dendritic cells (DCs) are another critical component of the immune system, acting as antigen-presenting cells that bridge the gap between adaptive and innate immunity. Cytokines secreted from the TME can trigger DCs to tolerate the presence of tumour cells and block the induction of an immune response.
Understanding the TME is important for developing new treatments and utilizing immunotherapy. Researchers are working to understand the role of the TME in cancer risk, development, and treatment.
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Tumour genetics
Pancreatic cancer occurs when cells in the pancreas mutate and multiply out of control, forming a tumour. The pancreas is a gland in the abdomen, situated between the spine and stomach. It produces hormones that regulate blood sugar levels and enzymes that aid in digestion.
Population genetics focuses on the identification and characterisation of inherited cancer syndromes within specific families or genetically restricted populations. The goal is to understand the transmission of genetic traits from parent to child and the associated increased risk of developing certain tumour types.
Cytogenetics, on the other hand, involves the study of chromosomes and their structures, arrangements, functions, and behaviour during cell division. This branch of genetics helps identify chromosomal abnormalities that may contribute to tumour development.
Molecular genetics is a rapidly advancing field due to tremendous progress in molecular biology over the past 50 years. It involves the characterisation of specific genes at the DNA level, allowing researchers to understand their role in the development of cancer. This includes the identification of genes involved in cell-cycle control pathways and DNA repair processes, such as KRAS, TP53, CDKN2A, SMAD4, and BRCA1/BRCA2, which are commonly mutated in pancreatic ductal adenocarcinomas (PDAC).
Understanding tumour genetics is crucial for developing targeted therapies and improving treatment outcomes for pancreatic cancer. For example, targeted therapy drugs like Larotrectinib and Entrectinib are used to control how cancer cells grow and spread. Additionally, advancements in this field have led to the development of personalised mRNA vaccines, which hold promise as a potential treatment for pancreatic cancer.
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Frequently asked questions
Pancreatic cancer occurs when cells in the pancreas mutate and multiply out of control, forming a tumour.
Symptoms include nausea, bloating, fatigue, jaundice, and lack of appetite. Abdominal pain and weight loss are also common.
Treatment options include surgery, chemotherapy, and radiation therapy. Surgery offers the best chance of long-term control, but most patients are diagnosed at later stages when surgery is no longer an option. Chemotherapy and radiation therapy can be used to shrink the tumour before surgery or to kill remaining cancer cells after surgery.
Pancreatic tumours can be either exocrine or neuroendocrine (endocrine). More than 90% of pancreatic cancers are exocrine tumours, with adenocarcinoma being the most common type. Less than 10% are neuroendocrine tumours, which often grow slower.
Pancreatic cancer can be diagnosed through imaging studies such as CT scans, MRIs, or endoscopic ultrasounds. Doctors may also take a sample of the tumour tissue to determine the exact diagnosis.
