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Tiruvalla Medical Mission (TMM) - Oncology (Cancer) & Nuclear Medicine

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Pancreatic Cancer
CANCER - ALL YOU NEED TO KNOW
1. Types of Cancer  >  3. Solid Tumors  >  Pancreatic Cancer

Pancreas

 

Common types of pancreatic cancer:

  • Adenocarcinoma: 85% of Pancreas Cancer cases
  • Acinar Cell Carcinoma/ Colloid Carcinoma: Better
  • Adenosquamous: Worse

Location:

  • 60-70%: Head of Pancreas
  • 20-25%: Body & Tail

Symptoms:

signs of Pancreatic cancer

Symptoms of Pancreatic cancer

IThe pancreatic cancer symptoms and signs include:

  • Ascites (distended abdomen) - due to spread of the pancreatic cancer in abdominal cavity 
  • Abdominal and back pain - Tumor pushing against the surrounding organs and nerves
  • Bone pain - due to pancreatic cancer spread 
  • Cachexia - (general weight loss and muscle wasting) usually due to metastasis (pancreatic cancer spread).
  • Chills - due to infection and obstruction of the bile ducts by increased size of pancreas
  • Diabetes - due to impaired insulin secretion by the pancreas
  • Fatigue – Pancreatic Cancer causes malnutrition and anaemia which causes fatigues 
  • Fever - due to bile ducts obstruction, leading to infection of bile ducts and liver. 
  • Hair thinning and hair loss - due to chemotherapy 
  • Jaundice (yellowing of skin or eyes) - due to obstruction in bile duct due to which bile backs up into the liver and enters the bloodstream. 
  • Loss of appetite (anorexia) - due to the pancreatic cancer blocking gut, or by the effects of therapy.
  • Stool discoloration - Bile duct and pancreatic duct are joined in the back of the head of the pancreas and opens into the duodenum. Due to blocked bile is released into bloodstream. As bile is not entering into the digestive tract, stool becomes light or clay-coloured. 
  • Thrombophlebitis (inflammation and clotting of veins) - body's response to pancreatic cancer or direct spread of the pancreatic cancer to blood vessels
  • Urine discoloration - due to accumulation of bile in the urine makes it appear darker than usual.
  • Weight loss - Almost all pancreatic cancers are associated with weight loss. Normal cells and malignant cells battle for nutrients. In addition, pancreatic cancers frequently impede digestion, which further adds to weight loss.

Common Chemotherapy Regimens

  • FOLFIRINOX
    (S-FU, Irinotecan, Leucovorin, Oxaliplatin)
  • NALIRIFOX
    (S-FU, Liposomal Irinotecan, Leucovorin, Oxaliplatin)
  • Gemcitabine + Nab-Paclitaxel
  • Targeted Therapy

The stages of pancreatic cancer are based on the TNM staging system developed by the American Joint Committee on Cancer (AJCC). This system evaluates the size and extent of the tumor (T), the involvement of lymph nodes (N), and the presence of metastasis (M) to classify the cancer into one of four stages (I-IV).

 

Here’s a detailed breakdown of the stages of pancreatic cancer:

 

Stage 0: Carcinoma in Situ (Tis, N0, M0)

 

Description: Abnormal cells are found in the lining of the pancreas but have not invaded deeper tissues.

Significance: This is a precancerous stage, and the cancer is not yet invasive.

Prognosis: Best chance for cure with early surgical intervention.

 

Stage I: Localized Pancreatic Cancer

 

Stage IA (T1, N0, M0)

 

•Tumor is confined to the pancreas.

•Tumor size: ≤2 cm in greatest dimension.

•No lymph node involvement.

•No metastasis.

 

Stage IB (T2, N0, M0)

 

•Tumor is confined to the pancreas.

•Tumor size: >2 cm but ≤4 cm in greatest dimension.

•No lymph node involvement.

•No metastasis.

 

Stage II: Locally Advanced Pancreatic Cancer

 

Stage IIA (T3, N0, M0)

 

•Tumor extends beyond the pancreas into nearby tissues (e.g., the duodenum or bile duct).

•No involvement of major blood vessels.

•No lymph node involvement.

•No metastasis.

 

Stage IIB (T1-T3, N1, M0)

 

•Tumor may extend beyond the pancreas.

•Cancer has spread to 1-3 regional lymph nodes.

•No metastasis.

 

Stage III: Locally Advanced and Unresectable

 

•Tumor involves nearby major blood vessels (e.g., the celiac axis, superior mesenteric artery, or hepatic artery).

•Cancer may or may not have spread to regional lymph nodes.

•No distant metastasis.

Key Feature: Usually unresectable (surgery is not an option for complete removal).

 

Stage IV: Metastatic Pancreatic Cancer (Any T, Any N, M1)

 

•Cancer has spread to distant organs such as the liver, lungs, or peritoneum.

•Tumor size and lymph node involvement may vary.

Prognosis: Poor, as the disease is advanced and treatment is usually palliative rather than curative.

