Pancreatic cancer

The Function of the Pancreas and Complications Associated with Pancreatic Cancer

The pancreas is an essential glandular organ located behind the stomach. It performs dual roles in the body—exocrine and endocrine. Exocrine functions involve the secretion of digestive enzymes into the small intestine to aid in the digestion of proteins, fats, and carbohydrates. The endocrine component produces vital hormones such as insulin and glucagon, which regulate blood sugar levels. When the pancreas is afflicted by diseases such as cancer, it disrupts its ability to perform these functions efficiently. Pancreatic cancer leads to digestive malabsorption, severe hormonal imbalances like diabetes, rapid systemic deterioration, and may culminate in fatal organ failure.

Pancreatic cancer begins in the tissues of the pancreas and is regarded by medical researchers as one of the most lethal cancers due to its asymptomatic onset and rapid progression. It typically arises from mutations in pancreatic cells that turn normal, functional cells into aggressive cancerous forms. Though not among the most commonly diagnosed cancers worldwide, it has an exceptionally high mortality rate, often due to late detection and lack of early warning signs. Raising awareness through widespread education and risk assessment, particularly by understanding contributing factors such as chronic pancreatitis, diabetes, and genetic predisposition, can significantly improve the odds of early intervention and survival.

Categories Associated With Primary And Secondary Pancreatic Tumours

Pancreatic cancers are typically classified under two main categories:

Primary Pancreatic Cancer: This refers to cancer originating directly in the pancreatic tissue. The most common type is Pancreatic Ductal Adenocarcinoma (PDAC), which begins in the ducts of the pancreas. Other types include Acinar Cell Carcinoma, Pancreatic Neuroendocrine Tumours (NETs), and rare tumours such as pancreatoblastoma.

Secondary (Metastatic) Pancreatic Cancer: This occurs when cancers from other organs, such as the breast, lung, or colon, spread to the pancreas. However, less common than primary pancreatic tumours, metastatic involvement complicates the clinical picture and typically signals advanced disease.

Known causes and risk factors include:

  • Chronic pancreatitis
  • Type 2 diabetes
  • Smoking and heavy alcohol use
  • Obesity
  • Genetic predisposition (e.g., BRCA2, Lynch syndrome)
  • Exposure to industrial chemicals

Signs And Symptoms of Pancreatic Cancer

Pancreatic cancer is often termed a “silent killer” because it shows no symptoms in early stages. However, signs emerge with disease progression, including:

  • Persistent abdominal or back pain
  • Significant and unexplained weight loss
  • Yellowing of the skin and eyes (jaundice)
  • Pale or greasy stools
  • Dark urine
  • Loss of appetite
  • Nausea and vomiting
  • Fatigue and general weakness
  • Newly onset diabetes or worsening of existing diabetes

These symptoms typically present after the tumour has grown or metastasised, making early detection challenging yet urgent.

Diagnosis of Pancreatic Cancer

A thorough diagnostic process for pancreatic cancer includes:

Laboratory Tests:

  • Liver function tests (due to bile duct obstruction)
  • CA 19-9 tumour marker (elevated in most pancreatic cancer patients)
  • Blood glucose levels

Imaging Studies:

  • Abdominal ultrasound
  • Endoscopic ultrasound (EUS)
  • CT scan and MRI for tumour localisation and metastasis detection
  • PET scan for whole-body metastasis assessment

Biopsy:

Tissue samples may be obtained through EUS-guided fine-needle aspiration or during surgery to confirm malignancy and cancer subtype.

Staging:

This includes determining whether the tumour is resectable (surgical removal possible) and evaluating its spread to lymph nodes or distant organs.

Best Treatment for Pancreatic Cancer

The treatment of pancreatic cancer depends on tumour type, location, extent of spread, and patient health. Major treatments include:

A. Traditional Treatments

B. Advanced and Alternative Treatments

C. Traditional Treatment for Pancreatic Cancer

1. Surgical Procedures

  • Whipple Procedure (Pancreaticoduodenectomy):
  • Commonly performed if the tumour is located in the pancreatic head and is operable. It involves the removal of the head of the pancreas, duodenum, bile duct, and part of the stomach.
  • Distal Pancreatectomy:
  • Removes the body and tail of the pancreas and often the spleen.
  • Total Pancreatectomy:
  • Rarely done, this procedure involves the complete removal of the pancreas and is often followed by lifelong insulin and enzyme therapy.

