Signs That Pancreatic Cancer Has Spread To The Brain

What Happens When Cancer Spreads To The Brain

Cancer cells can break away from the primary tumor and travel to the brain, usually through the bloodstream. They commonly go to the part of the brain called the cerebral hemispheres or to the cerebellum, where they form a mass.

Some metastatic brain tumors appear many years after the primary cancer. Others metastasize so quickly that they are identified before the primary cancer.

When the cancer cells reach the brain and form a tumor, it may lead to a variety of symptoms that can be shared by nonmetastatic brain tumors as well.

Treating Pancreatic Cancer Based On Extent Of The Cancer

This information is about treating exocrine pancreatic cancer, the most common type of pancreatic cancer. See Pancreatic Neuroendocrine Tumor for information about how that type is typically treated.

Most of the time, pancreatic cancer is treated based on its stage how far it has spread in the body. But other factors, such as your overall health, can also affect treatment options. Talk to your doctor if you have any questions about the treatment plan they recommend.

It can be hard to stage pancreatic cancer accurately using imaging tests. Doctors do their best to figure out before treatment if there is a good chance the cancer is resectable that is, if it can be removed completely. But sometimes cancers turn out to have spread farther than was first thought.

Signs Of Pancreatic Cancer

Pancreatic cancer can have symptoms similar to viral hepatitis or gallstones, or no symptoms at all. Because of this, its often diagnosed after it has spread. Symptoms may include:

• Pain in the upper abdomen, often with pain in the back directly behind the upper abdomen
• Unexplained weight loss
• Floating or foul-smelling stools
• Ascites, a condition in which excessive fluid builds up in the abdominal cavity causing swelling and distention of the belly and, sometimes, pain and difficulty breathing
• New or sudden worsening of diabetes
• Difficulty swallowing, which becomes worse over time
• Excessive burping
• Loss of appetite or feeling full early after starting to eat
• Weakness or fatigue

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Why Is Pancreatic Cancer A Concern

All cancers are important to detect and treat, and this is especially true of cancer of the pancreas. Even though it is relatively uncommon it is the twelfth most common new cancer each year, but importantly it is the fourth most common cause of cancer death, trailing only lung, colon, and breast cancers. In other words, even though only 48,000 people a year will be diagnosed nearly that many will die from it. Early detection gives the best hope of successful treatment.

Why Is Early Detection Important For Pancreatic Cancer

Today, there is no established way or tool to find pancreatic cancer early.

When diagnosed early, surgery offers the best chance of controlling pancreatic cancer for a long time. Most patients are diagnosed at later stages and are not eligible for surgery, though. So, tests to find pancreatic cancer in the earliest stages are urgently needed.

As early detection study continues and as technology gets better, researchers predict that we will make progress toward finding the disease earlier.

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Brain Metastasis In Pancreatic Cancer

In pancreatic cancer the majority of patients are diagnosed with an already advanced, metastatic disease appointing its dismal prognosis. Despite being a very metastatic cancer, involvement of the nervous system has been shown to be extremely rare in pancreatic cancer. Our literature search revealed only 12 reports of patients diagnosed with brain metastases originated from pancreatic cancer ante-mortem. These cases are summarized in Table 1.

Stage 4 Pancreatic Cancer Symptoms

One reason that pancreatic cancer gets diagnosed late is that it can be easy to miss the signs. A person may not know that they have cancer because they do not feel sick. Even if they do have symptoms, they might not bother them much.

The symptoms of pancreatic cancer usually do not start until the cancer cells have gotten into other organs. The intestines are often one of the first places cancer goes. It can also go to the liver, lungs, bones, and even the brain.

