Pancreas Cancer

21.03.2024

PANCREAS CANCER DIAGNOSIS AND TREATMENT

Pancreatic cancer is a type of cancer caused by malignant cells that develop in an organ called the pancreas. The pancreas is located between the stomach and small intestine and controls the production of important hormones such as digestive enzymes and insulin. Pancreatic cancer often has no symptoms in the early stages and can therefore be difficult to diagnose. However, in later stages, symptoms such as abdominal pain, weight loss, jaundice and digestive problems may occur. Pancreatic cancer usually follows an aggressive course and becomes difficult to treat if it is not diagnosed early. Therefore, paying attention to risk factors and performing regular health checks emphasizes the importance of early diagnosis. Risk factors may include smoking, family history, obesity, and conditions such as chronic pancreatitis. Pancreatic cancer can have a very bad course if left untreated, so early diagnosis and appropriate treatment are of great importance.

WHAT ARE THE RISK FACTORS?

Many factors may contribute to the development of pancreatic cancer, but it can be difficult to pinpoint the exact causes. Some of the main factors that can lead to or increase the risk of pancreatic cancer include:

Age: Pancreatic cancer is generally more common in middle-aged or older individuals. The risk increases with age.

Smoking: Smoking significantly increases the risk of pancreatic cancer. Avoiding smoking may reduce this risk.

Family History: A family history of pancreatic cancer may increase the risk of the disease. A person's risk may increase, especially if there is a history of pancreatic cancer in first-degree relatives (parents, siblings, children).

Genetic Factors: Some genetic syndromes and mutations may increase the risk of pancreatic cancer. In particular, it has been associated with mutations in certain genes such as BRCA2, PALB2, and ATM.

Chronic Pancreatitis: Chronic pancreatitis is associated with long-term inflammation of the pancreas and may increase the risk of pancreatic cancer.

Diabetes: It is known that diabetic patients have an increased risk of pancreatic cancer. However, the reason for this relationship is not fully understood.

Obesity: Obesity may increase the risk of pancreatic cancer. Having a high body mass index may increase this risk.

High Red Meat Consumption: Some research shows that consuming high amounts of red meat and processed meat may increase the risk of pancreatic cancer.

Alcohol Consumption: Excessive alcohol consumption may increase the risk of pancreatic cancer.

Gender: Men are slightly more likely to develop pancreatic cancer than women.

These risk factors may differ between individuals, and everyone's risk of pancreatic cancer is different. However, knowing these risk factors, making healthy lifestyle choices and going for regular health check-ups can help reduce the risk of pancreatic cancer.

HOW DOES IT OCCUR?

The mechanisms of pancreatic cancer development are quite complex and not yet fully understood. It is known that pancreatic cancer usually begins as a result of genetic mutations in pancreatic cells. In particular, mutations in the K-RAS gene play an important role in the development of pancreatic cancer. These mutations lead to uncontrolled growth and proliferation of cells. In addition, risk factors such as inflammation of the pancreas (chronic pancreatitis), consumption of high-fat and processed foods, alcohol consumption and obesity may also be effective in the development of pancreatic cancer. A thorough understanding of the mechanisms of pancreatic cancer will help develop more effective diagnostic and treatment methods.

Image 1: Many complaints such as lightening of stool color, darkening of urine color, nausea and vomiting can be observed in pancreatic cancer.

WHAT ARE THE SYMPTOMS?

Pancreatic cancer usually does not cause symptoms in the beginning, or its symptoms may be mild. However, as the disease progresses, the following symptoms may occur:

Stomach ache: Pancreatic cancer can often cause constant or severe pain in the upper abdomen or back area.

Loss of Appetite and Weight Decrease: Patients often experience loss of appetite and may lose weight.

Nausea and Vomiting: This type of cancer causes negative effects on the digestive system and can lead to digestive problems such as nausea and vomiting.

Jaundice (Yellowing of the Skin and Eyes): Pancreatic cancer can block the bile duct and cause jaundice. This can cause yellowing of the skin and eyes, dark urine color, and light stool color.

Diarrhea or Constipation: Because it can disrupt digestive system functions, patients may experience intestinal problems such as diarrhea or constipation.

Diabetes: Pancreatic cancer can damage insulin-producing cells, which can lead to the development of diabetes.

