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General Surgery

Pancreatic Cancer

It is a type of cancer formed by the uncontrolled proliferation of cells in the pancreatic gland, which is positioned horizontally behind the stomach and holds critical importance in both digestion and blood sugar regulation by secreting insulin.

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ℹWhat is Pancreatic Cancer?

The pancreatic gland has two fundamental functions: the production of enzymes that aid digestion (exocrine function) and the production of hormones like insulin and glucagon that control blood sugar (endocrine function).

Pancreatic cancer can develop from exocrine or neuroendocrine cells. The exocrine type is more common, and its most frequent histological type is Adenocarcinoma. It is usually detected in advanced stages. Pancreatic neuroendocrine tumors (islet cell tumors) are rarer and generally have a better prognosis.

Common Symptoms

Jaundice
Yellowing of the whites of the eyes and the skin, itching of the skin, and darkening of urine color.
Loss of Appetite and Weight Loss
Involuntary and significant weight loss.
Abdominal or Back Pain
This pain worsens when eating or lying down and may be relieved by leaning forward.
Changes in Bowel Habits
Diarrhea due to fatty stools (steatorrhea).
Indigestion and Bloating
Discomfort and gas in the upper abdomen.
Fatigue
May be accompanied by high fever, hot/cold flashes, or chills.

Diagnosis Methods

Computed Tomography (CT)
Evaluates the pancreas, adjacent organs, and vascular features of the tumor. The preferred method for determining surgical eligibility.
MRI and MRCP
Provides high-resolution soft tissue images. MRCP clearly demonstrates strictures or obstructions in the biliary and pancreatic ducts.
Endoscopic Ultrasonography (EUS)
Allows very close examination of the pancreas, excellent for detecting small tumors. Fine Needle Aspiration Biopsy (FNAB) can be performed.
FDG PET-CT
Determines whether the disease has metastasized to distant parts of the body.
Blood Tests
CA 19-9 and CEA tumor markers, liver function tests (bilirubin, ALT, AST, GGT) are assessed.
ERCP
An endoscopic method that can be used for both diagnosis and treatment. While showing obstructions in the ducts, it also allows for biopsy sampling.

Treatments

Surgery
The most fundamental method with curative potential. The Whipple procedure (pancreatoduodenectomy) is performed for tumors in the head of the pancreas, while distal pancreatectomy is used for tumors in the tail/body.
Chemotherapy
Administered for Neoadjuvant (to shrink the tumor before surgery), Adjuvant (to reduce the risk of recurrence after surgery), or Palliative purposes in advanced metastatic stages.
Radiotherapy
Usually administered concurrently with chemotherapy. It can be applied to shrink locally advanced tumors before surgery.
Targeted Therapy
PARP inhibitors may be administered in cases harboring BRCA gene mutations.
Immunotherapy
Although not a standard treatment, it may be administered in cases where MSI-H and dMMR are detected.
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