Pancreatic cancer: Cancer (tumor) in pancreas with jaundice

The pancreas is a large organ located behind the stomach. It produces enzymes and releases them in the intestines so that the body can digest and absorb food, especially fat. The pancreas is also important in the production and release of insulin and glucagon. These are hormones that help the body control blood sugar levels. Pancreatic cancer is cancer that starts in the pancreas. The exact cause of pancreatic cancer is unknown, but several risk factors are known. Depending on the size and location of the tumor, the patient may have no symptoms or abdominal pain radiating to the back and jaundice. For many physicians, diagnosing pancreatic cancer presents a clinical challenge. The diagnosis is often made at a late stage, which means that treatment is mainly palliative. However, surgical intervention is potentially life-saving or life-prolonging in some patients who receive early diagnosis and treatment.

  • Pancreatic cancer synonyms
  • Epidemiology condition
  • Causes and risk factors of cancer in pancreas
  • Symptoms: Abdominal pain and jaundice
  • Diagnosis and examinations
  • Pancreatic cancer treatment and prognosis
  • Complications of tumor in the pancreas

Pancreatic cancer synonyms

Pancreatic cancer is also known by these synonyms

  • pancreatic carcinoma
  • pancreatic cancer
  • carcinoma of the pancreas
  • carcinoma of the pancreas
  • pancreatic carcinoma

Epidemiology condition

The incidence of pancreatic cancer in the West is estimated at 10 cases per 100,000. Pancreatic cancer is the fifth most common cause of cancer death in the Western world. The incidence increases with age and the majority of cases occur in patients over the age of sixty. About 60% of patients with this condition are men. About 95 percent of pancreatic cancers are adenocarcinomas (malignant glandular tissue and glandular epithelial growths) and the other patients have pancreatic cancer of ductal origin (originating in a duct). Some examples of the latter type of cancer include:

  • a cell tumor of the islets of Langerhans
  • a glucagonoma (tumor in the pancreas with too much glucagon in the blood)
  • an insulinoma (tumor in the pancreas with persistent insulin production)
  • a VIPoma (neuroendocrine tumor in pancreas with diarrhea)

Smoking is a risk factor for pancreatic cancer / Source: Geralt, Pixabay

Causes and risk factors of cancer in pancreas

Smoking doubles the risk of pancreatic cancer. Other possible environmental factors that contribute to the development of pancreatic cancer include long-term exposure to the petroleum product naphthalamine, obesity, alcohol abuse, a diet low in fruit and vegetables and diabetes mellitus. Chronic pancreatitis is a precursor to pancreatic cancer. In particular, patients with hereditary trypsinogen gene mutations have a 100-fold increased risk of developing cancer. Pancreatic cancer may also be genetically determined. Pancreatic cancer develops progressive premalignant ductal histological changes. This means that the cells change from a precancerous stage to an invasive cancer. A small percentage of pancreatic adenocarcinomas arise from lesions caused by pancreatic cysts.

Symptoms: Abdominal pain and jaundice

Symptoms vary depending on the location and size of the tumor and whether the tumor has already affected other organs. An adenocarcinoma of the pancreas can be clinically divided into two diseases, namely lesions of the head and lesions of the body and tail. A characteristic that occasionally also occurs in pancreatic cancer is ascites (fluid accumulation in the abdomen).

Head of the pancreas

A carcinoma (cancer of the skin, mucous membranes and organs) of the head of the pancreas or the ampulla of Vater (place where the duct of the gallbladder and the duct of the pancreas open into the duodenum (first part of the small intestine) ) often causes obstruction of the bile ducts, or jaundice (icterus). These more localized lesions are usually painless, although increasing pain is possible as the tumor grows.

Body or tail of the pancreas

A carcinoma located in the body or tail of the pancreas usually causes chronic abdominal pain (in the upper part of the abdomen) and diarrhea in combination with non-specific symptoms such as anorexia (a loss of appetite), weight loss, nausea, vomiting, difficulty swallowing , unusual belching, bloating, fatigue/cancer fatigue and weakness. Radiating back pain is also possible. Characteristic is a partial relief of pain when leaning forward. Bile duct obstruction (blockage of the bile ducts) and jaundice are symptoms that also occur occasionally, but these are mainly signs of a late stage of the disease.

