Pancreatic Cancer

Pancreatic cancer refers to a speading cell mass malignant neoplasm of the pancreas. The most common type of pancreatic cancer, accounting 95% of these tumors is adenocarcinoma, which arises within the exocrine component of the pancreas. A minority arises from the islet cells and is classified as a neuroendocrine tuor. The symptoms that lead to diagnosis deepend on the location, the size, and the tissue type of the tumor. They may include abdominal pain and jaundice (if the tumor compress the bile duct.

Pancreatic cancer is the fourth most common cause of cancer death across the globe (1) Pancreatic cancer often has a poor prognosis: for all stages combined, the 1- and 5- year relative survival rates are 25% and 6% respectively; (2) for local disease tje 5-year surival is approximately 20% while the median survival for locally advanced and for metastic disease, which collectively represent over 80% of individuals, (3) is about 10 and 6 mounths respectively,(4)Panceatic cancer is sometimes referred to as a "silent killer" because early pancreatic cancer often does not cause symptons, (5) and the later symptoms are usualy nonspecific and varied. Therfore pancreatic cancer is often not diagnosed until it is advance.

Signs and symtoms Pain in the upper abdomen that typically radiates to the back Loss of appetite and or nausea and vomiting Significant weight loss Painless jaundice(yellow tint to the whites of eyes and or yellowish skin in serious casesThe jaundice maym be associated with itching as the salt from excessbile can cause skin irritation. Trousseau sign, in which blood clots form spontaneously in the portal blood vessels is sometimes associated with pancreatic cancer. Diabetes mellitus or elevated blood sugar levels.Develope diabetes in an elderly individual may be an early warning sign months or years bfore they are diagnosed with pancreatic cancer . However the mechanism for this association is not known. Clinical depression has been reported in association with pancreatic cancer sometimes presenting before it is diagnosed. However, the mechanism for this association is not known. Symptoms of pancreatic cancer metastasis. Typically, pancreatic cancer first

metastasizes to regional lymph nodes, and later to the liver and, less to the lungs; it occasionally metastasizes to bone or brain.

Risk factors for pancreatic cancer may include; Family history Age Smoking Diets low in vegetables and fruits Diets high in red meat Diets high in suga-sweetened drinks. In particular, the common soft drink sweetener fructose has been linked to growth of pancreatic cancer cells. Obesity Diadetes mellitus is both risk factor for pancreatic cancer, and as noted earlier, new onset diabetes can be an early sign of the disease Gingivitis or periodontal disease Alcohol It is controversial whether alcohol consumption is a risk factor for pancreatic cancer.Overall, the association is consistenly weak and the majority of studies have found no association. Although excessively drinking of alcohol is a major cause of chronic pancreatitis, which in turn predisposes to pancreatic cancer.

Diagnosis Pain is present in 80% to 85% of patients with locally advanced or advanced metastastic disease. The pain is ususlly felt in the upper abdomen as a dull ache that radiates straight through to the back. Itmay be intermittent and made worse by eating. Weight loss canbe profound; it can be associated with anorexia, early satiety, diarrhea, or steatorrhea. Jaundice is often accompanied by puritus and urine. Painful jaundice is present in approimately one-half of patients with locally unresectable disease, while painless jaundice is present in approximately one-half of patients with a potentially resectable and curable lesion. The inital presentation varies according to location of the cancer. Malignanies in the pancreatic body or tail usually present with pain and weight loss, while those in the head of gland typically present with steatorrhea, weight loss, and jaundice. The recent onset of atypical diabetes mellitus, a history of recent but unexplained thrombophlebitis

(Troussseau sign), or a previous attack of pancreatitis are sometimes noted. Courvoisier sign defines the presence of jaundice and a painlessly distended gallbladder as strongly indicative of pancreatic cancer, and may be used to distinguish pancreatic cancer from gallstones. Tiredness, irritability and difficulty eating because of pain also exist. Pancreatic cancer is often discovered during the course of the evaluaton of afoementioned symptoms.

Pathophysiology The definitive diagnosos is made by endoscopic needle biopsy or surgical excision of the radiologically suspicious tissue. Endoscopic ultrasound is often used to visually guide the needle biopsy procedure. Treatment Treatment of pancreatic cancer depends on the stage of the cancer The Whipple procedure is the most common surgical treament for cancers involving the head of the pancreas.This procedure involves removing the pancreatis head and the curve of the duodenum together (pancreato-duodenectomy), makinga bypass for food from stomach to jejunum (gastro-jejunostomy) and attaching a loop of jejunum to the cystic duct to drain bile (cholecysto-jejunostomy). It can be preformed only if the patient is likely to survive major surgery and if the cancer is localized without invading local structures or metastasizing. It can, therefore, be preformed in only the minority of cases. Cancers of the tail of the pacreas can be resected uing a proceure known as a distal pancreatectomy.Recently, localized cancers of the panceas have been resected using minimally invasive (laparoscropic) approaches. After surgerlyu, adjuvant chemotherapy with gemcitabine has been shown in several large radomized studies to significantly increase the 5-year surival (from approximately 10 to20%), and should be offered if the patient s fit after surgery. Surgery can be preformed for palliation, if the malignancy is invading or compressing the duodenum or colon. IN tha case, bypass surgery might overcome the obstruction and improve quality of life, but it is not intended as a cure. Chemotherapy In patients not suitable for resection with curative intent, palliative chemotherapy may be used to improve quality of life and gain a modest surival benefit.