What is Pancreatic Cancer?

The pancreas is a secretory organ located behind the stomach and in front of the spinal bones, producing the enzymes necessary for digestion and hormones effective in the regulation of blood sugar.

It empties the enzymes it produces for digestion into the duodenum, the first part of the small intestine, through the pancreatic duct.

It is the formation of a tumor, mass, which develops as a result of the development and uncontrolled proliferation of abnormal cells in the pancreas. Some tumors can be benign. Malignant tumors are called cancer.

Malignant tumors grow out of control and can spread to other tissues and organs. Pancreatic cancer usually spreads to the liver, abdominal wall, lungs, bone and/or lymph nodes.

Pancreatic Cancer Risk Factors

DNA, Changes in our genetic code cause cancer. It can be familial and acquired over time. DNA changes acquired over time develop with exposure to harmful substances. Sometimes it can develop spontaneously.

The exact causes of pancreatic cancer are not fully understood. It is thought to be familial- hereditary in approximately 5-10% of patients. Most pancreatic cancers develop spontaneously or due to factors such as smoking, obesity, and advanced age.

If you have the following risk factors, you have an increased risk for pancreatic cancer;

• Two or more first-degree relatives with pancreatic cancer
• Development of pancreatic cancer in a first-degree relative before age 50
• Having a genetic syndrome associated with pancreatic cancer

If you have any of these risk factors, it is recommended to receive genetic counseling and to be included in a close monitoring program.

Acquired Risk Factors for Pancreatic Cancer

• Long-term diabetes
• Chronic and familial pancreatitis
• Smoking and alcohol use
• Be of African-American or Askenazi ethnicity
• Be over 60 years old
• Having a male gender
• A diet rich in red and processed meat
• Obesity

It should not be taken to mean that everyone with these risks will develop pancreatic cancer. However, one or more of these risk factors are encountered in patients who develop pancreatic cancer.

What are the symptoms of pancreatic cancer?

Pancreatic cancer can cause only vague, unexplained symptoms;

• Pain in the abdomen or back
• weight loss
• It may be accompanied by jaundice (yellowing of the skin and/or eyes)/itching.
• Anorexia
• Nausea
• change in stool
• Pancreatitis (inflammation of the pancreas)
• emerging diabetes

If you have one or more of these symptoms, evaluation and further investigation for pancreatic cancer is recommended.

Fatigue, weakness, and depression may also be signs of pancreatic cancer.

Who gets pancreatic cancer?

Although pancreatic cancer, known as one of the most dangerous types of cancer, is generally seen in men aged 60 and over, it is extremely possible for this disease to be seen in individuals outside this group. Many factors can cause pancreatic cancer. Today, smoking, diabetes and obesity are known as the most important factors causing pancreatic cancer.

How is pancreatic cancer diagnosed?

Pancreatic tumors can only be visualized by imaging methods such as Computed Tomography (CT), Magnetic resonance g (MR) or Endoscopic ultrasonography.

Why is diagnosis difficult in pancreatic cancer?

The pancreas is located deep in the abdomen and cannot be seen or felt by the physician on physical examination. In addition, its symptoms are not always obvious and develop over time.

Although many tests can be used for diagnosis, unfortunately there is no standard test. This makes the diagnosis more difficult.

Pancreatic cancer treatment

Treatment of pancreatic cancer depends on the general condition of the patient and the stage of the disease. Although the only curative treatment is surgery, surgery, chemotherapy and radiation therapy are used in the treatment.

How is pancreatic cancer detected early?

Early diagnosis in pancreatic cancers is generally learned as a result of the controls and examinations made on the patient’s complaints. This disease is known as a very insidious type of cancer. For this reason, it is extremely possible that it cannot be detected during general examinations and controls. Sudden weight loss, sudden diabetes, loss of appetite, pain in the abdomen and similar symptoms are among the symptoms of pancreatic cancer.

At what age does pancreatic cancer occur?

Pancreatic cancer is known as one of the most dangerous types of cancer and can be seen in people of almost all ages and genders. It has been observed in the past that this disease, which can be seen in all ages and all genders, in other words pancreatic cancer, was mostly seen in men aged 60 and over. Having pancreatic cancer in other members of the family also increases the risk of pancreatic cancer.

Why is pancreatic cancer difficult to treat?

Surgery is the best treatment option in the long-term control of pancreatic cancer. However, many patients have advanced tumors at the time of diagnosis. It is very important to diagnose pancreatic cancer at an early stage.

Has anyone beaten pancreatic cancer?

Although pancreatic cancer is known as one of the most dangerous and deadly cancer types today, there are certainly individuals who have overcome this disease and regained their health. Pancreatic cancer is a disease that can definitely be defeated, especially if it can be diagnosed at an early stage.

Pancreatic cancer is known as a type of cancer that spreads extremely fast. This is the most important reason why it is considered one of the most dangerous types of cancer. Although the success rate in the treatment of this disease, namely pancreatic cancer, is lower than other types of cancer, it is possible to get a positive response and return the patient to life in a quality manner. According to historical data, the 5-year survival rate in pancreatic cancer cases has been explained as five percent.

LAPAROSCOPIC-HYBRID AND OPEN SURGERY OPTIONS

In our hospital, pancreatic surgery is performed with laparoscopic (closed), hybrid method (use of closed and open surgery together) and open surgical techniques.

The use of different methods is of great importance in determining the most appropriate treatment method for each patient.

ERAS PROTOCOL

ERAS (Enhanced Recovery After Surgery) is the term used to describe the concept of multimodal, perioperative interventions to improve postoperative outcomes.

The program was introduced more than 10 years ago, and there is now ample evidence that it accelerates postoperative recovery, shortens hospital stay, morbidity, and recovery time.

Although different terminologies are used, it is generally called ERAS in Europe and fast track in America.

Prof. from Denmark Henrik Kehlet’s work towards the end of the 1990s laid the cornerstones for this protocol, which is why he is known as the creator of ERAS.

ERAS proposes changes to a patient’s entire journey, which begins before surgery and ends at home. The protocol includes more than 20 evidence-based elements to be implemented in the perioperative period.

In meta-analyses published in recent years, it was emphasized that by applying ERAS protocols in major surgeries, the duration of hospital stay was shortened by 2-3 days and complications were reduced by 30-50%.

ERAS proposes changes to a patient’s entire journey, which begins in the pre-operative outpatient clinic and ends at home upon discharge.

EXPERIENCE AND DIFFERENT APPROACHES IN THE TREATMENT OF OUR AGE PATIENTS

As it is known, the number of elderly people in the society is increasing in our country as in the whole world. Surgical procedures in advanced age require different approaches specific to this patient group in preparation, surgical technique and postoperative care, especially in major surgeries such as pancreatic cancer.

With the protocols we have prepared especially for the elderly patient group in our hospital, we are able to overcome the obstacle of age alone to surgery and achieve successful results.

VOLUME FACTOR

Pancreatic cancer surgery is a major surgical practice that requires advanced surgical technique, experience, and often the use of vascular surgery.

Many studies show that the number of operations performed annually in pancreatic cancer surgery is an effective factor on patient survival.

The generally accepted annual number of surgeries is 15 or more. We are at the service of our patients with over 75 years of pancreatic cancer surgery experience.

References: KOÇATAKAN, P., & ATASEVEN, H. (2021). Pankreas Kanseri. Ankara Eğitim ve Araştırma Hastanesi Tıp Dergisi, 54(1), 59-65.