Once cancer goes to other parts of the body, a person can start to feel very sick. They can also have serious medical conditions, such as:

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Symptoms If Cancer Has Spread To The Bone

You might have any of the following symptoms if your cancer has spread to the bones:

• pain from breakdown of the bone the pain is continuous and people often describe it as gnawing
• backache, which gets worse despite resting
• weaker bones they can break more easily
• raised blood calcium , which can cause dehydration, confusion, sickness, tummy pain and constipation
• low levels of blood cells blood cells are made in the bone marrow and can be crowded out by the cancer cells, causing anaemia, increased risk of infection, bruising and bleeding

Cancer in the spinal bones can cause pressure on the spinal cord. If it isn’t treated, it can lead to weakness in your legs, numbness, paralysis and loss of bladder and bowel control . This is called spinal cord compression. It is an emergency so if you have these symptoms, you need to contact your cancer specialist straight away or go to the accident and emergency department.

What Are Symptoms Of Advanced Pancreatic Cancer

Pancreatic cancer may cause only vague, unexplained symptoms, such as:

• Pain, usually in the abdomen or back
• Recent-onset diabetes

If you are experiencing one or more of these symptoms, speak to your doctor immediately and reference pancreatic cancer.

Many of these symptoms can show at any stage. A person with advanced pancreatic cancer may also have ascites , fatigue and blood clots.

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Confusion Restlessness Or Agitation

Sometimes a person may become confused, restless or agitated. Your loved one may not know where they are or who is with them. Or they may fidget, or want to move about even if theyre not able to. You may want to reassure them by reminding them of who you are and what is going on around them.

They may describe speaking to someone who has died or they may see things that arent there. If theyre not upset, its fine to talk to them about what they can see or hear. Some people may be frightened staying near them, gently touching them and reassuring them may help. A calm room with quiet music and familiar items like photos nearby can also help.

It can be upsetting for you if your family member is confused or agitated. There could be different reasons for why it is happening, so speak to the doctor or nurse. They will look for anything that is causing it, like pain, problems with their bladder or bowels, or issues with their medicines. They may recommend giving medicine to relax and calm them. Or they may suggest putting in a catheter . This will stop the bladder getting full and causing discomfort. If you are worried that your family member may be in pain, the doctor or nurse can help with this.

How Are Metastatic Brain Tumors Treated

Treating a brain tumor is usually only one step in treating metastatic cancer. At Yale Medicine, treatment is carefully coordinated among the neurosurgery, radiation oncology, and medical oncology teams.

Treatment for brain metastases usually involves radiation and surgery, since chemotherapy has limited ability to penetrate the brain. Patients may also be given corticosteroids to reduce swelling, as well as anti-seizure medications.

Patients whose brain scans reveal only a few metastases can be considered for a targeted radiation treatment called radiosurgery. At Yale Medicine, this treatment is delivered using a machine known as the Gamma Knife. If this procedure deemed appropriate, imaging required for treatment, treatment planning, and radiation delivery can all be done in one day.

For those with larger or more widespread brain tumors, Yale Medicine also offers the more comprehensive treatment options, including:

• Hippocampal sparing whole brain radiation therapy with memantine
• Surgical resection or laser ablationguided by MRI in the operating room
• Microsurgical resection of tumor

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What Stage 4 Pancreatic Cancer Means

Doctors use stages when they talk about how cancer has grown or spread. Stage 4 is the last stage. It means that cancer cells have spread to other parts of the body. When this happens, cancer is called metastatic.

One way to stage cancer is called the TNM system. It has 3 parts:

• T : This part is based on how big a tumor is and where it has spread to. The T rating goes from T0 to T4. In stage 4 pancreatic cancer, the primary tumor can have any T rating.
• N : Lymph nodes help filter substances in the body. When cancer cells get to the lymph nodes, it’s easier for them to spread. Stage 4 pancreatic cancer can have an N rating of N1 or N2 .
• M : Metastasis means cancer has spread to other organs and lymph nodes. There are only two M stages: M0 or M1. Any pancreatic cancer with an M1 rating is at stage 4.

What Is Advanced Cancer

Pancreatic cancer is advanced when it is unresectable, or cant be removed by surgery. The cancer has spread to nearby blood vessels or lymph nodes, somewhat outside the pancreas or to distant organs . This is usually stage III or IV. Staging is the process doctors use to describe the cancers size and if it has spread.

