What Is Pancreatic Cancer
Pancreatic adenocarcinoma is the most common type of pancreatic cancer. This type of cancer of the pancreas originates in the exocrine glands. Islet cell tumor or pancreatic neuroendocrine cancer is a different type of cancer that arises in the endocrine glands of the pancreas.
Pancreatic adenocarcinoma is among the most aggressive of all cancers. By the time that pancreatic cancer is diagnosed, many people already have disease that has spread to distant sites in the body . Pancreatic cancer is also relatively resistant to medical treatment, and the only potentially curative treatment is surgery. In 2010, approximately 43,000 people in the United States were diagnosed with pancreatic cancer, and approximately 36,000 people died of this disease. These numbers reflect the challenge in treating pancreatic cancer and the relative lack of curative options.
How Is Chronic Pancreatitis Linked To Pancreatic Cancer
Chronic pancreatitis is a risk factor for pancreatic cancer, increasing the risk of pancreatic cancer by 2 to 3 times that of the general population. However, smoking is a risk factor for both pancreatic cancer and chronic pancreatitis, so the relationship between the two is not completely clear.
Furthermore, a pancreatic cancer tumour can sometimes block the narrow tube running down the middle of the pancreas , which means that the pancreas enzymes dont reach the gut to digest food. This can resemble chronic pancreatitis, which is why its important to conduct further tests to make a diagnosis.
Diabetes which has developed recently and not linked to weight gain can also be a warning sign of pancreatic cancer. Pancreatic cancer should therefore be excluded by a CT scan in people with new signs of chronic pancreatitis and especially with new signs of diabetes.
Fatty Pancreas Can Cause Pancreatic Cancer
Pancreatic steatosis can accelerate the development of pancreatic cancer , according to a new paper by Cedars-Sinai investigators.
Fat accumulation in the pancreas is an understudied condition that can lead to pancreatic cancer, according to a new paper by Cedars-Sinai investigators published in EBioMedicine, which is part of The Lancet Discovery Science suite of journals.
Pancreatic steatosis involves the infiltration of fat into the pancreas or pancreatic inflammation. Its worldwide prevalence has nearly tripled from 1975 to 2016, according to the World Health Organizationa trend that has been linked to rising obesity rates. Studies report anywhere from 10% to 58% of the worldwide population may have pancreatic steatosis.
“Unlike nonalcoholic fatty liver disease, which is really well studied, pancreatic steatosis is unexplored and lacks guidelines for diagnosis and treatment,” said Emily Truong, MD, lead author of the paper and an internal medicine resident physician. “Understanding what causes pancreatic steatosis and how those same mechanisms might lead to pancreatic cancer is extremely important because these mechanisms might explain other obesity-driven cancers.
Truong authored the paper with Stephen Pandol, MD, professor of Medicine, director of Basic and Translational Pancreas Research and program director of the Gastroenterology Fellowship Program, and Christie Y. Jeon, ScD, research associate professor of Medicine.
Stephen Pandol, MD
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What To Know About Pancreatic Cancer
Dr. Mitchell says, Pancreatic cancer is a type of cancer that starts in the pancreas. The pancreas is a gland located in the abdomen, behind the stomach. The pancreas has two main functions: to produce enzymes that help digest food and hormones, such as insulin, that regulate blood sugar levels. Pancreatic cancer usually starts in the cells lining the pancreas ducts. These cells are called exocrine cells. Less often, pancreatic cancer begins in the hormone-producing cells of the pancreas, called islet cells. When pancreatic cancer begins in the exocrine cells, it is called exocrine pancreatic cancer. When it starts in the islet cells, it is called an islet cell tumor or neuroendocrine tumor. Most pancreatic cancers are exocrine tumors.
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Pathogenesis Of Pancreatic Cancer In Chronic Pancreatitis
It has long been accepted that the chronic inflammatory processes which characterize CP promote metaplasia and neoplastic transformation. Studies have attempted to define the progression of inflammation to malignancy in the setting of chronic pancreatitis . It is believed that the cytokines and reactive oxygen species that are generated during inflammation cause DNA damage. Chronic inflammation leads to accumulation of DNA damage, finally progressing to oncogenic mutations in K-ras, p16 and p53 resulting in malignant transformation. However, this explanation is too simplistic considering that malignancy occurs at different rates in different types of CP, thereby suggesting that alternate mechanisms might exist.
