EVERYTHING YOU NEED TO KNOW ABOUT PANCREATIC CANCER

The exact causes of pancreatic cancer are not always clear, but several factors have been identified as potential contributors to the development of this cancer. These include:

1. Smoking: Cigarette smoking is a significant risk factor for pancreatic cancer. Smokers are more likely to develop this type of cancer compared to non-smokers.

2. Age: The risk of pancreatic cancer increases with age, and the majority of cases occur in individuals over the age of 65.

3. Family History and Genetics: A family history of pancreatic cancer or certain genetic mutations can increase the risk. Specific genetic syndromes, such as hereditary pancreatitis and familial atypical multiple mole melanoma (FAMMM) syndrome, are associated with higher pancreatic cancer risk.

4. Chronic Pancreatitis: Long-term inflammation of the pancreas, often due to conditions like chronic pancreatitis, can elevate the risk.

5. Obesity: Being overweight or obese is linked to an increased likelihood of developing pancreatic cancer.

6. Diabetes: People with long-standing diabetes may have a higher risk of pancreatic cancer.

7. Dietary Factors: A diet high in red and processed meats and low in fruits and vegetables may contribute to the risk.

It's important to note that while these factors are associated with an increased risk, pancreatic cancer can still develop in individuals without these risk factors, and not everyone with risk factors will develop the disease. Early detection and timely medical intervention are crucial for managing pancreatic cancer.

Pancreatic cancer symptoms can vary, and they may not appear until the cancer is advanced. Common symptoms include:

1. Abdominal Pain: Pain in the upper abdomen or back is a common symptom, especially as the cancer grows and presses against surrounding organs.
2. Jaundice: Yellowing of the skin and eyes may occur due to blocked bile ducts caused by the tumor.
3. Unexplained Weight Loss: Sudden and unexplained weight loss, even when eating habits haven't changed, can be a sign of pancreatic cancer.
4. Loss of Appetite: A decrease in appetite and feelings of fullness even after eating small amounts of food.
5. Nausea and Vomiting: These symptoms may occur as a result of digestive issues caused by pancreatic cancer.
6. Changes in Stool: Light-colored or greasy stools may indicate a blockage in the bile ducts.
7. New-Onset Diabetes: Diabetes that develops suddenly and without a clear cause, especially in individuals over 50, can sometimes be an early sign of pancreatic cancer.
8. Digestive Problems: Indigestion, diarrhea, or changes in bowel habits can occur as the tumor affects the digestive system.
9. Fatigue: Feeling unusually tired or weak, even after getting enough rest, can be a symptom of pancreatic cancer.

LIVER FUNCTION TESTS:

In pancreatic cancer, liver function tests (LFTs) may show certain changes that can indicate how the cancer is affecting the liver. It can be due to blockage of liver juices by cancer itself or direct liver involvement due to spread of the tumor. These changes include:

1. High Bilirubin Levels: This can cause yellowing of the skin and eyes (jaundice) due to blockage of the bile duct by the tumor.

2. Increased Alkaline Phosphatase (ALP): This can happen when the bile duct is blocked, affecting the flow of bile.

3. Elevated Liver Enzymes (AST and ALT): These enzymes may rise due to the cancer spreading to the liver or bile duct blockage.

4. High Gamma-Glutamyl Transferase (GGT): Another marker of bile duct blockage.

5. Low Albumin Levels: This can indicate malnutrition due to cancer-related weight loss or altered liver function.

6. Abnormal Blood Clotting: Liver involvement by cancer can affect blood clotting, leading to abnormal clotting tests.

7. High Amylase and Lipase Levels: These enzymes may be elevated due to inflammation caused by the cancer.

SERUM TUMOR MARKERS:

Serum markers, also known as tumor markers, are substances produced by cancer cells or by the body in response to cancer. In pancreatic cancer, several serum markers can help in diagnosis, monitoring treatment response, and detecting disease recurrence. The main serum markers used include CA 19-9, CEA, CA 125, CA 72-4, and AFP. CA 19-9 is the most common and widely used marker. However, these markers are not specific to pancreatic cancer and can be elevated in other conditions. They are typically used alongside imaging and other diagnostic tests to aid in the diagnosis and management of pancreatic cancer.