2. External Beam Radiation Therapy

Uses linear accelerators to target pancreatic tumours with precision, aiming to shrink tumours before surgery or relieve pain in inoperable cases. While effective, there’s potential for damage to surrounding organs such as the intestines or liver.

3. Systemic Chemotherapy

Standard regimens include drugs such as gemcitabine, FOLFIRINOX (a combination of four drugs), or nab-paclitaxel. Administered intravenously, this approach can shrink tumours, improve symptoms, and prolong survival, but may cause hair loss, nausea, fatigue, and immunosuppression due to its impact on healthy cells.

B. Advanced Treatments for Pancreatic Cancer

Emerging and less invasive therapies are showing promise in treatment with minimised side effects. These include:

1. Microinvasive Therapies and Surgeries

  • NanoKnife for Pancreatic Cancer (IRE):
  • Particularly beneficial for tumours close to blood vessels. This non-thermal technique uses electrical pulses to disrupt cancer cell membranes. Widely approved in the U.S., Europe, and Asia, it preserves surrounding tissue and offers an option for inoperable tumours.
  • Cryosurgical Ablation:
  • Destroys pancreatic tumours by freezing them to sub-zero temperatures. Often combined with immunomodulatory techniques to boost the patient’s immune response (cryo-immunology). It causes necrosis of cancer cells without harming adjacent tissues.

2. Targeted Therapies

I. Microvascular Interventional Chemo

  • Transcatheter Arterial Infusion (TAI) and Chemoembolization (TACE):
  • These allow high-dose chemotherapy delivery directly to the pancreas, reducing systemic side effects. Microcatheters are inserted into arteries feeding the tumour to infuse drugs or block the blood supply.

II. Targeted Drug Therapy

New molecules like PARP inhibitors (for BRCA mutation carriers) and kinase inhibitors target molecular abnormalities in cancer cells, leaving healthy cells relatively untouched. These reduce overall toxicity and enhance patient tolerance.

3. Targeted Radiation Therapy (Brachytherapy / Radioembolization)

Though still rare for pancreatic cancer, some trials have explored placing radioactive seeds in the pancreas. Iodine-125 and Palladium-103 isotopes have been used for patients with tumours resistant to external radiation. Techniques allow minimal collateral damage and faster recovery time.

4. Stem Cell Therapies and Immunotherapies for Pancreatic Cancer

Innovative treatments such as CAR-T cell therapy and immune checkpoint inhibitors (e.g., anti-PD-1, anti-CTLA-4) have been adapted for pancreatic tumours. They activate the patient’s immune system to identify and destroy cancer cells. Combining these with microinvasive techniques significantly enhances efficacy and may offer long-term remission.

Prevention and Lifestyle Management

Reducing exposure to modifiable risk factors is crucial:

  • Avoid tobacco use
  • Maintain a healthy weight and a diet rich in fruits and vegetables
  • Limit alcohol intake
  • Treat chronic pancreatitis and diabetes proactively
  • Genetic counselling and regular screening for high-risk individuals (e.g., family history, hereditary syndromes)

Early surveillance can drastically improve prognosis in genetically susceptible patients.

Prognosis and Survival Rates

Due to the silent and aggressive nature of pancreatic cancer, prognosis tends to be poor. The average five-year survival rate across all stages is around 11%. For tumours detected early and treated surgically, the five-year survival may rise to 25%–30%. Unfortunately, most cases are diagnosed at advanced stages, resulting in a median survival of 6–11 months. Emerging treatments continue to improve life expectancy and quality of life.

Conclusion

Pancreatic cancer remains one of the most challenging malignancies due to its asymptomatic development, rapid progression, and resistance to treatment. However, with improved diagnostic tools, awareness, and revolutionary treatments—including microinvasive and immunological therapies—the outlook is steadily improving. Rigorous monitoring, risk reduction, and public education are essential to curbing the impact of this deadly disease.