Hereditary pancreatitis is associated with multiple mutations in cationic trypsinogen and idiopathic chronic pancreatitis has mutations in SPINK-1. Both of these mutations have been implicated in the development of PC .
Diabetes mellitus is a known risk factor for PC . Whether the coexistence of CP with DM increases the overall risk of PC is unclear. In a population based cohort study by Liao et al., risk of PC in patients with CP and DM combined was higher than that for patients with CP alone . This finding is confounded by the fact that diabetes could be a manifestation of PC in CP, rather than a risk factor.
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Other Dangerous Drugs That Affect The Pancreas
Other types of drugs may also put people at risk of pancreatitis and pancreatic cancer. For example, Depakote, an anticonvulsant used to treat seizure disorders, includes a black box warning on its label for the risk of pancreatitis. Other drugs that may trigger dangerous acute pancreatitis include immunosuppressant drugs used in organ transplants, certain diuretics and anti-inflammatory drugs, and tetracycline, an antibiotic.
Pancreatitis and pancreatic cancer are very serious illnesses that affect an important gland in the body. In addition to natural or unknown causes, there are several medications that put patients at risk of developing these conditions. Type 2 diabetes drugs are especially implicated, but all medications that could affect the pancreas should be carefully weighed for benefits versus risks.
What Is Acute And Chronic Pancreatitis
Inflammation of the pancreas is termed pancreatitis and its inflammation has various causes. The pancreas is a gland located in the upper part of the abdomen. It produces two main types of substances, digestive juices, and digestive hormones. Once the gland becomes inflamed, the pancreatitis can progress to swelling of the pancreas and surrounding blood vessels, bleeding, infection, and damage to the gland, which causes digestive juices become trapped and start “digesting” the pancreas itself. If this damage persists, the gland may not be able to carry out normal functions.
Pancreatitis may be acute or chronic . Either type can be very severe, even life threatening. Either type can have serious complications.
Acute pancreatitis usually begins soon after the damage to the pancreas begins. Attacks are typically very mild, but about 20% of them are very severe. An attack lasts for a short time and usually resolves completely as the pancreas returns to its normal state. Some people have only one attack, whereas other people have more than one attack, but the pancreas always returns to its normal state unless necrotizing pancreatitis develops and becomes life threatening.
Chronic pancreatitis begins as acute pancreatitis. If the pancreas becomes scarred during the attack of acute pancreatitis, it cannot return to its normal state. The damage to the gland continues, worsening over time.
Acute Pancreatitis Symptoms and Signs
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Long Term Inflammation Of The Pancreas
Long term inflammation of the pancreas is called chronic pancreatitis. It is most often caused by long term drinking of alcohol. There is a link between having chronic pancreatitis and developing pancreatic cancer.
Rarely, pancreatitis can also run in families . It accounts for about 1 in 100 cases of pancreatitis. A faulty gene that you inherit from one parent causes it.
People with hereditary pancreatitis have a higher risk of developing pancreatic cancer compared to the rest of the population.
Red And Processed Meat
Eating red meat may increase the risk of pancreatic cancer, particularly meat cooked at high temperatures. Red meat includes beef, lamb and pork.
Eating processed meat may also increase your risk of pancreatic cancer. Processed meat is meat that has been preserved by smoking, curing, salting or adding chemical preservatives. It includes sausages, ham, bacon, salami and burgers.
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How Is Chronic Pancreatitis Treated
Chronic pancreatitis is treated by replacing the enzymes that the pancreas can no longer produce, by taking pills that contain pancreatic enzymes with meals and snacks to help digest the food, controlling diabetes with tablets and/or insulin, and most importantly, trying to make changes in lifestyle that remove the triggers most importantly alcohol and smoking.
