Pancreatic cancer is one of the most common insidious types of cancer. It is 30% more common in men than in women. The incidence of pancreatic cancer has been on the rise in recent years.

RISK FACTORS

Advanced age: The incidence of pancreatic cancer and the pancreatic cancer-associated mortality increase gradually after the age of fifty. Smoking is one of the most important risk factors for pancreatic cancer and it is one of the modifiable risk factors. Compared to individuals with normal body weight, the risk of pancreatic cancer increases by approximately 20% in obesity, which is one of the preventable risk factors. Examples of other modifiable risk factors include diet and alcohol use. There is evidence that red meat and processed meat products increase the risk of pancreatic cancer and that nutrients in fruits and vegetables reduce the risk.

It has been shown that there is a 50% increase in the risk of pancreatic cancer in patients with type 2 diabetes diagnosed more than five years ago. Chronic pancreatitis is another risk factor, increasing the likelihood of developing pancreatic cancer by 6 folds.

The presence of pancreatic cancer in the first degree (parents or siblings) or second degree relatives (uncles, aunts or cousins) in the family increases the risk of developing pancreatic cancer. The risk of developing pancreatic cancer in people with familial chronic pancreatitis ranges from 40 to 75% throughout their lives.

WHAT ARE THE PRESENTING COMPLAINTS (SYMPTOMS) IN PANCREATIC CANCER?

The initial complaints of pancreatic cancer are not specific to the disease and they are among the reasons for late diagnosis. Pain in the abdominal region is common in pancreatic cancer. The patient may indicate that the pain has spread to the back or lower back. In tumors located in the head region of the pancreas, the most important symptom is painless jaundice. The patient may consult the doctor with the complaint of urinating dark-colored urine and the discoloration of the feces. Cancer-related weight loss, loss of appetite, and blockage of the gastric outlet due to the tumor may result in nausea and vomiting.

HOW IS THE DIAGNOSIS MADE IN PANCREATIC CANCER?

In the physical examination, the abdominal region is examined thoroughly and the eyes of the patient are examined in detail for jaundice.

Laboratory blood tests may show severely elevated levels of bilirubin, alkaline phosphatase, gamma glutamyl transpeptidase and high levels of aspartate aminotransferase and alanine aminotransferase to a lesser extent due to biliary tract obstruction. Carbohydrate antigen (CA) 19-9 levels are high in 75-85% of the pancreatic cancer patients.

Computed tomography of the abdomen is the most commonly used radiological examination method providing extensive information. The possibility of surgery and the likelihood of treatment success with surgery can be shown with an accuracy rate of up to 95%. However; advanced stage disease is diagnosed in one third of the patients, in whom the decision for surgery has been made based on CT findings. In these patients, treatment success is unlikely.

MR cholangiopancreatography (MRCP) is a noninvasive method for imaging the biliary tract and pancreatic duct in patients with jaundice.

While the diagnostic role of ERCP (endoscopic visualization of the biliary tract allowing interventional procedures) is outdated with the advances in MRI and MRCP, its therapeutic use is still valid in indicated cases.

HOW IS STAGING PERFORMED IN PANCREATIC CANCER?

A well-performed staging of the tumor provides benefits both for estimating the survival and selecting the treatment strategy. Tomography allows for making the diagnosis and it helps to determine whether complete tumor excision is likely without leaving any residual tumor tissue.

HOW IS PANCREATIC CANCER TREATED?

The most effective treatment for pancreatic cancer is surgery. If the general condition of the patient suitable and if the tumor is likely to be removed with surgery, surgical treatment should be performed. The standard treatment plan for the stage 0, IA, and IB tumors includes partial or total excision of the pancreas along with the removal of surrounding tissue and organs. A variety of surgical techniques can be performed depending on the location of the tumor. The standard surgical treatment is the Whipple operation. When the cancer involves the trunk and tail of the pancreas, splenectomy with distal pancreatectomy is performed. Postoperative chemotherapy may be given.

The standard treatment plan for stage IIA is the removal of the pancreas when tumor excision is likely. Chemotherapy is given after surgical treatment. If the tumor is not likely to be removed during surgery, a biopsy should be performed. If the tumor causes biliary tract obstructions, surgery should be performed to eliminate these complaints. Preoperative chemotherapy (neoadjuvant) is performed if the tumor is determined to be unlikely due to the tumor invasion into vessels or organs.

In stage IIB and III diseases; the disease has spread to the duodenum, bile ducts, lymph nodes, and other surrounding tissues but the major vessels and nerves. The tumor cannot be removed with surgery. Treatment of these tumors is usually performed with chemotherapy.

In stage IV disease, the tumor has spread to other parts of the body. At this disease stage, efforts should be spent to alleviate complaints. Chemotherapy can be given.

When the tumor cannot be surgically removed, palliative treatments are performed.