Fatigue and Weakness: Pancreatic cancer can weaken the body and patients often experience feelings of fatigue.

These symptoms do not always mean pancreatic cancer, as similar symptoms may indicate other health problems. However, if you are experiencing these symptoms, it is important to be evaluated by a physician, especially if you have risk factors (such as family history or smoking). Early diagnosis can increase the effectiveness of pancreatic cancer treatment.

HOW IS IT DIAGNOSED?

Pancreatic cancer is usually diagnosed using a series of medical tests and imaging methods. The first step involves the patient's medical history and physical examination. Blood tests are then performed and markers of pancreatic cancer (for example, CA 19-9) are measured. However, the diagnosis is usually confirmed by imaging studies. The pancreas is visualized using methods such as computed tomography (CT) scans, magnetic resonance imaging (MRI), endoscopic ultrasonography (EUS) and positron emission tomography (PET). To increase diagnostic accuracy, a biopsy may sometimes be performed, which takes samples of pancreatic tissue to determine the type and stage of cancer. Diagnosing pancreatic cancer at an early stage can make treatment options more effective, so it is important for people with any suspicious symptoms or risk factors to have regular health checks.

Image 2: In pancreatic cancer, a treatment plan is made according to the tumor stage.

WHAT ARE THE PATHOLOGICAL TYPES?

Pancreatic cancer can have several pathological types that may arise from different cell types. The main pathological types of pancreatic cancer are:

Ductal Adenocarcinoma: The most common type of pancreatic cancer is ductal adenocarcinoma. This type of cancer originates from cells in the glands of the pancreas and causes tumor growth by blocking the channels called pancreatic ducts. Ductal adenocarcinoma may occur in the pancreatic head or body-tail region.

Cystic Papillary Tumor: Cystic papillary tumors may have a more benign course and a lower risk of malignancy. These tumors may contain fluid-filled cystic structures.

Insulinoma: Insulinoma arises from the insulin-producing beta cells of the pancreas. These tumors are rare and usually cause overproduction of the hormone insulin, leading to symptoms of hypoglycemia (low blood sugar levels).

Glucagonoma: Glucagonoma originates from the alpha cells of the pancreas and causes overproduction of the hormone glucagon. These tumors can cause symptoms such as high blood sugar levels, skin rashes, and weight loss.

Somatostatinoma: Somatostatinoma is a rare pancreatic tumor that causes overproduction of the hormone somatostatin. Symptoms may include diarrhea, abdominal pain and weight loss.

Each pathological type may have different symptoms, prognosis and treatment options. Pancreatic cancer diagnosis and treatment approach is determined according to the pathological type and stage of the tumor. There are important receptors and targets to consider in pancreatic cancer treatment. These molecular marks control the growth and spread of cancer cells. Among these, EGFR (Epidermal Growth Factor Receptor) and HER2 (Human Epidermal Growth Factor Receptor 2) are important receptors for drugs targeting cancer cells. Additionally, VEGFR (Vascular Endothelial Growth Factor Receptor) supports the growth of the tumor by acting on the blood vessels and can be treated with VEGFR inhibitors. While PD-1 and PD-L1 expression is required for immunotherapy, KRAS gene mutations and BRCA1/BRCA2 mutations also play a critical role in determining treatment options. Pancreatic cancer treatment is personalized according to the molecular profiles of patients and the most appropriate treatment plan is determined by genetic tests.

HOW IS TUMOR STAGING DONE?

Staging of pancreatic cancer involves classifying the tumor according to its size, spread, and other organs to which it has spread. Pancreatic cancer staging is important in determining treatment options for the disease and predicting prognosis. The most widely used staging system accepted by the American Cancer Society (ACS) and the International Cancer Society (UICC) is the TNM (Tumor, Node, Metastasis) system and is described as follows:

T (Tumor):

TX: The size or extent of the tumor cannot be assessed.

T0: No tumor.

T1: Tumor < 2 cm

T2: Tumor 2-4 cm

T3: Tumor > 4 cm

T4: The tumor has surrounded adjacent large vessels or spread to other organs.

N (Lymph Nodes):

NX: Lymph nodes cannot be evaluated.

N0: Cancer has not spread to the lymph nodes.

N1: Cancer has spread to 1-3 lymph nodes.

N2: Cancer has spread to more than 4 lymph nodes.