The involvement of a dietician or dietary advice is very helpful: because fat is not absorbed well in chronic pancreatitis, low fat diets can lessen symptoms of malabsorption. Vitamin supplements are often advisable.
Chronic pancreatitis can be painful, so people may need to take medication to manage the pain. Occasionally, pain relief needs to be quite strong.
Surgery for pancreatitis is not done very often and is becoming even less common. Surgery for chronic pancreatitis can help but should only ever be considered after a prolonged period of discussion with specialist pancreas surgeons.
Pain In The Stomach Or Back
Pancreatic cancer can cause a dull pain in your upper tummy , which may spread to your back.
To begin with, the pain may come and go, but as the tumour becomes larger and more advanced, the pain may be more constant and last longer.
The pain is often worse when you lie down or after you’ve eaten. You may also have pain or tenderness in your abdomen if your liver, pancreas or gallbladder are enlarged.
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What Is Pancreatitis
Pancreatitis is inflammation in the pancreas. This condition can be mild and will resolve itself without treatment, but it can also be severe and life-threatening. Pancreatitis can also be chronic or acute. The latter is more common, comes on suddenly and can be deadly. It may require emergency medical treatment. Chronic pancreatitis is a long-lasting type of inflammation that can significantly reduce quality of life.
Pancreatitis can have many different causes and having multiple incidents of acute pancreatitis can lead to a chronic condition. Alcoholism, smoking, genetics, high levels of calcium, physical injury, infections, high triglyceride levels, surgery, gallstones, and certain medications can all cause or contribute to pancreatitis.
There are also several complications that can result from pancreatitis, especially if it is not successfully treated to bring down the inflammation. These include malnutrition, diabetes, infections, kidney failure, the formations of cysts in the pancreas, which can burst and cause internal bleeding and infections, difficulty breathing, and pancreatic cancer.
What Can I Do
- Contact our specialist nurses on our Support Line if you are worried about your risk of pancreatic cancer.
- If you smoke, get help to stop smoking.
- If you are overweight and dont have pancreatic cancer, the NHS website has some helpful tips to help you lose weight.
- Read more about having a family history of pancreatic cancer.
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Type 2 Diabetes Drugs Damage The Pancreas
The number of diagnoses being made for type 2 diabetes is on the rise. This condition occurs when the body loses its sensitivity to the insulin produced by the pancreas, which in turn results in high blood sugar levels that can have serious health complications. Many people can control their diabetes with changes in diet and exercise and with weight loss, but many will also need to take a medication that supports those efforts and lowers blood sugar.
Many of these drugs act in the pancreas, to boost production of insulin or to help the body react to it more, but these actions can have serious consequences for the pancreas. Several drugs used to treat type 2 diabetes now carry warnings that they may increase the risk of a patient developing pancreatitis or even pancreatic cancer.
An example is the drug Byetta, made by Bristol Myers Squibb. It belongs to a class of drugs called incretin mimetics. It works to treat type 2 diabetes by stimulating the pancreas to produce and release more insulin. Since an initial warning by the FDA in 2007 that Byetta could cause pancreatitis and pancreatic cancer, the research evidence has continued to grow showing that this drug has serious and harmful potential side effects. The current recommendation is that anyone with a history of any type of pancreas problem should not use this drug. Bristol Myers Squibb is facing lawsuits over these side effects from plaintiffs who accuse the company of not warning them of these serious risks.
What Are The Stages Of Pancreatic Cancer
Pancreatic cancer is categorized into five different stages. Your diagnosis depends on the size and location of the tumor and whether or not the cancer has spread:
- Stage 0: Also known as carcinoma in situ, Stage 0 is characterized by abnormal cells in the lining of the pancreas. The cells could become cancerous and spread to nearby tissue.
- Stage 1: The tumor is in the pancreas.
- Stage 2: The tumor is in the pancreas and has either spread to nearby tissues, organs or lymph nodes.
- Stage 3: The cancer has spread to major blood vessels near the pancreas. It may have also spread to nearby lymph nodes.
