Pancreatic Cancer, its incidence cuts across all racial and socio-economic barriers and is nearly always fatal. 90% die within the 1st yr of diagnosis.

STAGING OF PANCREATIC CANCER

Stage is a term used in cancer treatment to describe the extent of the cancer’s spread. The stages of pancreatic cancer are from 0 to IV.

The best treatment for pancreatic cancer depends on how far it has spread, or its stage. The stages of pancreatic cancer are easy to understand. What is difficult is attempting to stage pancreatic cancer without resorting to major surgery. In practice, doctors choose pancreatic cancer treatments based upon imaging studies, surgical findings, and an individual’s general state of well being.

“Montefiore is a leader in diagnostic techniques, using cutting-edge fusion scan technology. With this imaging technique, we are able to assess the status of tumors both before and after surgical treatment more accurately than ever before. In addition, we employ state-of-the-art intra-operative imaging techniques that provide a clear picture of the tumor during the treatment itself, so that we can adjust our efforts as needed.”

Montefiore Hospital in Bronx, NY

6.) Angiography

This is an x-ray test that looks at blood vessels. A small amount of contrast dye is injected into an artery to outline the blood vessels, and then x-rays are taken.

An angiogram can show if blood flow in a particular area is blocked by a tumor. It can also show abnormal blood vessels (feeding the cancer) in the area. This test can be useful in finding out if a pancreatic cancer has grown through the walls of certain blood vessels.  Usually the catheter is put into an artery in your inner thigh and threaded up to the pancreas.

Blood Tests

Several types of blood tests can be used to help diagnose pancreatic cancer or to help determine treatment options if it is found.

Liver function tests: Jaundice (yellowing of the skin and eyes) is often one of the first signs of pancreatic cancer. Doctors often get blood tests to assess liver function in people with jaundice to help determine its cause. Certain blood tests can look at levels of different kinds of bilirubin (a chemical made by the liver) and can help tell whether a patient’s jaundice is caused by disease in the liver itself or by a blockage of bile flow (from a gallstone, a tumor, or other disease).

Tumor markers: Tumor markers are substances that can sometimes be found in the blood when a person has cancer. Tumor markers that may be helpful in pancreatic cancer are:

• CA 19-9
• Carcinoembryonic antigen (CEA), which is not used as often as CA 19-9

Neither of these tumor marker tests is accurate enough to tell for sure if someone has pancreatic cancer. Levels of these tumor markers are not high in all people with pancreatic cancer, and some people who don’t have pancreatic cancer might have high levels of these markers for other reasons. Still, these tests can sometimes be helpful, along with other tests, in figuring out if someone has cancer.

In people already known to have pancreatic cancer and who have high CA19-9 or CEA levels, these levels can be measured over time to help tell how well treatment is working. If all of the cancer has been removed, these tests can also be done to look for signs the cancer may be coming back.

Other blood tests: Other tests, like a CBC or chemistry panel, can help evaluate a person’s general health (such as kidney and bone marrow function). These tests can help determine if they’ll be able to withstand the stress of a major operation.

Biopsy

A person’s medical history, physical exam, and imaging test results may strongly suggest pancreatic cancer, but usually the only way to be sure is to remove a small sample of tumor and look at it under the microscope. This procedure is called a biopsy. Biopsies can be done in different ways.

Percutaneous (through the skin) biopsy: For this test, a doctor inserts a thin, hollow needle through the skin over the abdomen and into the pancreas to remove a small piece of a tumor. This is known as a fine needle aspiration (FNA). The doctor guides the needle into place using images from ultrasound or CT scans.

Endoscopic biopsy: Doctors can also biopsy a tumor during an endoscopy. The doctor passes an endoscope (a thin, flexible, tube with a small video camera on the end) down the throat and into the small intestine near the pancreas. At this point, the doctor can either use endoscopic ultrasound (EUS) to pass a needle into the tumor or endoscopic retrograde cholangiopancreatography (ERCP) to place a brush to remove cells from the bile or pancreatic ducts.

Surgical biopsy: Surgical biopsies are now done less often than in the past. They can be useful if the surgeon is concerned the cancer has spread beyond the pancreas and wants to look at (and possibly biopsy) other organs in the abdomen. The most common way to do a surgical biopsy is to use laparoscopy (sometimes called keyhole surgery). The surgeon can look at the pancreas and other organs for tumors and take biopsy samples of abnormal areas.

