What is Pancreatic Cancer?

The pancreas is an organ located in the rearmost part of the abdomen, approximately 15 cm long, and its front side is completely covered by the stomach, duodenum and large intestine (colon). Although it has many important functions, it plays an important role in digesting food and keeping blood sugar balanced. Although pancreatic cancers develop in every region of the organ, they most commonly develop in the head region. Again, they most frequently originate from secretory cells and are called adenocarcinoma.

Risk factors

Hastalığın sebebi bilinmemekle birlikte sigara içenlerde ve şişman bireylerde daha sık görülür. Hastaların hemen hemen %30’unda pankreas kanserinin nedeni sigara kullanımıdır. Erişkin tip şeker hastalığına bağlı pankreas kanseri tartışmalıdır. Çok az sayıda hastada soya çekim ile pankreas kanseri gelişebilir. Pankreas kanseri erkeklerde kadınlardan daha sık görülmekte olup risk yaşla birlikte artar. Ortalama yaş erkeklerde 63, kadınlarda ise 67’dir.

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, glazier-colored stools, pallor, sudden onset of diabetes without a family history, and 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 yellowing of the skin occurs, followed by the urine color darkening to 'tea-coloured urine', and finally resulting in a light color of the stool, described as 'glazier's paste'. The cause of jaundice is the obstruction of the excretion of bilirubin produced in the liver into the duodenum as a result of obstruction of the bile duct by pancreatic cancer. While the pain is initially described as a vague abdominal pain, a mild discomfort, it later becomes an abdominal pain that hits the back. It is blunt in nature. It is often accompanied by symptoms of bloating and indigestion.

What are the First Symptoms of Pancreatic Cancer?

Pancreatic cancer usually does not cause symptoms in the early stages and is often diagnosed in more advanced stages. However, some symptoms may be observed even in the early stages. These symptoms may include:

• Stomach ache: Pancreatic cancer usually causes pain in the upper abdominal area. This pain is usually constant and severe.
• Loss of appetite: Some people with pancreatic cancer may experience loss of appetite, weight loss, and fatigue.
• Diarrhea or constipation: Pancreatic cancer can affect bowel movements and cause diarrhea or constipation.
• Nausea and vomiting: Some people with pancreatic cancer may experience nausea and vomiting.
• Jaundice: Pancreatic cancer can block the bile ducts and cause symptoms such as jaundice. This symptom is manifested by yellowing of the skin and eyes.

These symptoms may not be specific to pancreatic cancer and may also be a symptom of other diseases. Therefore, people who experience any one or more of these symptoms are recommended to consult their doctor. It is also recommended that people with risk factors (for example, smokers or those with a family history of pancreatic cancer) have regular screening tests.

Diagnosis

Diagnosis can be difficult because the disease occurs with insidious symptoms. In patients caught in the early stages, it is important for the physician to suspect this disease and conduct research on it, most frequently at the time of application to the physician.

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

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

Computed tomography (CT) and magnetic resonance imaging (MRI): BT ağız ve damar yolu ile kontrast ilaç verilerek çekildiğinde pankreas tümörleri hakkında çok önemli bilgiler verir. Yaklaşık %95 ve üzerinde tanı koydurucu özelliği vardır. MR görüntüleme aynı şekilde tümörün ayırıcı tanısında önemlidir. Bu iki inceleme gerektiğinde birlikte kullanılarak hastaya verilecek ameliyat kararı için doğru sonuçlara ulaşılmasını ve tümörün evrelemesinin doğru yapılmasını sağlarlar.

Pancreatic tumor, pancreatic resection (removal)

Treatment

At the beginning of treatment, at the end of physical examination, laboratory and radiological examinations, the stage of the pancreatic tumor, its relationship with neighboring organs, and whether it has spread to neighboring vessels and/or distant organs are determined and the chance of surgical removal is evaluated. Surgery cannot be performed on advanced stage tumors. Along with chemotherapy to be applied to these patients, some interventions can be applied to improve the comfort of life by correcting existing jaundice, providing nutritional support, and reducing pain. For this purpose, endoscopy is performed through the mouth through the stomach, placing a tube (stent) that allows passage to the bile duct, draining the bile out of the abdominal skin with a catheter inserted into the intra-liver bile ducts with the help of a needle, advanced pain management techniques, and injecting this part through the mouth in tumors that cause obstruction in the duodenum. Methods such as insertion of a stent by entering the endoscopic method are used.

Surgical treatment: If the tumor is suitable for surgical removal after examination, 'Whipple surgery' is classically performed. In addition, if the tumor is located in the body and tail part of the pancreas, relatively easier resection methods are applied. Surgical removal of the tumor is the only chance of cure for these patients. In pancreatic head tumors, the surgery becomes more complicated as it is not possible to surgically remove only the head part of the pancreas. In Whipple surgery; Along with the head of the pancreas, the gallbladder, a part of the main bile duct, the duodenum, a part of the stomach and the surrounding lymph nodes are removed en bloc.

Pankreas Kanserinin Cerrahi Tedavisi (Whipple Ameliyatı) Oldukça uzun süreli, çok çeşitli organların çıkartıldığı ve yeniden devamlılığın sağlandığı bu ameliyat sırasında veya kısa süre sonrasında hastanın ölüm (mortalite) veya kanama olması, sindirim sisteminin devamlılığını sağlamak için yapılan dikişlerden kaçak olması (fistül) gibi kötü durumlarla (morbidite) karşılaşılabilmektedir. Dünyada kabul edilen ölüm oranı %5 ve altındaki orandır. Yine ameliyat sonrasında ortaya çıkan komplikasyonlar için dünyada kabul edilen oran %15-20’dir. Ülkemiz şartlarında bu oranlar %5-10 mortalite ve %20-25 morbidite oranlarıdır.

Radiation Therapy: Also called radiotherapy. It involves using high-energy rays to kill cancer cells. Radiation therapy only affects the cells in the area being treated. Radiation is the application of external beams through a machine. Radiotherapy is used alone or in combination with chemotherapy instead of surgery, especially if the location and size of the tumor makes surgery difficult or in cases where surgery cannot be performed. Radiotherapy can be used in combination 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. In pancreatic cancer, drug treatment called chemotherapy can be applied, taking into account the general condition of the patients before or after surgery. Chemotherapy may be used along with radiotherapy to shrink the tumor before surgery or as primary treatment instead of surgery. Surgery and radiotherapy have no place in widespread advanced disease. It has been reported that the quality of life of patients can be significantly improved and their survival may be prolonged by applying chemotherapy to this group of patients.

After Treatment

Survival: Erken tanı ile ameliyat edilip tam iyileşme şansı %50’nin altındadır. Antikanser ilaçlar ve ışın tedavisi iyileşme oranını artırır. Ancak geride kanser hücresi bırakılan ameliyatlardan sonra veya komşu organlara yayılım olan durumlarda sağkalım oranları iyi değildir.

Protection: For protection, one should stay away from tobacco, have a balanced diet, exercise regularly and lose excess weight.