Diagnosis and examinations

Physical examination

In the case of a carcinoma of the head of the pancreas, the patient presents with jaundice in combination with the characteristic skin scratches secondary to cholestasis (bile congestion due to narrowing or closure of the bile ducts that carry bile from the liver to the intestine). In some patients the gallbladder can be felt (Courvoisier’s sign). Possible palpable signs of pancreatic cancer include a central abdominal mass (tumor in the abdomen) or hepatomegaly (an enlargement of the liver). With carcinoma of the body and tail, the patient often has no physical signs. Other physical symptoms include thromboembolic signs (blood vessel blockages due to the presence of a blood clot), polyarthritis (inflammation of multiple joints) and skin nodules that sometimes predate the cancer by many months or years. Finally, some common signs that occur with pancreatic cancer are dark-colored urine, orange urine, and clay-colored stools.

Diagnostic research

The patient first receives an ultrasound. This examination confirms the presence of biliary obstruction and dilated intrahepatic bile ducts and a mass in the head of the pancreas. An ultrasound is less reliable when the cancer is located in the body and tail of the pancreas due to overlying intestinal gases, with a detection sensitivity of 60%.

CT scan
A contrast-enhanced spiral CT scan reveals the presence of a mass in the pancreas. This examination is also necessary prior to a possible surgical resection (surgical removal of part of the pancreas). The doctor examines any local involvement of the lymph nodes and distant metastases.

A laparoscopy, an internal examination of the abdominal cavity and the pelvis, is also a useful instrument for preoperative assessment of the tumor.

ERCP stands for “endoscopic retrograde cholangiopancreaticography”. This internal examination of the bile ducts and pancreas is usually only necessary during palliative treatment.

Percutaneous needle biopsy
A percutaneous needle biopsy (removing a piece of tissue with a needle) is not recommended in patients who may need surgery, because this can be a source of tumor cell spread within the peritoneum. However, if the patient requires palliative chemotherapy, percutaneous needle biopsy is essential for treatment.

MRI scan
An MRI scan and an endoscopic ultrasound are techniques that are useful in a small proportion of patients in whom the tumor is insufficiently defined.

Differential diagnosis

The diagnosis is in principle not difficult in the presence of painless jaundice or epigastric pain (pain over the stomach area in the center of the upper abdomen) that radiates to the back with progressive weight loss. Unfortunately, many patients experienced very minor symptoms or changes in the body such as pain, altered bowel habits and weight loss. Imaging examination and then a CT scan is essential in suspecting the diagnosis of pancreatic cancer.

The doctor also considers the following conditions as differential diagnoses:

  • acute pancreatitis (inflammation of the pancreas with abdominal pain and digestive problems)
  • chronic pancreatitis
  • cysts (abnormally shaped cavities in the body) on the bile ducts (choledochal cysts)
  • a stomach ulcer
  • an inflammation of the gallbladder (cholecystitis: abdominal pain, fever and nausea)
  • an inflammation of the bile ducts with fever, abdominal pain and jaundice (cholangitis)
  • gallstones (cholelithiasis: hard deposits in gallbladder with biliary colic)
  • stomach cancer

Pancreatic cancer treatment and prognosis

The treatment of pancreatic cancer depends on the stage of the tumor.

Surgical procedure

The five-year survival rate for pancreatic cancer is approximately 2-5%. Only surgical intervention increases the chance of long-term survival. About 20% of all patients with a localized tumor are suitable for resection. However, older patients often suffer from other diseases or other factors are present, so that major surgery is excluded. Doctors often decide in advance which candidates are suitable for this major procedure. Surgery is only possible if the tumor has not spread or has only spread very little.

Palliative treatment

In most cases, treatment is palliative. Jaundice, a debilitating complication, is associated with severe itching (pruritus) in many patients, but jaundice is also the cause of nonspecific malaise (a general ill feeling), lethargy (morbid lethargy) and anorexia. Endoscopic placement of endoprostheses (stents) is an excellent palliative treatment option. Palliative surgery is useful for duodenal obstruction (occlusion of the duodenum), a complication that occurs in 10% of patients. When pancreatic cancer is in advanced stages, self-expanding metal stents provide excellent short-term results.

Radiotherapy and chemotherapy

The results of radiotherapy are disappointing, but chemotherapy treatment does improve short-term survival in advanced disease and also offers benefits in patients undergoing pancreatic resection.

Complications of tumor in the pancreas

As the disease progresses, abdominal pain is a frequent complication that is sometimes very difficult to treat.

read more

  • Chronic pancreatitis: Persistent inflammation of the pancreas
  • Pancreatitis: Pancreatitis with abdominal pain
  • Cancer pain: Causes & types of pain and types of pain medication
  • Cancer Treatment: Different treatments for cancer
  • Cancer recurrence (recurrence): Types, risk factors and tips
Pancreatic cancer: Cancer (tumor) in pancreas with jaundice
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