Conquer Pancreatic Cancer: Dr. Mahmoud Tabbal's Pioneering Approach

The vast majority of pancreatic cancers are adenocarcinomas that begin either in the glands inside the pancreas that make enzymes for digestion, or the ducts that carry digestive enzymes out of the pancreas.

Pancreatic neuroendocrine tumours (NETs), develop from cells in the endocrine gland of the pancreas, which secretes the hormones into the bloodstream to regulate blood sugar. NETs, also known as endocrine or islet cell tumors, are rare, accounting for less than 5 percent of pancreatic cancers.

Adenocarcinomas and pancreatic neuroendocrine tumours are malignant, which means that they can grow into and destroy surrounding tissue and may spread to other parts of the body.

Cysts and other benign tumours can form in the pancreas. Benign tumours are not cancerous – they may grow in their place but do not spread. However, some benign tumours can be precursors to pancreatic cancer. 

Symptoms or signs of pancreatic cancer often don’t occur until the disease is advanced. They may include:

• Abdominal pain that may radiate to the back
• Loss of appetite or unintended weight loss
• Yellowing of the skin or the whites of the eyes (jaundice)
• Light-coloured, fatty stools
• Dark-coloured urine
• Itchy skin
• New or worsened diabetes
• Blood clots
• Fatigue

See your doctor if you are concerned about any unexplained symptoms. Similar symptoms may occur with many other conditions.

The cause of pancreatic cancer is not clear and research is ongoing.

Some factors which appear to increase the risk of pancreatic cancer have been identified. These include:

• Smoking – has been identified as one of the biggest risk factors
• Family history of pancreatic cancer
• Diabetes
• Increasing age
• Men are slightly more affected by pancreatic cancer than women
• Chronic inflammation of the pancreas (pancreatitis)
• Obesity
• Family history of genetic syndromes that can increase cancer risk

One research study found that the combination of smoking, long-standing diabetes and a poor diet increases the risk of pancreatic cancer beyond the risk of any one of these factors alone.

There is no single test to diagnose pancreatic cancer, and detecting tumours can be challenging as the pancreas sits deep in the abdomen and is hidden behind other organs. Pancreatic cancer is often diagnosed when it is more advanced, as may not be picked up in the early stages when there are no symptoms.

A combination of diagnostic tests may be required, such as:

• Imaging tests, such MRI or CT scan, may reveal an abnormal growth or tumour in the pancreas
• Endoscopic Ultrasound (EUS) – uses an ultrasound device to make images of your pancreas from inside your abdomen by passing a thin, flexible tube (endoscope) down your oesophagus and into your stomach
• Biopsy – removing a sample of tissue from the pancreas to examine under the microscope in a laboratory, may be done during endoscopic ultrasound.
• Blood test – for specific proteins (tumour markers) shed by pancreatic cancer cells

These tests are usually performed if a patient has symptoms of pancreatic cancer, although they may be recommended to screen at-risk groups, especially those with a family history of pancreatic cancer.

If your doctor confirms a diagnosis of pancreatic cancer, additional tests may be required to determine the extent (stage) of the cancer and develop the most appropriate treatment plan.

Treatment options depend on the type, location and stage of the cancer. Options may include surgery, chemotherapy, radiation therapy or a combination of these. In general, the earlier a cancer is detected, the better the prognosis.

Surgical procedures

• The Whipple procedure (pancreaticoduodenectomy) can be performed for cancers occurring in the head of the gland. It involves removing the head of the pancreas, the first part of the small intestine (duodenum), the gallbladder, part of the bile duct and nearby lymph nodes. The remaining parts of the pancreas, stomach and intestines are reconnected.
• Distal pancreatectomy may be performed to remove a tumour that occurs in the pancreatic body and tail.
• Total pancreatectomy is sometimes required to remove the entire pancreas. It is possible to live relatively normally without a pancreas but lifelong insulin and enzyme replacement is required.

All surgical procedures involve the risk of bleeding and infection and possible nausea or vomiting. A long recovery period may be required.

Chemotherapy drugs may be either injected or taken orally to help kill cancer cells, relieve symptoms and prolong survival.

Radiation therapy uses high-energy beams to destroy cancer cells.

Chemoradiation – a combination of chemotherapy and radiotherapy, may be used before surgery to help shrink a tumor, or after surgery to reduce the risk that pancreatic cancer may recur.

Palliative care

For advanced pancreatic cancer that is not amenable to surgery, chemotherapy or radiotherapy, treatment may focus on symptom relief and improving quality of life. Palliative care may also be provided to complement other treatments.

Finding out about a cancer diagnosis can cause stress and worry. Here are some ways that may help you cope and get the right treatment and support:

• Educate yourself about your cancer to help you make decisions about your care. Share any questions or concerns with your specialist doctor, who will be able to advise you about the details of your cancer and your treatment options. They will also be able to recommend trusted sources of further information.
• Build a support network of trusted friends and family who can help you with practical tasks or provide a listening ear. If stress, anxiety or depression are causing significant problems in your daily life, talk to your doctor who may recommend professional counselling.
• Consider joining a support group specifically for pancreatic cancer to connect with others who are going through similar experiences. Ask your doctor for information on pancreatic cancer support groups in your area or online.

The cause of pancreatic cancer appears to be complex and involve many different factors. Making the following lifestyle changes can help to reduce your risk:

• Avoid smoking and exposure to second-hand smoke. If you smoke, talk to your doctor about strategies to help you stop.
• Maintain a healthy weight and get regular exercise. If you need to lose weight, aim for a slow, steady weight loss.
• Eat a healthy diet with plenty of fruits, vegetables and whole grains and less fatty foods.

If you have a family history of pancreatic cancer, discuss with your doctor whether you would benefit from genetic counselling and screening.

Remember:

Early detection can improve treatment outcomes. Consult your doctor if you experience unexplained symptoms or have a family history of pancreatic cancer.