by dr ylm
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| The late Steve Jobs had a neuroendocrine tumour of the pancreas. - Reuters |
MY aunt has been diagnosed recently with pancreatic cancer. The only positive thing I can say about this is that she is 89 years old. Funnily enough, a few years back, she had some symptoms of bloating and indigestion. She was investigated then, and the doctor said she had some pancreatic enzyme problems. Where is our pancreas and what does it do?
We all have a pancreas. It is a six-inch long organ that sits at the back of our abdomen, behind our stomach. The head of the pancreas is connected to the first part of our small intestine, called the duodenum. The part that connects the pancreas to the duodenum is called the pancreatic duct.
The head tapers to a tail, which sits on the left side of our body. The pancreas actually looks like a leaf.
The pancreas has several functions. It has an exocrine component, as well as an endocrine component called the Islets of Langerhans. Tumours can arise from either part, but mostly from the exocrine portion. The exocrine produces the pancreatic enzymes which aid in our digestion. The endocrine produces the hormones insulin and glucagon, which regulate our body’s metabolism.
In the US, 30,000 people are diagnosed every year with pancreatic cancer. It is a cancer with a very poor outlook. Once diagnosed, only 5% of patients survive five years.
It is extremely deadly, and that’s why you should really understand that it exists, and it is getting more common than you think. I personally know of seven relatives and friends who have had pancreatic cancer.
Is this the type of cancer that Steve Jobs had?
Steve Jobs had a neuroendocrine tumour of the pancreas, and we talked about it a while back in this column. Because the neuroendocrine tumours often present with very specific hormonal imbalance symptoms, they are much easier to detect and are associated with a better outcome.
Today, we will be focusing on the exocrine part of the pancreas that can lead to cancer. This is the extremely deadly type of pancreatic cancer.
How will I know if I have pancreatic cancer?
Pancreatic cancer is one of the most difficult cancers to detect. Unlike breast cancers that present with a lump or lung cancers that present with a cough, the symptoms of pancreatic cancer are very non-specific and often occur very late into the disease.
But as the pancreatic cancer grows, there can be symptoms like:
- Pain in the upper abdomen due to the cancer growth pushing against your nerves.
- Jaundice, if the cancer is located at the head of the pancreas and encroaches upon the bile duct and liver.
- Loss of appetite, loss of weight.
- Nausea, vomiting.
- Weakness and fatigue.
- Pale or grey stools and excess fat in the stools.
- Depression.
There is a particular symptom or sign that pancreatic cancer is associated with, called Trosseau’s sign. This presents as spontaneous blood clots which occur in the main blood vessel of the abdomen called the portal vein and deep vein clots in the arms and legs.
If it’s so difficult to diagnose, how does pancreatic cancer actually get detected?
It is usually detected after a battery of tests. There are some blood tests which detect tumour specific markers like CEA and CA19-9. If these are raised, there is a strong suspicion of pancreatic cancer (and also other cancers).
This is followed by imaging of the patient’s body involving CT scans, and perhaps MRI scans.
Ultrasound and scopes may also be used, depending on the symptoms of the patient, especially a scope called the ERCP, which is administered through the mouth and into the stomach to look at the duodenum and pancreatic head.
A biopsy is then taken of the suspected tumour.
Is there any treatment for pancreatic cancer?
Yes, but most of the time, it’s just to extend life and make the patient comfortable for a little while longer (palliative).
You can surgically remove the pancreas or part of it. The Whipple’s procedure is the most common surgery done for cancers of the pancreatic head. In this, not only the pancreas is removed, but also the stomach, duodenum, lymph nodes and surrounding tissue.
If the cancer cannot be removed, the surgeon can opt to bypass the blocked bile duct so that bile and enzymes can flow again.
Naturally, there is also chemotherapy and radiotherapy.
Can I prevent myself and my loved ones from getting pancreatic cancer?
Pancreatic cancer is associated with smoking, so quit smoking. Keep healthy, maintain your weight, exercise, and eat more fruits and vegetables.
But even then, you cannot really prevent pancreatic cancer or any sort of cancer. Still, you can reduce the risk.
http://www.thestar.com.my/Lifestyle/Viewpoints/Tell-Me-About/Profile/Articles/2013/07/24/A-deadly-cancer.aspx
