Types of pancreatic tumors
The pancreas has two functions: it produces digestive enzymes and hormones, including insulin. Tumors can arise from different types of cells and vary widely in their course. In addition, cystic formations are found in the gland, some of which are precancerous.
- Ductal adenocarcinoma is the most common and aggressive
- Neuroendocrine tumors - grow more slowly, better prognosis
- Mucinous cystic tumors and intraductal papillary mucinous tumors (IPMN) are precancerous
- Tumor of the head - early causes jaundice
- Tumor of the body and tail - asymptomatic for a long time, often manifested by pain
Risk factors
Most cases occur in people over 60 years of age. The most significant modifiable factor is smoking. About 10% of cases are associated with heredity.
- Smoking
- Age over 60 years
- Chronic pancreatitis
- Obesity and type 2 diabetes
- Pancreatic cancer in two or more close relatives
- Hereditary syndromes: BRCA1/2 mutations, Lynch syndrome, etc.
- Alcohol abuse (via chronic pancreatitis)
Symptoms
Symptoms depend on the location of the tumor. The tumor of the head of the gland compresses the common bile duct, so often the first sign is jaundice, often without pain, with itching. Tumors of the body and tail are manifested by pain in the abdomen and back, which intensifies while lying down and weakens when sitting and bending forward.
- Jaundice, itchy skin, dark urine, light-colored stools
- Pain in the upper abdomen radiating to the back
- Weight loss, loss of appetite
- Weakness, fatigue
- Nausea, indigestion, fatty stools
- New or sharply worsening diabetes mellitus
Diagnostics
An ultrasound may suggest a tumor, but due to gases in the intestines, the iron is often difficult to see. The main method is multiphase CT with contrast using a special “pancreatic” protocol: it shows the tumor and its relationship to large vessels, which determines the possibility of surgery. Endoscopic ultrasound can detect small tumors and take a biopsy. The CA 19-9 tumor marker is used to assess the course of the disease, but not for screening.
- CT scan of the abdomen with intravenous contrast
- MRI with MR cholangiopancreatography
- Endoscopic ultrasound with fine needle biopsy
- Blood biochemistry: bilirubin, liver enzymes, glucose
- Tumor marker CA 19-9
- Chest CT to rule out metastases
Treatment
The only method of radical treatment is surgical removal of the tumor, for example pancreaticoduodenectomy for a tumor of the head. Such operations are complex and must be performed in centers with extensive experience. Chemotherapy is prescribed before and after surgery. If the tumor grows into large vessels, chemotherapy can shrink it and make surgery possible. In case of a widespread process, chemotherapy, stenting of the bile ducts for jaundice, pain relief and enzyme replacement therapy are carried out. Decisions are made by a multidisciplinary team.
- Stop smoking
- Control weight and blood sugar
- If you have pancreatic cancer in several relatives, consult a geneticist
- For pancreatic cysts - observation as prescribed by a doctor
- Do not delay testing if you have painless jaundice.
