Pancreatic cancer is one of the most aggressive tumors with the worst prognosis. Despite its low incidence compared to other types of cancer, its high mortality makes it a priority in cancer research and treatment.
What is pancreatic cancer?
Pancreatic cancer is a disease in which the cells of the pancreas grow out of control. In Spain, pancreatic cancer ranks 8th in frequency, with an annual incidence of approximately 8,993 cases in 2023. This type of cancer is one of the most aggressive cancers and, despite its relatively low incidence, it has a high mortality rate.
Types of pancreatic cancer
Pancreatic ductal adenocarcinoma (PDAC)
This is the most common pancreatic tumor and accounts for approximately 95% of exocrine pancreatic cancers. It develops in the cells lining the ducts of the pancreas, which transport digestive enzymes. This type of cancer is usually detected in advanced stages due to the lack of early symptoms.
Other less common types:
- Pancreatic Neuroendocrine Tumors (NET): originate in the endocrine cells of the pancreas, which produce hormones such as insulin.
- Acinar cell carcinomas: they form from the cells that produce pancreatic enzymes3.
- Adenosquamous, squamous cell, and other carcinomas: include several rare types of exocrine pancreatic cancer.
Importance of recognizing symptoms
Pancreatic cancer is known as a “silent killer” because it usually has no obvious symptoms in its early stages. This means that it is often diagnosed in advanced stages, when treatment options are limited and survival rates are low.
Nonspecific symptoms, such as abdominal pain, weight loss, jaundice and digestive problems, can be easily confused with other diseases, delaying diagnosis. Early detection is crucial to increase the chances of successful treatment and improve survival rates.
Main symptoms of pancreatic cancer
- Jaundice: jaundice manifests as a yellowing of the skin and eyes. This occurs due to obstruction of the bile ducts by the tumor, which prevents bile from flowing properly from the liver to the intestine, accumulating in the body.
- Abdominal or back pain: pain related to pancreatic cancer is usually located in the upper abdomen and may radiate to the back. This pain may be constant or intermittent and is often worse when lying down or after eating.
- Unexplained weight loss and lack of appetite: unexplained weight loss and lack of appetite are common because pancreatic cancer affects the body’s ability to properly digest and absorb nutrients.
- Extreme fatigue: Persistent weakness and fatigue are common symptoms because the body is using too much energy to fight the disease, and poor nutrient absorption contributes to the feeling of exhaustion.
- Nausea and vomiting: these digestive symptoms can occur due to obstruction of the digestive system by the tumor, making it difficult for food to pass through and causing stomach discomfort.
Risk factors associated with pancreatic cancer
Smoking: Smoking is one of the most important risk factors for pancreatic cancer. The risk of pancreatic cancer is about twice as high in smokers as in people who have never smoked. About 25% of pancreatic cancers are thought to be caused by cigarette smoking.
Diabetes: Pancreatic cancer is more common in people with diabetes. According to the American Cancer Society, the reason for this is unknown. The risk is mainly found in people with type 2 diabetes. This type of diabetes is increasing in children and adolescents as obesity also increases in these age groups. Type 2 diabetes in adults is also often related to being overweight or obese. It is uncertain whether there is an increased risk in people with type 1 (in younger people) of the disease.
Chronic pancreatitis: chronic pancreatitis, a long-term inflammation of the pancreas, is associated with an increased risk of pancreatic cancer. Chronic pancreatitis often affects people who consume a lot of alcohol or tobacco.
Family history of pancreatic cancer: approximately 10% of pancreatic cancer cases are related to inherited genetic mutations. These mutations can be passed from parent to child and can increase the risk of developing pancreatic cancer.
Obesity and diet: having a high body mass index (BMI) is associated with an increased risk. Obese people (body mass index [BMI] of 30 or more) are approximately 20% more likely to develop pancreatic cancer.
Age: The risk of pancreatic cancer increases as a person ages. Almost all patients are older than 45 years of age. About two-thirds of patients are at least 65 years old. The average age at diagnosis is 70 years.
