Patient Information about Pancreatic Cancer
What is the pancreas?
The pancreas is an organ located in the horizontal plane behind the lower end of the stomach in our upper abdomen. It regulates the metabolism of sugar taken from the foods we eat by secreting some hormones, including insulin. It also secretes fluids called enzymes that help digest food.
What is Pancreatic Cancer?
As with other cancers, it is not known what causes pancreatic cancer. Pancreatic cancer occurs as a result of mutations in the DNA of pancreatic cells. These mutations lead to the formation called “tumor” as a result of uncontrolled cell proliferation. The majority of pancreatic cancers arise from the cells lining the pancreatic ducts. This type of cancer is called “pancreatic adenocarcinoma”.
What are the signs and symptoms of pancreatic cancer?
Pancreatic cancer is a very insidious disease and usually signs and symptoms do not occur unless it reaches an advanced stage. It usually occurs with the following signs and symptoms:
one. Stomach ache: The cause of abdominal pain in the back or waist is compression or invasion of the nerves in the abdomen by the tumor.
2. Jaundice (yellowing of the skin and eyes). It occurs as a result of obstruction of the bile ducts (choledochal duct) from the liver by pancreatic cancer, especially in tumors of the head region of the pancreas. Your skin and whites of eyes will become yellow, itchy, darkening in urine color and pale in stool color.
3. weight loss There are several reasons for . Among these reasons are cancer itself reducing appetite, inability to eat as a result of the tumor’s pressure on the stomach, and inability to digest food as a result of pancreatic enzymes not flowing into the intestine.
4. bowel obstruction It may occur as a result of invasion or compression of the duodenum by pancreatic cancer. In this case, nausea and vomiting may occur.
How is Pancreatic Cancer diagnosed?
1. Imaging Tests Creating pictures of your internal organs, including the pancreatic gland, is the main method in the diagnosis of pancreatic cancer. These tests include ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MR). These tests not only diagnose pancreatic tumor, but also help you choose your treatment by determining the stage of your disease.
2. Blood Tests The most important one is a special type of protein called CA 19-9 that is released from pancreatic cancer cells and passes into the blood. It has been used as a Tumor Marker for pancreatic adenocarcinoma, but it is not always reliable.
3. Biopsy, It is a necessary procedure for the definitive diagnosis of pancreatic cancer. It is the process of taking a small piece of the pancreas to be examined under a microscope. This procedure is performed by placing a needle through your skin into your pancreas under the guidance of Computed Tomography.
What are the Stages of Pancreatic Cancer?
Your doctor is staging your disease according to the results of the tests. The stages of pancreatic cancer are as follows:
Stage I . Cancer is confined to the pancreas.
Stage II : Cancer has spread beyond the pancreas to surrounding tissues and organs. Lymph nodes may be involved.
Stage III . The cancer has spread out of the pancreas and invaded the vessels near the pancreas. It may have spread to the lymph nodes.
Stage IV . The cancer has spread outside the pancreas and spread to the liver, lungs and peritoneum.
What is the treatment for Pancreatic Cancer?
Treatment of pancreatic cancer depends on the stage of the disease, the location of the cancer in the pancreas, the patient’s age, general condition, and the patient’s preferences. The first goal in treatment is to completely remove the cancerous tissue by surgery, if possible. This is often not possible, as pancreatic cancer typically spreads early and is rarely diagnosed at an early stage. Even if diagnosed early, the probability of recovery from the disease is very low. In 80-95% of the patients, surgery cannot be performed because the disease is at an advanced stage at the time of diagnosis. In patients with advanced pancreatic cancer who cannot undergo surgery, treatments (drugs and radiation treatments) are performed to stop the progression of the disease. In addition, treatments are applied to relieve some of the patient’s discomfort. Among these relaxing treatments, there are interventions made by entering the stent by entering the biliary tract through the skin to relieve the patient’s jaundice, and by inserting a needle through the skin, called celiac ganglion blockade, to relieve pain.
What is the Role of the Radiologist in Pancreatic Cancer?
1. Detection of pancreatic tumor: Radiologist makes the first diagnosis with films showing your internal organs (ultrasound, computed tomography and magnetic resonance). In a patient with symptoms of pancreatic cancer such as jaundice, abdominal pain and weight loss, the first thing to do should be imaging (usually computed tomography). Thus, the first doctor to see and detect your tumor with these films is the Radiologist.
2. Staging of pancreatic cancer : It is done by the radiologist with imaging methods. After this staging, your treatment options will become clear.
3. Needle biopsy i It will be done by the Interventional Radiologist and the definitive diagnosis of your disease will be made. This procedure is performed by an Interventional Radiology Specialist under the guidance of computed tomography, by inserting a needle through the skin.
4. Elimination of bile duct obstruction by placing a Stent:In those with advanced disease (80-95% of patients with pancreatic cancer) ) Percutaneous Transhepatic Cholangiography and Percutaneous Biliary Stent placement are performed to relieve jaundice. This intervention is performed by the Interventional Radiology Specialist in the angiography unit. It is performed by inserting a thin needle into the liver after the patient is anesthetized by intravenous drug administration. The narrowed or blocked bile duct is opened and a metal tube called a stent is placed in the biliary tract. The diameter of the metal stent placed by the interventional radiologist is the width of the pen tip before it is placed (outside the body), while it expands spontaneously inside (after it is placed) and opens up to a diameter of 10 mm. Thus, the problem of stent occlusion is minimized. However, the inner diameter of the plastic tubes placed by gastroenterologists with an endoscope (with ERCP) is 2-3 mm wide, there is not enough bile flow through them and they are blocked early.
5. Celiac Ganglion Blockage: It is another attempt made by the Interventional Radiology Specialist for the relief of abdominal pain. In advanced cancer, since the nerves in the upper abdomen are invaded by cancer cells, pain occurs and cannot be relieved with painkillers. In this case, in order to reduce or relieve the patient’s pain, a needle is inserted into the abdominal nerve transformer with a needle under the guidance of computed tomography, and the nerves are burned with alcohol and the transmission of pain to the brain via the nerves is prevented. Thus, the patient does not feel pain.
3 Main Initiatives of Interventional Radiology in Pancreatic Cancer
For definitive diagnosis: Needle biopsy (CT-guided)
To remove yellowness: Percutaneous Bile Stent placement
For pain relief: Celiac Block (CT-guided)
In summary, the Radiology Specialist diagnoses your disease in patients with pancreatic cancer and also performs your treatment in patients who cannot undergo surgery.