Pancreatic cancer is one of the most severe types of cancer; only a few per cent of patients survive for five years after diagnosis. The severity is accentuated by the fact that pancreatic cancer is seldom detected in the early stage. It develops when healthy cells in the pancreatic tissue turn malignant. Pancreatic cancer is becoming more common, but the reason is not known. Most pancreatic cancers are adenocarcinomas, or glandular carcinomas, while a minority of them are rare subtypes, such as islet cell cancers.

Risk of disease

Pancreatic cancer, as with cancers in general, is most frequently found in elderly people, peaking at the age of 70. The risk factors are not fully known, but it seems obvious that smoking (particularly in men), chronic pancreatitis and diabetes are connected with pancreatic cancer. Alcohol predisposes indirectly to pancreatic cancer: excessive use of alcohol elevates the risk for chronic pancreatitis, which in turn increases pancreatic cancer risk. Smoking, including the use of snuff, increases the risk of pancreatic cancer, as well as certain inheritable characteristics. However, anyone can get pancreatic cancer.

Symptoms

Pancreatic cancer is an insidious disease, because it normally presents very few symptoms or no symptoms at all in the early stage. The most common symptoms, usually associated with an advanced stage of disease, include weight loss, pain in the upper stomach, back pain and jaundice. Bowel movements may change; the patient may suffer from diarrhoea, nausea and possibly vomiting. In a minority of patients, acute pancreatitis may be a symptom of cancer.

Diagnosis

A number of different methods are used for examining the pancreas. They include ultrasound, CT and MRI scans and needle aspirate samples. Blood samples may be analysed for the presence of the CA 19-9 marker. It is an agent excreted by cancer cells, and it is present in the serum in 80% of pancreatic cancer patients. However, the marker is unreliable and, therefore, cannot be used for screening.

Treatment

The primary treatment of local pancreatic cancer is surgery. Surgery is not always curative, because it is rarely possible to completely remove the cancerous tissue. Surgery may be palliative, such as relieving the symptoms of a patient with obstructed bile ducts. Other treatments include chemotherapy or a combination of chemotherapy and radiotherapy.

There are several alternative chemotherapies available. The total duration of chemotherapy depends on its efficiency and the patient’s general physical condition; due to the side effects, a relatively good general physical condition is necessary. Chemotherapy does not cure metastasised pancreatic cancer, but it relieves symptoms and increases life expectancy.

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