Some people might not need a biopsy

Rarely, the doctor might not do a biopsy on someone who has a tumor in the pancreas if imaging tests show the tumor is very likely to be cancer and if it looks like surgery can remove all of it. Instead, the doctor will proceed with surgery, at which time the tumor cells can be looked at in the lab to confirm the diagnosis. During surgery, if the doctor finds that the cancer has spread too far to be removed completely, only a sample of the cancer may be removed to confirm the diagnosis, and the rest of the planned operation will be stopped.

If treatment (such as chemotherapy or radiation) is planned before surgery, a biopsy is needed first to be sure of the diagnosis.

“To diagnose pancreatitis and find its causes, doctors use your medical history, a physical exam, lab and imaging.   tests. Health care professionals may use lab or imaging tests to diagnose pancreatitis and find its causes. Diagnosing chronic pancreatitis can be hard in the early stages. Your doctor will also test for other conditions that have similar symptoms, such as peptic ulcers or pancreatic cancer.”.

MAYO CLINIC

The top of pancreas attaches to the gall bile duct (allowing it into the head of the pancreas) and than there is the mesenteric artery.  Blood supply to the liver, pancreas and gallbladder is via the celiac artery (or celiac axis or celiac trunk). The celiac artery also supplies the duodenum, stomach and esophagus (the foregut and its derviatives). The pancreas is also supplied to some extent by the superior mesenteric artery that goes through the head of the pancreas.  This is how metastasis occurs (spreading) of pancreatic cancer can occur.  These arteries allow cancerous cells thorough the head into the bile duct into the blood stream and metastasis can now happen.  This can’t occur in the tail of the pancreas, its not attached to anything; which is the best place for it to occur & be diagnosed versus the head of the pancreas due to location.

Pancreatic cancer is hard to find early. The pancreas is deep inside the body, so early tumors can’t be seen or felt by health care providers during routine physical exams. People usually have no symptoms until the cancer has become very large or has already spread to other organs.

For certain types of cancer, screening tests or exams are used to look for cancer in people who have no symptoms (and who have not had that cancer before). But for pancreatic cancer, no major professional groups currently recommend routine screening in people who are at average risk. This is because no screening test has been shown to lower the risk of dying from this cancer, unfortunately.

Genetic History is one of the most common risk factors in getting most cancers, including Pancreatic.  Some people might be at increased risk of pancreatic cancer because of a family history of the disease (or a family history of certain other cancers). Sometimes this increased risk is due to a specific genetic syndrome.

Genetic testing looks for the gene changes that cause these inherited conditions and increase pancreatic cancer risk. The tests look for these inherited conditions, not pancreatic cancer itself. Your risk may be increased if you have one of these conditions, but it doesn’t mean that you have (or definitely will get) pancreatic cancer. 

Knowing if you are at increased risk can help you and your doctor decide if you should have tests to look for pancreatic cancer early, when it might be easier to treat. But determining whether you might be at increased risk is not simple. The American Cancer Society strongly recommends that anyone thinking about genetic testing talk with a genetic counselor, nurse, or doctor (qualified to interpret and explain the test results) before getting tested. It’s important to understand what the tests can − and can’t − tell you, and what any results might mean, before deciding to be tested.

For people in families at high risk of pancreatic cancer, newer tests for detecting pancreatic cancer early may help. The two most common tests used are an endoscopic ultrasound or MRI. These tests are not used to screen the general public, but might be used for someone with a strong family history of pancreatic cancer or with a known genetic syndrome that increases their risk. Doctors have been able to find early, treatable pancreatic cancers in some members of high-risk families with these tests.

Tests for Pancreatic Cancer and even other Cancers:

A.)  Doctor’s Visit

The M.D. is usually the first thing done and the M.D. will ask about your medical history to learn more about your symptoms. The doctor might also ask about possible risk factors, including smoking and your family history.  Your doctor will also do a physical examine you to look for signs of pancreatic cancer or other health problems.

Doctors are also studying other new tests to try to find pancreatic cancer early.  Interested families at high risk may wish to take part in studies of these new screening tests.

B.)  Imaging Testing=It can be used:

• To look for suspicious areas that might be cancer
• To learn how far cancer may have spread
• To help determine if treatment is working
• To look for signs of cancer coming back after treatment

1.) CT Scan-detailed cross-sectional images of the body/pancreas.  Their are special types of CT known as a multiphase CT scan or a pancreatic protocol CT scan. During this test, different sets of CT scans are taken over several minutes after you get an injection of an intravenous (IV) contrast.  CT-guided needle biopsy: CT scans can also be used to guide a biopsy needle into a suspected pancreatic tumor.

