31 December 2020 Author : Rui Maio What is the pancreas? The pancreas is a gland that belongs to the digestive system and the endocrine system . It is located near the stomach, is divided in three regions (head, body, and tail) and its main functions are: In the digestive system: produce the pancreatic juice that contains enzymes used in the digestion of various types of foods; In the endocrine system: produce hormones, of which the best known is insulin that regulates blood glucose (blood sugar level). In pancreatic cancer , this organ cells change and grow in an uncontrolled manner. Pancreatic cancer is the third leading cause of death due to cancer in Europe and is the digestive cancer with the worst prognosis. Symptoms and warning signs Often, in the early stages of the disease , pancreatic cancer does not cause symptoms. When symptoms occur, they are usually due to the relationship between the pancreas and other organs of the digestive system and can be: Jaundice (yellow skin or eyes); Change of urine color, turning orange or tea color; Change of stool color, turning yellow, reddish, grayish or whitish; Pain in the abdomen or around; Swelling or feeling of fullness; Nausea, vomiting or indigestion; Fatigue; Lack of appetite; Unexplained weight loss; Sudden onset diabetes or sudden change in blood sugar control in diabetics; Dilated gallbladder. However, having one or more of these symptoms does not mean that you have pancreatic cancer. It is important to discuss any symptoms with your doctor, as they may related with several problems. Risk factors for developing pancreatic cancer The main risk factors for this disease are: Smoking: smokers are 2-3 times more likely to develop pancreatic cancer; Age: higher risk for people over 50; Family history: some studies show that about 10% of pancreatic cancers are caused by inherited genetic changes; Obesity: people who are overweight and have a body mass index (BMI) higher than 30 kg/m 2 are at greater risk; Chronic pancreatitis; Sudden onset diabetes or sudden changes in glycemic control (blood sugar) in diabetics. Not all people with risk factors develop pancreatic cancer. However, the likelihood of developing it is greater than that of people without risk factors. How to prevent pancreatic cancer Only 5%-10% of pancreatic cancers are due to genetic causes. The rest are due to environmental causes. Thus, contributions to prevent pancreatic cancer are: Adopt a healthy lifestyle, which includes an adequate diet (including fruits and vegetables and preferring fat-free meat and white meats over red meats) and physical exercise; Maintain a healthy weight; Moderate the consumption of alcoholic beverages; Do not smoke or give up smoking. There is no specific screening method for pancreatic cancer. However, in the context of regular check-up and considering risk factors and personal and family health history, some tests that may allow early detection , for example: Abdominal ultrasound; CT scan or MRI. Treatment of pancreatic cancer Surgery Surgical resection of the pancreas should only be performed in specialized centers , namely with experience in hepato-bilio-pancreatic surgery and vascular reconstruction capacity that sometimes necessary in these patients. An experienced team is decisive for the treatment of pancreatic cancer. Surgery is currently the only potentially curative treatment option for pancreatic cancer. Survival at 5 years is 20% for operated patients. However, at the time of diagnosis, only 15%-20% of tumors are considered resectable. Pancreatic cancer without distant metastasis can be divided into 3 categories according to the local extent of the disease: Resectable; Borderline resectable; Locally advanced (unresectable). Although this classification has therapeutic implications, the decision to perform surgery depends on the experience of the surgeon and the surgical technique. For example, in specialized centers, borderline resectable tumors, that is, tumors without distant metastases, but with venous involvement, can be resected in bloc with resection of these veins and vascular reconstruction. The type of surgery depends on the location of the tumor and includes: Resection of the body and tail of the pancreas and splenectomy (removal of the spleen) for tumors located on the body and tail; Whipple resection or cephalic duodenopancreatectomy (removal of the head of the pancreas and part of the intestine - duodenum) for tumors of the head of the pancreas; In multifocal tumors, that is, which affect various parts of the organ, total pancreatectomy (surgical removal of the entire pancreas) is indicated. Standard lymphadenectomy (removal of lymph nodes) must involve excision of 15 or more lymph nodes to have an adequate pathological staging. Enlarged lymphadenectomy is not indicated, as survival is similar and increases morbidity. Minimally invasive surgery has been used in some centers in pancreatic cancer surgery. For distal tumors (body and tail), laparoscopic body-caudal pancreatectomy it does not seem to have poorer results in terms of survival, and has advantages in hospital length of stay and the beginning of oral feeding; On the contrary, laparoscopic dudenopancreatectomy is extraordinarily demanding, so its performance is still not recommended. Mortality, hospital length of stay, state of surgical margins, survival and costs are closely related to the volume of patients and surgeries, so cephalic duodenopancreatectomy is only recommended in specialized centers, which perform at least 15 to 20 pancreatic resections per year. Chemotherapy and radiation therapy In recent years there has been a greater focus on pancreatic cancer research to promote the improvement of quality of life and increase the range of treatment options . If the tumor is operable, surgery is performed to remove it completely. Chemotherapy after surgery (adjuvant chemotherapy) is a treatment that increases the likelihood of cure. On the other hand, through the combination of several drugs it has been possible to increase the life expectancy patients with inoperable pancreatic cancer, destroying cells that divide uncontrollably and very quickly. In some cases, it is even possible to reduce the size of the tumor making it operable, after chemotherapy and radiotherapy treatments. In other cases, it is possible to delay the progression of pancreatic cancer and the onset of symptoms of the disease, preserving the quality of life and increasing survival. Several types of pancreatic cancer have recently been identified which may have very different forms of treatment in the future, so clinical research is crucial . New treatments have emerged that can change, little by little, the panorama of this disease. Meet the general surgery team from Hospital da Luz network and book your consultation . The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