 

Resectability Status

 

In addition to the stages, pancreatic cancer is also categorized by resectability, which indicates whether the tumor can be surgically removed:

1.Resectable:

•Tumor is localized and can be completely removed with surgery.

2.Borderline Resectable:

•Tumor involves nearby blood vessels but might still be removed with advanced surgical techniques.

3.Unresectable/Locally Advanced:

•Tumor cannot be removed due to extensive involvement of major blood vessels or surrounding tissues.

4.Metastatic:

•Cancer has spread to distant organs, making surgery for cure not possible.

 

Summary of Staging

 
Stage Tumor (T) Lymph Nodes (N) Metastasis (M) Key Features
Stage 0 Tis N0 M0 Precancerous (non-invasive).
Stage IA T1 (≤2 cm) N0 M0 Confined to pancreas, ≤2 cm.
Stage IB T2 (>2-4 cm) N0 M0 Confined to pancreas, >2 cm.
Stage IIA T3 (>4 cm) N0 M0 Beyond pancreas, no nodes involved.
Stage IIB T1-T3 N1 (1-3 nodes) M0 Local spread with lymph node involvement.
Stage III T4 Any N M0 Involves major vessels, unresectable.
Stage IV Any T Any N M1 Metastatic disease.

 

Treatment by Stage

Stage 0/I: Surgery (Whipple procedure or distal pancreatectomy), possibly followed by chemotherapy or radiation.

Stage II: Surgery, often combined with adjuvant chemotherapy or chemoradiation.

Stage III: Chemotherapy or chemoradiation, with surgery in selected cases.

Stage IV: Systemic therapies (chemotherapy, targeted therapy, immunotherapy) and palliative care.

Understanding the stage helps guide the treatment plan and provide a prognosis for the patient.

Pancreas surgery:

A pancreas surgery will be performed depending on the disease that a person is suffering from.

Some of the surgical procedures that have been considered safe and effective are as follows:

i. The Whipple Procedure –
Also known as pancreaticoduodenectomy, this procedure works best for patients suffering from pancreatic cancer or some other benign complications restricted to the head of the pancreas.

The surgeon will remove the head of the pancreas, part of the bile duct and the gall bladder. They will then reconnect the remaining pancreas to the intestine, bile duct and stomach.

ii. Distal pancreatectomy –
This surgical procedure will often be laparoscopic meaning it will be aided by a small camera and smaller incisions at the surgical site.

This procedure intends to remove tumors at the end or tail of the pancreas.

iii. Total pancreatectomy –
A relatively rare procedure because of the undisputable side-effects attached to it such as diabetes, this surgery constitutes removal of the entire pancreas, the gallbladder, part of the stomach, small intestine and the spleen. It is performed when cancer spreads throughout the pancreas but can still be removed.

iv. Endoscopic retrograde cholangiopancreatography –
ERCP is performed when the cause of pancreatitis seems to be something such as a gallstone lodged in the bile duct. In this procedure, a tube with a tiny video camera at the end of it will be slid down the throat into the small intestine and stomach after which dye will be injected into the drainage tube of the pancreas to locate the possible obstruction.

The purpose of the dye is to produce enhanced images of the pancreas and the bile ducts on the X-ray machine. This helps the doctor view the site of the blockage after which he or she can remove the hindrance. Special instruments such as a balloon catheter or a basket catheter are inserted through the tube to remove this obstruction or stretch a segment of the bile duct.

v. Pancreatic pseudocyst drainage –
A pancreatic pseduocyst is caused due to chronic pancreatitis. This is a fluid-filled sac that forms in the abdomen and is comprised of pancreatic enzymes, blood, and necrotic (dead) tissue.

To remove it, endoscopic drainage is required in which the fluid is removed from the pseduocyst. The process of inserting a tube is the same: it is inserted just as it is in ERCP except the dye is replaced with surgical tools that are positioned on the tube to drain the fluid all while looking at the video footage of the organs concerned.

vi. Bypass surgery –
This procedure is carried out for unblocking a blocked bile duct in which the flow of bile will be rerouted to the small intestine instead of the common bile duct, bypassing the pancreas. This surgery can be a laparoscopic one, thus making it minimally-invasive.

vii. Spleen surgery –
When pancreatic cancer starts affecting the splenic artery or the lymph nodes in the hilum of the spleen, it is best to remove the spleen all while carrying out a distal pancreatectomy.

viii. Stent surgery –
This surgery is carried out to treat the symptoms of pancreatic cancer. A stent may end up causing more problems rather than solving them. Some of its complications include the stent getting blocked due to bile-build up or cancer growing through it, infection in the stent or the stent moving out of its original place.

Types of stent surgeries include:

a. Duodenal stent: When pancreatic cancer starts to block the first part of your intestine, a stunt will be installed to keep the duodenum open. This should help significantly.

b. Bilary stent: When pancreatic cancer starts to block your bile duct and causes intense jaundice, a stent will be installed in your bile duct.

Pancreas Surgery

Pancreatic Cancer

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