Most pancreatic cancer patients are diagnosed with advanced cancer. Patients diagnosed at an earlier stage can also develop advanced cancer if it spreads.

Advanced cancer does not mean you should give up hope or that there is not treatment. Treatments for advanced pancreatic cancer may shrink the cancer, slow its growth, relieve symptoms or a mix of these.

Some doctors use different definitions for advanced cancer. If your doctor says the cancer is advanced, ask what that means for the patient.

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Pancreatic Cancer Stage 1

Stage 1 pancreatic cancer involves a tumor thats only in the pancreas. This stage is divided into two subcategories, depending on the size of the tumor:

• Stage 1A. The tumor measures 2 cm or less.
• Stage 1B. The tumor measures more than 2 cm but less than 4 cm.

Stage 1 pancreatic cancer typically doesnt cause any noticeable symptoms.

If detected at this stage, pancreatic cancer may be curable with surgery.

Immunotherapy For Metastatic Brain Tumors

Cancer immunotherapy is a fast-growing field of research that seeks to develop drugs, vaccines and other therapies that trigger the immune systems natural abilities to fight cancer. Many immunotherapy drugs for metastatic brain tumors act as checkpoint inhibitors. Normally, tumor cells can evade attack by activating certain proteins that disarm your immune system. Checkpoint inhibitors prevent tumor cells from exploiting this process.

Immunotherapy drugs to treat metastatic brain tumors include:

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Surprise Finding: Pancreatic Cancers Progress To Lethal Stage Slowly

Pancreatic cancer develops and spreads much more slowly than scientists have thought, according to new research from Johns Hopkins investigators. The finding indicates that there is a potentially broad window for diagnosis and prevention of the disease.

“For the first time, we have a quantifiable estimate of the development of pancreatic cancer, and when it would be best to intervene,” according to Christine Iacobuzio-Donahue, M.D., Ph.D., associate professor of pathology and oncology at Johns Hopkins’ Sol Goldman Pancreatic Cancer Research Center, “so there is potentially a very broad window for screening.” Right now, however, she adds, “pretty much everybody is diagnosed after that window has closed.”

Pancreatic cancer is notoriously difficult to detect in its early stages because there are frequently few symptoms and current imaging techniques are not specific for cancer.

Bert Vogelstein, M.D., professor and director of the Ludwig Center for Cancer Genetics and Therapeutics at the Johns Hopkins Kimmel Cancer Center and an investigator at the Howard Hughes Medical Institute, says the results show that “many pancreatic cancer cases have a long lag time before they are detected through conventional tests. This leaves room to develop new early, diagnostic tools and intervene with potentially curative surgery.”

The results contradict the idea that pancreatic cancers metastasize very early in their development, says Iacobuzio-Donahue.

Pancreatic Cancer Life Expectancy And Survival Rate

A survival rate is a percentage of how many people with the same type and stage of a cancer are still alive after a specific amount of time. This number doesnt indicate how long people may live. Instead, it helps gauge how successful treatment for a cancer might be.

Many survival rates are given as a 5-year percentage, which refers to the percentage of people alive 5 years after being diagnosed or starting treatment.

Its important to keep in mind that survival rates arent definitive and can vary greatly from person to person depending on age, overall health, and how the cancer progresses. As a result, they also cant determine an individuals life expectancy.

Survival rates for pancreatic cancer are typically provided for localized, regional, and distant stages:

• Localized. Cancer hasnt spread from the pancreas, which corresponds with stages 0, 1, or 2A.
• Regional. Cancer has spread to nearby tissues or lymph nodes, which corresponds with stages 2B and 3.
• Distant. Cancer has spread to distant sites, like the lungs or bones, which corresponds with stage 4.

Heres a look at the 1-, 5-, and 10-year relative survival rates from diagnosis for each stage.

