Pancreatic Cancer

WHAT IS PANCREATIC CANCER?

The pancreas, a 15-centimeter-long dual-functional secretory gland located in the abdominal cavity, is surrounded by the stomach, small intestine, spleen and liver. There are two separate groups of cells that enable the pancreas, which has two main tasks under the name exocrine and endocrine, to perform these tasks. Exocrine secretes sap, which helps digestion, and transmits it to the small intestine. Thus, carbohydrates, proteins and fats contained in foods are decomposed and stored as energy. Endocrine function, on the other hand, tries to maintain glucose in the blood at a certain level by secreting the hormones glycogen and insulin.

WHAT ARE THE TREATMENT METHODS ACCORDING TO THE STAGE OF PANCREATIC CANCER?

Resectable (suitable for surgical intervention, operable): If the tumor can be removed in pancreatic cancer, the surgical method, which is the only solution method for curing pancreatic cancer, should be applied. Although the tumor is removed by surgical method, pancreatic cancer can recur most of the time. Chemotherapy treatment administered in combination with gemcitabine (gemzar) or 5-FU after pancreatic surgery can delay the recurrence of cancer by up to 6 months.  

Regionally advanced: Pancreatic cancer has progressed regionally, but has not spread to distant organs. If the patient is not suitable for surgical intervention, interventions are performed according to the patient’s clinic. If there is a bile duct obstruction, a stent can be placed.  If there is an area of the intestine blocked by the cancer, a new path between the stomach and the small intestine is opened by bypass. Dec.

Metastatic (spread over a wide area): If pancreatic cancer has spread to the abdomen, liver, lungs, bones and brain, radiation therapy or surgical intervention alone will not be enough. One of the standard methods of treatment for pancreatic cancer that has spread is chemotherapy treatment. This treatment extends the patient’s life expectancy by shrinking the cancer.

Recurrent (recurrent) Pancreatic Cancer: A recurrent cancer that recurs at or near the same area after pancreatic cancer surgery is called a recurrence. If the cancer is going to recur in a remote area, it will occur primarily in the liver. When exocrine pancreatic cancer recurs, the same treatment as for metastatic cancer is planned and chemotherapy treatment is applied to the patient.

Neuroendocrine Pancreatic Cancer (Pnet)

Resectable (suitable for surgical intervention): If surgery can be performed, the surgical technique that is considered appropriate according to the type, size and location of the tumor in the pancreas is determined and operated on. Laparoscopy can be performed before surgery to determine the stage and exact location of the tumor.

Anresectable (unsuitable for surgical intervention): Neuroendocrine pancreatic tumors usually grow slowly. In these tumors, the Gallium 68 DOTATOC method, which is one of the molecular imaging methods called endocrine cancer imaging, is used and the tumor can be examined. Two methods are applied Decoupled in the treatment. In order to eliminate the problems caused by the hormone secreted from the tumor, the patient is prescribed stomach medications that reduce acid secretion called proton pump inhibitors. After that, chemotherapy, smart drug application and/or targeted radioisotopes are applied to regress the tumor.

HOW IS THE DIAGNOSIS MADE IN PANCREATIC CANCER?

Early diagnosis of pancreatic cancer may not be very easy. Because there are no signs and symptoms in the early stages of pancreatic cancer. The fact that the symptoms of pancreatic cancer resemble many symptoms of the disease, and the fact that the pancreas is hidden behind organs such as the stomach, small intestine, liver, is also effective in preventing early diagnosis.

A diagnosis of pancreatic cancer is usually made by detailed imaging of the pancreas and its surroundings with the help of various tests. Determining the extent to which cancer cells have spread into and out of the pancreas (the state of spread of cancer) is called staging.  Radiological imaging methods are used for staging. For an accurate treatment plan for pancreatic cancer, the stage of cancer along with early diagnosis is very important.

