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Pancreatic carcinoma – causes, symptoms, diagnosis, treatment, pathology

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Try it free today! Pancreatic carcinoma describes the pancreas
having cancerous cells arise. Now a healthy pancreas has two types of glands, exocrine
glands which sends digestive enzymes off to the small intestine, and endocrine glands
which help regulate metabolism in the body, for example, maintaining normal blood sugar. Over 95% of pancreatic tumors develop in the
pancreas’s exocrine tissues, and of these, tumors arising in the epithelial cells lining
the pancreatic ducts account for the vast majority of cases. This type of pancreatic
cancer is known as pancreatic adenocarcinoma due to the cells glandular-like (“adeno”)
appearance under the microscope, often pancreatic adenocarcinoma is used interchangeably with
pancreatic carcinoma. These tumors typically form in the head or neck of the pancreas,
but in some cases tumors form in the tail. Around 5% of exocrine pancreatic carcinomas
are caused by malignancies in the acinar cells, which are the cells that produce the digestive
enzymes like trypsinogen, and around 1% are cystadenocarcinomas, or malignant cysts. There
are also other types of pancreatic cancer, but those are even more rare. Generally, pancreatic carcinoma is caused
by genetic mutations in the ductal epithelial cells, and these mutations might activate
oncogenes which promote cancer or inactivate tumor suppressor genes. Either way, this can
lead to uncontrolled cell growth caused by the disruptions of the cell signalling pathways
that regulate cell survival and growth, as well as multiple immune system responses like
inflammation and stress responses. Although it’s not exactly clear how the
genetic mutations that trigger pancreatic carcinoma develop, there are some well known
modifiable risk factors like smoking which increases the risk by two to five-fold, obesity,
as well as eating a diet high in red meat. There are also some non-modifiable risk factors
like being male, being African American, and being over 65 years old. Also, certain other diseases seem to increase
the risk of developing pancreatic carcinoma as well, like diabetes, chronic pancreatitis,
and liver cirrhosis, all of which are linked to excessive alcohol consumption, so there
does seem to be an indirect relationship between pancreatic carcinoma and alcohol as well. Finally, a family history of pancreatic cancer
is also an important risk factor that increases individual risk, with inherited mutations
in BRCA2, or breast cancer gene 2 being the most common cause of inherited pancreatic
carcinoma, and mutations in PALB2 taking second place. Initially symptoms are often vague, like nausea,
vomiting, and fatigue. There might also be weight loss, which may be due to cancer-associated
anorexia, or malabsorption due to an obstructed pancreatic duct which can cause steatorrhea,
foul-smelling greasy loose stools. One of the most specific symptoms of pancreatic
carcinoma is midepigastric pain that radiates to the mid- or lower-back, which often hurts
the most at night when the individual is lying down flat. Other classic symptoms that have
been described include Trousseau sign, which is when blood clots, that can be felt as small
lumps under the skin, appear unexpectedly in superficial veins, and then over time,
migrate to different locations. As well as Courvoisier sign, which is when the gallbladder
is enlarged and palpable, and the patient does not find it at all tender to the touch,
which is unlike gallstones. This occurs when the common bile duct is blocked by a tumor
so this sign suggests the tumor is more likely in the head of the pancreas than the tail. The location of the tumor can affect the symptoms
as well. For example, if the tumor is in the head of the pancreas, then it can block the
common bile duct, leading to a backup bile and causing obstructive jaundice. Individuals
might have a loss of appetite, darker urine, and lighter stools, as well as eventually
developing pruritus, or itchy skin, and having their skin turn yellow. If the tumor affects the endocrine function
of the pancreas, then a new onset of diabetes in an older patient might also be a sign of
pancreatic carcinoma. Laboratory findings are generally non-specific
for pancreatic carcinoma; serum amylase and lipase levels may be elevated, as well as
tumor markers CA 19-9 antigen, which is a molecule that helps with immune-surveillance,
and CEA, a glycoprotein involved in cell adhesion. The activation of oncogenes and tumor suppressor
genes can disrupt their production, so that elevated levels appear in the bloodstream.
Since these aren’t specific for pancreatic carcinoma, though, they might even be elevated
in patients without cancer, particularly those who smoke, and so these can’t be used for
diagnosis. Sometimes when there are related problems like obstructive jaundice it might
cause elevated bilirubin, alkaline phosphatase, and transaminase levels. Medical imaging techniques and biopsy are
used to confirm a diagnosis.Staging of the tumor is dependent on size and locations of
the tumor. Stage 1 is tumors less than 2 cm, stage two is tumors greater than 2 cm, stage
3 is it can spread to neighboring tissues and organs like the duodenum and the stomach,
and stage 4 is metastatic, meaning it can spread through the blood and lymph to other
tissues like the liver and lungs. Finally, imaging can be used to help determine if it’s
resectable. For treatment, chemotherapy might be given
as a neoadjuvant, meaning used to shrink the tumor before surgery, or as an adjuvant therapy
after surgery, or to help individuals who can’t have surgery at all. A major surgical
procedure, called a Whipple procedure, is sometimes used to remove cancer from the head
of the pancreas. Since several organs share a blood supply in this region of the body
it also necessitates the removal of the gallbladder, the duodenum, and parts of the jejunum and
stomach. Unfortunately, most people with pancreatic
carcinoma have a poor prognosis because it’s typically pretty advanced at the time of diagnosis.
Even among patients with stage I pancreatic carcinoma, the long-term survival rates are
pretty low. Alright, as a quick recap, pancreatic carcinoma
is most commonly a cancer of the exocrine pancreas, especially in the ductal epithelial
cells of the head or neck of the pancreas, and it’s often caused by mutations in oncogenes
and tumor suppressor genes, which leads to unchecked cell growth.

12 thoughts on “Pancreatic carcinoma – causes, symptoms, diagnosis, treatment, pathology

  1. My aunt was diagnosed with pancreatic cancer stage 2 two months ago.
    Later-in the operation-the doctors told us that it was actually a stage 3 tumor and they had to take out the whole pancreas spontaneously.
    She's right now recovering from the operation and will hopefully get into the chemotherapy soon.

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