If you or a loved one was recently diagnosed with pancreatic cancer, its understandable to immediately wonder about life expectancy, but this depends on a range of factors that vary greatly from person to person. Your healthcare team can provide the most accurate estimate based on these factors.

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Risk Factors For Pancreatic Cancer Include:

Gender

More men than women are diagnosed with pancreatic cancer.

Age

Although pancreas cancer can occur in younger patients most occur in people over the age of 60.

Chronic pancreatitis

Long-term inflammation of the pancreas, often caused by excessive alcohol abuse, has been linked to an increased risk for pancreatic cancer.

Smoking

Heavy cigarette smokers are two or three times more likely than nonsmokers to develop pancreatic cancer.

Obesity

Pancreatic cancer is more common in overweight, inactive people.

Diabetes

Pancreatic cancer occurs more often in diabetic patients.

Race

African-Americans are more likely than whites to be diagnosed with pancreatic cancer and present with more advanced disease.

Workplace exposures

Exposure to certain occupational carcinogens like pesticides and chemicals used in the metal industry may increase the risk of pancreatic cancer.

Genetic factors

Most pancreatic cancer is not hereditary. A small percentage of patients have a familial type which can be associated with genetic mutations that are associated with melanoma or breast cancer.

Mutations in the genes BRCA1 and BRCA2, which increase the risk of breast, prostate, and certain gynecologic cancers, have been found in some families with a history of pancreatic cancer.

Family history

The Pancreas Contains Two Main Types of Cells:

1. Exocrine cells that produce digestive juices

2. Endocrine cells that produce hormones

Types Of Pancreatic Cancer

When cells inside your pancreas grow abnormally, its called pancreatic cancer. Cells clump into masses called tumors. There are several types of pancreatic cancer. Each type is diagnosed and treated differently. It is critical to have a skilled and experienced pathologist determine what type of pancreatic cancer you have.

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Signs And Symptoms Of Pancreatic Cancer

Early pancreatic cancers often do not cause any signs or symptoms. By the time they do cause symptoms, they have often grown very large or already spread outside the pancreas.

Having one or more of the symptoms below does not mean you have pancreatic cancer. In fact, many of these symptoms are more likely to be caused by other conditions. Still, if you have any of these symptoms, its important to have them checked by a doctor so that the cause can be found and treated, if needed.

Pancreatic Cancer Stage 2

Stage 2 pancreatic cancer is cancer that remains in the pancreas but may have spread to a few nearby lymph nodes or blood vessels.

This stage is divided into two subcategories, depending on where the cancer is and the size of the tumor:

• Stage 2A. The tumor is larger than 4 centimeters but hasnt spread to any lymph nodes or nearby tissue.
• Stage 2B. The tumor has spread to nearby lymph nodes, but not to more than three of them.

Symptoms of stage 2 pancreatic cancer tend to be very subtle and may include:

• targeted drug therapies

Your doctor may use a combination of these approaches to help shrink the tumor and prevent possible metastases.

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What Makes Yale Medicine’s Approach To Treating Metastatic Brain Tumors Unique

Yale Medicine is the only multidisciplinary consortium providing comprehensive brain cancer care in southern New England. This gives patients access to the full range of treatment options, from medical therapy to cutting-edge radiosurgery.

At Yale Medicine, treatment is personalized to the patient’s needs, and is evidence-based, acquired through national research and experience. Discussion of challenging cases occurs at a weekly tumor board, and recommendations are communicated back to the involved physicians to ensure a seamless coordination of care.

What You Need To Know

• Metastatic brain cancer is caused by cancer cells spreading to the brain from a different part of the body.
• The most common types of cancer that can spread to the brain are cancers of the lung, breast, skin , colon, kidney and thyroid gland.
• Metastatic brain tumors are five times more common than primary brain tumors .
• Metastatic brain tumors can grow rapidly, crowding or destroying nearby brain tissue. Sometimes a patient may have multiple metastatic tumors in different areas of the brain.

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