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Pancreatic cancer

The pancreatic cancer or pancreatic adenocarcinoma is a slow – growing tumor, which early diagnosis is difficult because poverty and specificity of the symptoms presented in its initial phase.

In the advanced stages in which it is usually diagnosed, it has a very poor prognosis. Its 5-year survival is only 1-2% and mortality in the first year is 85%.

It is the second leading cause of death from gastrointestinal tract tumors. Its incidence has increased in recent decades in almost all countries.

It is more common in elderly patients and somewhat more common in men. The average age is around 60 years for men and almost 70 for women. The disease tends to affect men more, but with exceptions, such as in Spain, where women seem to be somewhat more susceptible.

Causes of pancreatic cancer

Its cause remains unknown, and there are a number of risk factors for suffering from the disease, of which only its causal relationship with tobacco and chronic pancreatitis has been demonstrated.

There is a higher prevalence in metal workers and chemical industries with alkylating substances, benzidine and asbestos, especially in people with more than ten years of exposure to them.

The consumption of abundant products rich in vegetable proteins such as lentils, peas, beans and some fruits, will significantly reduce the risk of suffering from this disease.

Alcohol and coffee have also been linked to the onset of the disease.

There are diseases that are associated with the appearance of pancreatic cancer:

  • Diabetes mellitus
  • Gallstones .
  • History of cholecystectomy.
  • Chronic pancreatitis.
  • Tropical calcifying pancreatitis.
  • Genetic mutations.

It originates in the ductal epithelium in 90% of cases (ductal cell adenocarcinoma), and in 10%, in acinar cells, endocrine cells or connective tissue. The size of the lesion at the time of diagnosis varies according to its location, and can reach 5 cm in the head and more than double in the body and tail of the pancreas. Those located cephalad end up producing stenosis of the pancreatic duct and the bile duct.

The location of the lesion in order of frequency is: head, body and tail.

Cystadenocarcinoma, the second most important tumor type, is preferentially located in the body and tail. Its retroperitoneal situation favors direct extension to other structures such as common bile duct, portal vein, cava, aorta, etc. Invasion by continuity of the duodenum can cause obstruction.

Dissemination through the lymphatic system occurs early, producing lymph node metastases.

Its perineural dissemination is very frequent, which would partly explain the abdominal pain in these patients.

Distant dissemination, by blood, occurs in 90% of cases (liver, peritoneum, lung, adrenal, spleen or kidney).

Pancreatic Cancer Symptoms

Pancreatic cancer is a tumor of insidious development, whose early diagnosis is very difficult due to the poverty and non-specificity of the symptoms it presents in its initial phase.

The symptoms they produce will vary depending on the location of the tumor and the structures affected by it.

Weight loss is usually the earliest and most constant symptom.

Abdominal pain, present in 80% of patients, is variable in its intensity and location, although the most frequent is its location in the epigastrium with radiation to both hypochondria and back. It is usually fixed in nature, but can also present as crampy pain.

Pancreatic head tumors usually present in 70% of patients due to a yellowish pigmentation of the skin-mucosa, of progressive course and often painless, caused by the gradual obstruction of the common bile duct in its pancreatic portion. Itching that produces great discomfort. Other less frequent symptoms are: anorexia, asthenia, dyspepsia, vomiting and behavioral disorders.

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There are diseases that can add to the tumor clinic, among them is diabetes, acute pancreatitis, ulcerative syndrome or digestive bleeding.

Among the most frequent physical findings we have jaundice , scratching lesions, liver enlargement, tenderness.

In advanced situations, we can find an increase in the size of the spleen due to splenic vein thrombosis or an increase in peritoneal fluid due to peritoneal carcinomatosis or portal thrombosis. In 10% there may be signs of thrombophlebitis. More rarely, systemic manifestations such as polyarthritis, panniculitis, etc.

How is it diagnosed?

At present, there is a large battery of diagnostic procedures, the use of which must be adjusted to the criteria of maximum effectiveness and diagnostic accuracy with the minimum economic cost and morbidity and mortality (damage and death).

Given the clinical suspicion, the first step should be abdominal ultrasound supplemented with a fine needle aspiration-puncture.

If the suspicion continues, the next step is to perform a computerized axial tomography, although if there is yellowish mucous skin pigmentation, it should go directly to endoscopic retrograde cholangiopancreatography.

If ECHO and CT are not conclusive, we must resort to ERCP and biliary prosthesis placement if there is obstructive jaundice, as a preoperative preparation method or even as a definitive treatment in inoperable and unresectable cases. In case of failure of the PNC, we will resort to transparietohepatic cholangiography.

The only definitive treatment for pancreatic cancer is surgical resection.

Treatment can be:

  • Curative: the generally accepted technique is resection of the duodenum and the head of the pancreas in cancers of the head and resection of the body and tail in those of the body and tail of the pancreas. Sometimes total resection of the pancreas is performed.
  • Palliative: surgery is the most complete method of palliative treatment, but also the one with the highest morbidity and mortality. Its objectives are biliary and digestive diversion, and the treatment of pain through alcoholization of the celiac plexus. This surgery would be indicated in cases of preoperative diagnostic doubt, when unresectability is established in the operating room, when there is compromise of the digestive tract and when other biliary drainage procedures (endoscopic or percutaneous) fail.

The radiation therapy has been used both as intra preoperational stage and postoperiatoriamente. Only after resection surgery does it seem to have any improvement in survival without increasing morbidity and mortality.

Chemotherapy has registered positive responses in terms of tumor mass reduction, but survival and quality of life do not significantly improve in patients treated with both monotherapy (5-fluoracil) and combinations of polychemotherapy.

How can I avoid it?

To prevent pancreatic cancer you should avoid:

  • Tobacco.
  • Alcohol.
  • Coffee.
  • Work with metals and alkylating substances, benzidine and asbestos.

Follow controls by specialists in digestive if you have:

  • Mellitus diabetes.
  • Gallstones.
  • History of gallbladder resection.
  • Chronic pancreatitis.
  • Family history of pancreatic cancer.

The consumption of abundant products rich in vegetable proteins reduces the risk of developing pancreatic cancer.

Pancreatic cancer has a poor prognosis conditioned by the delay in its clinical presentation. Generally, its intrapancreatic growth and lymphatic invasion are clinically undetectable and only the invasion of adjacent structures is usually symptomatic.

You should see a doctor when various symptoms appear such as:

  • Weightloss.
  • Persistent abdominal pain
  • Mucocutaneous yellowish pigmentation, etc.

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Hello Readers, I am Nikki Bella a Psychology student. I have always been concerned about human behavior and the mental processes that lead us to act and think the way we do. My collaboration as an editor in the psychology area of ​​Well Being Pole has allowed me to investigate further and expand my knowledge in the field of mental health; I have also acquired great knowledge about physical health and well-being, two fundamental bases that are directly related and are part of all mental health.

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