Pancreatic Cancer Turkey

What is Pancreatic Cancer?

The pancreas is the second largest gland in our body after the liver. It contains endocrine and exocrine cells, as well as duct cells that drain the exocrine secretions into the intestine. Pancreatic cancers are named differently depending on the cell type from which they originate:

Tumors originating from the endocrine glands are called pancreatic neuroendocrine tumors and make up 8-10% of pancreatic cancers (e.g., insulinoma, glucagonoma).
Acinar cell carcinoma originating from the exocrine glands is quite rare (1-2%).
Ductal adenocarcinoma, which arises from the cells that make up the ducts of the pancreas, is the most common (90%) and most aggressive type of pancreatic cancer.

What Causes Pancreatic Cancer?

Our bodies contain approximately 37 trillion cells. Cancer begins, develops, and spreads when a cell, for any reason, decides to grow anarchically in size and number. Many risk factors can trigger cancer. Being exposed to these factors does not necessarily mean that we will develop cancer, and some patients with cancer may not have any of these risk factors.

Some of the risk factors known to increase the likelihood of developing pancreatic cancer include:

Smoking: One of the most significant risk factors. Smokers have double the risk of developing pancreatic cancer compared to non-smokers. It is estimated that one-quarter of pancreatic cancers are related to smoking. The risk decreases when smoking is stopped.
Obesity: Obese individuals (those with a body mass index (BMI) of 30 or higher) have a 20% increased risk of pancreatic cancer. Even in individuals without excess weight, increased abdominal fat is thought to raise the risk.
Diabetes: Although the reason is not clear, the risk of pancreatic cancer is higher in diabetic patients (especially those with Type 2 diabetes). In these age groups, obesity, which is another risk factor, should also be considered.
Chronic Pancreatitis: Chronic pancreatitis is a long-term inflammatory process in the pancreas. The risk of cancer is higher in this environment. Chronic pancreatitis is commonly seen in heavy alcohol and cigarette users.
Family History: Those with a family history of pancreatic cancer are at higher risk. In some families, this is due to an inherited syndrome.
Hereditary Genetic Syndromes: Inherited genetic changes (mutations) can be passed from parent to child (e.g., Peutz-Jeghers syndrome, Lynch syndrome, and syndromes caused by mutations in the BRCA1 or BRCA2 genes). These genetic changes can cause about 10% of pancreatic cancers.

What Are the Symptoms of Pancreatic Cancer?

The symptoms of pancreatic cancer can vary depending on the location of the tumor in the pancreas. For example, cancers located in the head of the pancreas, which is near the main bile duct, can cause early symptoms such as jaundice due to bile duct obstruction. Patients may notice this and consult a doctor early. Some of the early symptoms in patients with cancers in the head of the pancreas include:

Jaundice: Pancreatic cancers that block the bile duct manifest as yellowing of the eyes and skin.
Dark Urine: Urine becomes dark in color, like tea. This is due to bilirubin, a dark yellow-brown substance produced by the liver, accumulating in the blood due to bile duct obstruction.
Light-colored Stools: The stool becomes pale or light gray because bile cannot pass into the intestine.
Itching: The substances in bile that accumulate in the blood can cause skin irritation and itching.
Blood Clots: Some patients may experience the first symptom as blood clots, especially in the veins of the legs. Symptoms such as leg pain, swelling, redness, and warmth may develop.
Diabetes: The pancreas produces insulin, which regulates blood sugar levels. Pancreatic cancer can damage the insulin-producing cells, leading to an increase in blood sugar. In some patients, newly developed diabetes may be the first sign of pancreatic cancer.

Cancers in the body and tail of the pancreas may not cause jaundice, even if they have grown larger, as they are farther from the bile duct. These cancers can go undetected for a longer time, leading to a delayed diagnosis, which can be a disadvantage for these types of cancers.

However, it should be noted that jaundice does not necessarily mean pancreatic cancer. Any condition that blocks the bile ducts (e.g., gallstones, hepatitis, lymph node pressure, and other liver and bile duct diseases) can cause similar symptoms. Other symptoms may appear when cancer becomes more widespread and obstructs the digestive system:

Pain: Abdominal and back pain is more commonly seen in cancers located in the body and tail of the pancreas. Pain occurs due to the tumor pressing on or invading the nerves behind the pancreas.
Weight Loss, Loss of Appetite: Pancreatic cancer affects both the function and position of the pancreas in the digestive system, which can lead to decreased appetite and malnutrition.
Nausea, Vomiting: These symptoms can develop if the tumor presses on the stomach outlet or duodenum, obstructing the passage of food.

How Is Pancreatic Cancer Diagnosed?

The diagnosis of pancreatic cancer is made using imaging techniques based on clinical suspicion. Radiological methods such as ultrasound (including endoscopic ultrasound),computed tomography (CT),and MRI are applied under the guidance of the physician. PET scans may be requested if necessary to evaluate the structure of the mass and its spread in the body. Biopsy, although not always possible, is essential for supporting the diagnosis through pathological examination. In cases where the diagnosis remains unclear, surgical exploration may be considered based on the decision of the clinical team or oncology council.

Can Pancreatic Cancer Be Detected by Ultrasound?

Yes, it can be detected, but this does not mean a definitive diagnosis. Ultrasound can guide initial suspicion, leading to further testing. Endoscopic ultrasound (EUS),performed through the mouth, esophagus, and stomach, allows the pancreas, located right next to the stomach, to be examined at the closest range. If necessary, a biopsy can be taken during this procedure.

Pancreatic Cancer Treatment Options

There are different staging methods, but the simplest classification is based on whether surgical resection, the only curative option, is possible:

Resectable Tumors: The cancer is confined to the pancreas and has not spread to surrounding organs or major blood vessels.
Borderline Resectable Tumors: The tumor may be difficult to remove surgically, but it may shrink with treatment (chemotherapy and/or radiotherapy) to allow complete removal.
Locally Advanced Tumors: These tumors have not metastasized to distant organs but have spread to nearby structures, making surgery difficult. However, advanced treatment techniques may allow surgery in some cases.
Metastatic Tumors: The tumor has spread to distant organs (e.g., liver, lungs). Surgery is not an option in this stage, and systemic treatments like chemotherapy and supportive care are applied.

Does Radiotherapy Have a Role in Pancreatic Cancer Treatment?

Radiotherapy is used as an adjunctive treatment. It can be applied along with chemotherapy to shrink the tumor and make surgery possible or after surgery to prevent local recurrence.

How Can Pancreatic Cancer Be Prevented?

It is known that alcohol, tobacco use, and obesity increase the risk of pancreatic cancer. Avoiding or reducing the use of these substances, maintaining a healthy body weight, and following a balanced diet can help reduce the risk. While nothing can be done about genetic factors, regular monitoring and early detection can also be considered preventive measures.