Diagnostic tests for pancreatic cancer
- Ultrasound and computed tomography (CT): these imaging tests are used to detect masses or abnormalities in the pancreas. Ultrasound is less invasive and is used as a first approximation, while CT provides more detailed images.
- Magnetic resonance imaging (MRI) and cholangiopancreatography: MRI provides detailed visualization of the soft tissues and pancreatic ducts. Cholangiopancreatography, which can be MRI (MRCP) or endoscopic (ERCP), is used to examine the bile and pancreatic ducts.
- Blood tests and tumor markers: Blood tests can measure the CA 19-9 marker, which is often elevated in people with pancreatic cancer. However, it is not specific and may be elevated in other conditions.
- Pancreatic biopsy: This test involves obtaining a sample of pancreatic tissue for a definitive diagnosis. It can be performed by image-guided fine needle or during endoscopy.
- Echoendoscopy: Echoendoscopy, also known as endoscopic ultrasound, is an advanced diagnostic technique that combines endoscopy and ultrasound to obtain detailed images of the digestive tract and adjacent organs, such as the pancreas.
Treatment options
Treatment of pancreatic cancer depends on the stage of the cancer, its location and the general health of the patient.
Surgical treatments
- Pancreatectomy: is a surgical procedure in which part or all of the pancreas is removed. This surgery is performed in cases of pancreatic tumors, chronic pancreatitis, cysts, or traumatic injuries, among other conditions.
- Minimally invasive pancreatectomy: pancreatectomy can be performed at IVOQA by laparoscopic or robotic surgery.
- Percutaneous tumor ablation: Percutaneous ablation is a minimally invasive procedure that uses imaging technology to guide the precise placement of one or more needles in the center of the tumor to be treated. These needles, using different technologies, apply energy to destroy a volume of tissue in a controlled manner, thus eliminating the tumor.
- IRE (Irreversible Electroporation): IRE is a non-thermal tumor ablation technique based on the application of high-voltage electrical pulses between pairs of needles inserted around a tumor. The current generated favors the creation of nanopores in the plasma membrane, triggering apoptosis. Therefore, IRE can be safely used in locations close to delicate vascular structures, contraindicated for the other thermoablative techniques.
Non-surgical treatments:
- Chemotherapy: uses drugs to destroy cancer cells. It can be administered before or after surgery, or as the main treatment if surgery is not an option.
- Radiation therapy: uses high-energy rays to destroy cancer cells. It is often combined with chemotherapy.
- Targeted therapy: uses drugs that specifically target abnormalities in the cancer cells.
Prevention and regular checkups.
Preventive measures
- Smoking reduction: quitting smoking is one of the most effective measures to reduce the risk of pancreatic cancer.
- Maintaining a healthy weight: adopting a balanced diet and regular exercise helps maintain a healthy weight, which can decrease risk.
- Diabetes control: keeping diabetes under control through proper diet, exercise and medication can reduce the risk of developing pancreatic cancer.
- Alcohol: Alcohol consumption is linked to an increased risk of several types of cancer, including pancreatic cancer. Drinking alcohol can damage the DNA of cells, which can lead to uncontrolled cell growth and eventually cancer. Also, heavy drinking can cause chronic pancreatitis, a persistent inflammation of the pancreas that is a known risk factor for pancreatic cancer.
Regular checkups:
- Regular Screening: for people with a family history of pancreatic cancer or with elevated risk factors, regular checkups are recommended. These may include imaging tests such as endoscopic ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) to detect any abnormalities in the pancreas.
- Genetic testing: In cases of family history, genetic testing can help identify mutations that increase the risk of pancreatic cancer3.
These measures can help detect pancreatic cancer at earlier stages, when it is more treatable.
Pancreatic tumors are particularly aggressive and require a multidisciplinary approach to select the best therapeutic option. Therefore, IVOQA has a team of surgeons highly trained in Surgical Oncology and Hepatobiliopancreatic Surgery. We have oncologists, digestive system specialists and interventional radiologists who work in collaboration with the surgeons to offer you the best treatment.