- Stage 4: In stage 4 pancreatic cancer, the cancer has spread to distant areas in the body, such as the liver, lungs or abdominal cavity. It has possibly spread to organs, tissues or lymph nodes near the pancreas.
Be sure to talk with your provider about your situation. Understanding your pancreatic cancer prognosis can help you make an informed decision about your treatment.
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Smoking And Smokeless Tobacco
Around 20 out of 100 cases of pancreatic cancer in the UK are caused by smoking. Cigarettes, cigars, pipes and chewing tobacco all increase pancreatic cancer risk.
The best way for people who smoke to reduce their risk of cancer and improve their overall health, is to stop smoking completely. The risk of pancreatic cancer in people who stopped smoking 20 years ago is the same as for people who have never smoked.
Study Design And Data Collection
Patients were seen as outpatients at least once a year, or unscheduled when symptomatic or when their disease was complicated. Special attention was paid to signs or symptoms suggestive of pancreatic cancer . Abdominal imaging and laboratory tests were performed when necessary. Patients were considered lost to follow up when they failed to attend our institution for more than one year. Person years were calculated from the date of clinical onset of CP, and either the end point of the study, the last personal contact, the date of diagnosis of pancreatic adenocarcinoma, the date of total pancreatectomy , or death. Data were prospectively registered on a database.
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Autophagy And Development Of Pancreatic Cancer
Earlier in this review, the role of autophagy in development of acute and CP was discussed. Autophagy also plays a complex part in the development of pancreatic cancer, with reports indicating both pro-tumorigenic and tumor-suppressive roles . PDAC cells have higher basal levels of autophagy than most other types of tumor cells, facilitating their survival under stressful conditions including nutrient deprivation, hypoxia, metabolic stress and chemotherapy . As the tumor environment is hypoxic, autophagy is often induced by hypoxia-inducible factor- signaling, or adenosine monophosphate activated protein kinase , the latter also being associated with pancreatitis . Elevated levels of autophagy in PDAC cells are critical in removal of ROS, preventing DNA damage and maintaining energy homeostasis, thus optimizing PDAC cell survival and proliferation .
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Is Epi A Symptom Of Pancreatic Cancer
EPI can be a sign of pancreatic cancer. There are also other causes, so having EPI doesnt mean you have pancreatic cancer.
Chronic pancreatitis is one of the main causes of EPI. Chronic pancreatitis is associated with a higher risk of cancer, especially pancreatic cancer.
In a large Danish study, 13.6 percent of people with chronic pancreatitis developed cancer, with pancreatic cancer being the most common type. This is compared to 7.9 percent of the control group.
There have been multiple studies looking at the rates of EPI in pancreatic cancer.
A 2015 review included people with pancreatic cancer who were not surgically treated. It reported that 50 to 100 percent of them had EPI.
In people with pancreatic cancer, PERT improves nutritional status. People who received PERT
- oily stool that floats and may be hard to flush
- stool thats a pale color
- pain in the upper abdomen, especially after you eat
Diagnosing EPI can be tricky. Many of the digestive symptoms can be similar to other conditions.
Fat in the stool is more likely to occur in EPI than with other conditions. If you naturally eat less fat because of digestive trouble, you may not have fatty stools. If you notice any change in your digestion, its smart to talk with your doctor.
Malnutrition is common in EPI. When you cant absorb nutrients from your food, some of these problems can also occur:
- unexplained weight loss
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Dna And Rna Biomarkers
Previous notions believed that nuclease in human plasma was too rich that DNA and RNA fragments could not be stably detected as markers for cancer detection. However, recent methodological studies showed that DNA and RNA molecules could also serve as markers with potential clinical utility. For example, KRAS2 mutations in codon 12 could stably be detected in circulating deoxyribonucleic acid, and its positive rate is significantly higher in PC than in CP patients . Combined normal serum CA19-9 and absence of circulating KRAS2 mutations may significantly increase the differential diagnosis efficacy between CP and PC . Our study also showed that the detection of KRAS gene mutations in samples of endoscopic ultrasound-guided fine needle aspiration biopsy was feasible for the diagnosis of PC .
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