CT SCAN OF THE ABDOMEN

In the context of diagnosing pancreatic cancer and planning for resection (surgical removal), CT scans offer several specific advantages:

1. Tumor Characterization: CT scans provide detailed images of pancreatic tumors, allowing for characterization of their size, location, and morphology. This information is crucial for determining whether a tumor is resectable (able to be surgically removed) or not.

2. Assessment of crucial blood vessels involvement: CT scans can accurately assess the extent of vascular involvement by the tumor, including encasement or invasion of nearby blood vessels such as the superior mesenteric artery (SMA), celiac artery, and portal vein. This information is critical for determining resectability and planning for vascular resection and reconstruction if necessary.

3. Evaluation of Adjacent Structures: CT scans provide comprehensive imaging of adjacent organs and structures, such as the duodenum, bile ducts, spleen, and surrounding lymph nodes. This helps in assessing the involvement of adjacent structures by the tumor and planning for en bloc resection if needed.

4. Identification of Distant spread: CT scans can detect distant metastases of pancreatic cancer to organs such as the liver, lungs, or peritoneum. Identification of metastatic disease influences the decision-making process regarding resection and may indicate the need for alternative treatment strategies.

5. Guidance for Surgical Planning: CT scans serve as a roadmap for surgical planning by providing precise anatomical details of the tumor and surrounding structures. Surgeons can use preoperative CT images to visualize the optimal surgical approach, identify critical structures to preserve, and plan for potential complications.

OTHER TESTS:

1. Endoscopic Ultrasound (EUS): EUS combines endoscopy with ultrasound imaging to obtain high-resolution images of the pancreas and nearby structures. It is commonly used to visualize small pancreatic tumors, assess lymph node involvement, and guide fine-needle aspiration (FNA) biopsies for tissue sampling.
2. Endoscopic Retrograde Cholangiopancreatography (ERCP): ERCP is a procedure used to visualize the bile ducts and pancreatic ducts. It can help identify bile duct obstruction, strictures, or tumors causing jaundice. Tissue samples can also be obtained during ERCP for pathological examination.
3. Positron Emission Tomography (PET) Scan: PET scans use a radioactive tracer to detect areas of increased metabolic activity in the body, which can help identify cancerous lesions, including metastases. PET scans can be used on individual basis to stage pancreatic cancer and assess treatment response.
4. Biopsy: Tissue biopsy is not always essential for confirming the diagnosis of pancreatic cancer if planned resection is possible. Biopsy samples can be obtained through various methods, including fine-needle aspiration (FNA) guided by imaging modalities such as CT, EUS, or ultrasound.

The management of pancreatic cancer typically involves a multidisciplinary approach, tailored to the individual patient's specific circumstances. It may include a combination of the following treatments:

1. Surgery: Surgical resection offers the best chance of cure for localized pancreatic cancer. The type of surgery depends on the tumor location, size, and extent. Common surgical procedures include pancreaticoduodenectomy (Whipple procedure) for tumors in the head of the pancreas, distal pancreatectomy for tumors in the body or tail of the pancreas, and total pancreatectomy for extensive disease.
2. Chemotherapy: Chemotherapy may be used before surgery (neoadjuvant chemotherapy) to shrink the tumor and improve resectability, or after surgery (adjuvant chemotherapy) to reduce the risk of recurrence. 
3. Radiation Therapy: Radiation therapy may be used alone or in combination with chemotherapy (chemoradiotherapy) to treat locally advanced pancreatic cancer or as adjuvant therapy following surgery to reduce the risk of local recurrence. Radiation therapy can help shrink tumors, relieve symptoms, and improve overall survival.
4. Targeted Therapy: Targeted therapies may be used in combination with chemotherapy for advanced pancreatic cancer. These drugs target specific molecular pathways involved in tumor growth and progression.
5. Immunotherapy: Immunotherapy drugs, such as checkpoint inhibitors (e.g., pembrolizumab, nivolumab), are being investigated in clinical trials for the treatment of pancreatic cancer. These drugs help the immune system recognize and attack cancer cells.
6. Pain Management and Supportive Care: Pancreatic cancer and its treatment can cause pain and other symptoms that require palliative care and supportive measures. Pain management, nutritional support, management of jaundice and other complications, and psychological support are important aspects of care for patients with pancreatic cancer.
7. Clinical Trials: Participation in clinical trials offers access to innovative treatments and investigational therapies that may improve outcomes for patients with pancreatic cancer. Clinical trials evaluate new drugs, treatment strategies, and therapeutic combinations.