M (Metastasis):

MX: Distant metastases cannot be evaluated.

M0: No distant metastasis.

M1: Cancer has spread to distant organs or tissues.

Pancreatic cancer staging is based on these TNM criteria. Staging may also be presented by a numerical stage classification (e.g., stage I, stage II, stage III, stage IV) that describes the stage of the disease. Once pancreatic cancer is diagnosed and staged, a better understanding of treatment options and prognosis is gained. Therefore, it is important for pancreatic cancer patients to complete staging in collaboration with their oncologists.

HOW IS TREATMENT DONE ACCORDING TO STAGES?

Pancreatic cancer treatment may vary depending on the stage of the disease, the size and location of the tumor, and the patient's general health condition.

Stage I and II Pancreatic Cancer: In these stages, the tumor is usually confined to a limited area of ​​the pancreas. Treatment usually begins with surgical intervention. Part or all of the pancreas may be removed (Whipple surgery or pancreatectomy). Chemotherapy or radiotherapy treatment may also be considered after surgery.

Stage III Pancreatic Cancer: The tumor has exceeded the limits of the pancreas and spread to neighboring organs or large blood vessels. Treatment may be a combination of surgery, radiotherapy and chemotherapy. It can be applied at this stage to shrink the tumor and make surgery possible later.

Evre IV Pancreatic Cancer: At this stage, the tumor has metastasized to other parts or organs of the body (for example, liver, lung, or peritoneum). Surgical intervention is rarely used at this stage. Systemic chemotherapy or targeted drugs are usually used. Supportive care is also important to relieve symptoms and improve quality of life.

Metastatic (Distant Spreading) Pancreatic Cancer: The tumor has spread to different parts of the body. The aim of treatment is to control symptoms, improve quality of life and prolong life. Chemotherapy, targeted drugs and immune therapy options may be used.

Pancreatic cancer treatment requires a multidisciplinary approach and is tailored to the patient's condition. The treatment plan is determined by an oncologist, surgeon, radiation oncologist and other specialists. When pancreatic cancer is diagnosed and staging is performed, a detailed discussion should occur about the patient's treatment options and expectations.

Image 3: In the treatment of pancreatic cancer, surgery is primarily used in the early stages, chemotherapy and radiotherapy in the later stages.

WHAT ARE SYSTEMIC DRUG TREATMENTS?

There are various drugs and treatment methods used in the treatment of pancreatic cancer. Here are some of these treatments:

Chemotherapy drugs:

Gemcitabine: Used as one of the standard chemotherapies for pancreatic cancer.

FOLFIRINOX: A chemotherapy regimen used as a combination of folinic acid, 5-fluorouracil, irinotecan and oxaliplatin.

Nab-paclitaxel: Paclitaxel is a chemotherapy drug that is bound to albumin.

Capecitabine: Capecitabine, a chemotherapy drug, can be used to treat pancreatic cancer.

Smart Drug Therapies:

Dabrafenib + Trametinib: It is a smart drug that targets BRAF-MEK mutations and can be used in cases of pancreatic cancer with BRAF V600E mutation.

Olaparib: It is a smart drug used in BRCA mutant patients and can be used to prevent the growth of tumor.

Immunotherapies:

The use of immunotherapies in the treatment of pancreatic cancer is in the research phase and studies in this field are ongoing. Immunotherapy drugs such as pembrolizumab and nivolumab are being evaluated for potential treatment of pancreatic cancer, but more studies are needed.

Treatment options may vary depending on the patient's stage, molecular characteristics of the tumor, and general health status. Therefore, pancreatic cancer treatment should be determined by an oncologist or specialist medical team based on the individual patient's situation.

HOW SHOULD FOLLOW-UP BE CARRIED OUT AFTER RECOVERY?

Monitoring and follow-up after pancreatic cancer treatment is important to closely monitor the patient's health and detect possible recurrences early. Post-recovery follow-up often may include: regular doctor's exams, blood tests, imaging studies (for example, computed tomography or MRI), measurement of tumor markers, and evaluation of symptoms. During follow-up, the patient's general health status and quality of life are taken into consideration. It is important for patients diagnosed with pancreatic cancer to work closely with an oncologist or other physicians for ongoing health monitoring after treatment. In this way, the chance of early diagnosis of possible relapses and starting treatment earlier increases, which can increase the patient's chance of survival.