We can list the tests performed to diagnose pancreatic cancer as follows;

Patient’s health history and physical examination: A general physical examination of the patient is performed and diseases in the past are questioned. It is examined if they have diseases such as diabetes and pancreatitis, which are risk factors for pancreatic cancer.
Blood test: The amount of certain substances such as bilirubin is measured by performing a blood test. Measurements that are higher or lower than normal are evaluated as a symptom of the disease that occurs in the organs or tissues that secrete that substance.
Tumor markers: To detect the presence of cancer in the blood or tissue, a tissue, urine or blood sample is taken and some measurements are performed. During these measurements, CA 19. two tumor markers named 9 and CEA can provide useful information for pancreatic cancer. These tests are a guide in the follow-up of patients diagnosed with pancreatic cancer rather than making a diagnosis. These types of tests are not performed on healthy individuals.
Magnetic Resonance Imaging (MRI): MRI is one of the important imaging methods for pancreatic cancer, as with all cancers. In particular, your relationship with the tissues around the pancreas and the liver interior is very effective for understanding the signs.
Computed Tomography (CT): It is one of the most guiding imaging methods in the diagnosis of cancer. In the CT application, also called computed tomography or computed axial tomography, contrast media can be given to the patient through a vein or by mouth to make the images more accurate.
Positron Emission Tomography (PET Scan): PET scan is also used to detect the location and volleys of the tumor. The patient is injected with a small amount of radionuclide substance and marked glucose, and the places where glucose accumulates are detected. Because cancerous cells collect more glucose, they appear darker in color and are detected.
Abdominal ultrasound: High energy sound waves are sent into the abdomen with abdominal ultrasound. These sound waves hit the tissues and make an echo. Thus, imaging of the inside of the abdomen and organs is provided.
Endoscopic Ultrasound (EUS): It is a diagnostic method usually performed by inserting an endoscopic device with light and an imaging lens at the tip into the breech or through the mouth. The echoes formed by high frequency sound waves are detected by the device and a detailed image of the organs called a sonogram is obtained and allows a biopsy to be taken from suspicious areas if necessary.
Endoscopic Retrograde Cholangiopancreticography (ERCP): With this method, the pancreatic duct and the main bile duct and bile ducts can be imaged from the duodenum. A small tube-shaped catheter is inserted into the pancreatic ducts through the endoscope and a detailed image of the bile ducts is taken by injecting a contrast agent.
Percutaneous Transhepatic Cholangiography (PTC): A catheter is inserted and inserted through the skin with the help of ultrasound to reach the biliary tract. Bile ducts are displayed using X-rays with the help of contrast media given from the catheter. If necessary, it is left in the catheter to drain the bile. This application is applied only in cases where ERCP cannot be performed.
Laparoscopy: It is a surgical method that controls the symptoms of the disease by looking at the abdomen and internal organs from the inside. Tubular tools, which we call ports, are placed from millimetric drills opened from the abdominal wall. The camera and instruments entered through these ports look into the abdomen. The location of the tumor, whether it has spread to the abdominal membrane or other organs, can be displayed. A biopsy can be taken to make a diagnosis.
Biopsy: This is the process of taking a cell or tissue sample to investigate the signs of cancer in the tissue in detail. There are several different biopsy methods for pancreatic cancer. Just as a cell sample can be taken from the pancreas with a thin needle during X-ray or ultrasound, it is also possible to perform the same procedure during laparoscopy.

TREATMENT OF PANCREATIC CANCER

The treatment of pancreatic cancer consists of 3 separate methods: surgery, chemotherapy and radiotherapy. This brings up the intervention and control of different specialist physicians in the treatment of pancreatic cancer. Pancreatic cancer treatment is performed together with all doctors specializing in gastroenterology, surgery, medical oncology, radiation oncology, interventional radiology and many other fields.

Most patients with pancreatic cancer are not candidates for therapeutic surgery due to early cancer spread to distant organs or widespread local involvement. Surgical procedures are performed on these patients to relieve occlusive symptoms such as jaundice and pain, which do not prolong life, but are aimed at making them have a more comfortable period. Depending on the general condition of the patients and their associated diseases, the average life expectancy in patients in whom pancreatic cancer has spread to other organs in the body is between 3 and 6 months Dec. In patients with local spread of the disease, the average life expectancy is 6 to 10 months.

Pancreatic cancer surgeries are one of the most difficult and problematic surgeries of surgery, and both the surgeon and hospital facilities should be adequate, especially with complications that may occur in the postoperative period.