2.) MRI(magnetic resonance imagery)-uses radio waves and strong magnets instead of x-rays to make detailed images of parts of your body. Most doctors prefer to look at the pancreas with CT scans, but an MRI might also be done.  Special types of MRI scans that can also be used are:

-MR cholangiopancreatography (MRCP), which can be used to look at the pancreatic and bile ducts, is described below in the section on cholangiopancreatography.

-MR angiography (MRA), which looks at blood vessels, is mentioned below in the section on angiography.

3. ) Ultrasound (US) tests

These tests use sound waves to create images of organs such as the pancreas. The two most commonly used types for pancreatic cancer:

A-Abdominal ultrasound – If it’s not clear what might be causing a person’s abdominal symptoms, this might be the first test done because it is easy to do and it doesn’t expose a person to radiation. But if signs and symptoms are more likely to be caused by pancreatic cancer, a CT scan is often more useful.

B-Endoscopic ultrasound (EUS): This test is more accurate than abdominal US and can be very helpful in diagnosing pancreatic cancer. This test is done with a small US probe on the tip of an endoscope, which is a thin, flexible tube that doctors use to look inside the digestive tract and to get biopsy samples of a tumor (more invasive but more detailed in results of the pancreas).

4.) Cholangiopancreatography

Abdominal This is an imaging test that looks at the pancreatic ducts and bile ducts to see if they are blocked, narrowed, or dilated. These tests can help show if someone might have a pancreatic tumor that is blocking a duct. They can also be used to help plan surgery.  If signs and symptoms are more likely to be caused by pancreatic cancer, a CT scan is often more useful.

A – Endoscopic ultrasound (EUS): This test is more accurate than abdominal US and can be very helpful in diagnosing pancreatic cancer. This test is done with a small US probe on the tip of an endoscope, which is a thin, flexible tube that doctors use to look inside the digestive tract and to get biopsy samples of a tumor.

SPYGLASS. This novel technology provides a direct view of the bile duct system, enabling our doctors to visualize lesions and narrowed areas (strictures) in the ducts and to biopsy them to see if they are cancerous. This approach ensures highly accurate sampling of the area in question. It is an excellent tool to use with confocal endomicroscopy.

B – Magnetic resonance cholangiopancreatography (MRCP):This is a non-invasive way to look at the pancreatic and bile ducts using the same type of machine used for standard MRI scans. Unlike ERCP, it does not require an infusion of a contrast dye. Because this test is non-invasive, doctors often use MRCP if the purpose is just to look at the pancreatic and bile ducts. But this test can’t be used to get biopsy samples of tumors or to place stents in ducts; like ERCP. can do also.

5.) Percutaneous transhepatic cholangiography (PTC): In this procedure, the doctor puts a thin, hollow needle through the skin of the belly and into a bile duct within the liver. A contrast dye is then injected through the needle, and x-rays are taken as it passes through the bile and pancreatic ducts. As with ERCP, this approach can also be used to take fluid or tissue samples or to place a stent into a duct to help keep it open. Because it is more invasive (and might cause more pain), PTC is not usually used unless ERCP has already been tried or can’t be done for some reason.

5.) Positron emission tomography (PET) scan

For a PET scan, you are injected with a slightly radioactive form of sugar, which collects mainly in cancer cells. A special camera is then used to create a picture of areas of radioactivity in the body.

This test is sometimes used to look for spread from exocrine pancreatic cancers.

PET/CT scan: Special machines can do both a PET and CT scan at the same time.

Pancreatoscopy. Here what is used is a small camera to visualize the pancreatic duct.

This test can help determine the stage (extent) of the cancer.  It might be able to detect metastasis (spreading beyond the pancreas).  See the top anatomy picture provided to understand this better by knowing the location of the organ to other parts of the body, if needed.

“November is a month of empowerment, education and inspiration for communities far and wide who have been touched by pancreatic cancer.  In 2021 in the U.S., there will be an estimated 1,898,160 new cancer cases. Smoking is one of the most important risk factors for pancreatic cancer. The risk of getting pancreatic cancer is about twice as high among people who smoke compared to those who have never smoked. About 25% of pancreatic cancers are thought to be caused by cigarette smoking. Cigar smoking and the use of smokeless tobacco products also increase the risk. However, the risk of pancreatic cancer starts to drop once a person stops smoking .”

American Cancer Society

Pancreatic cancer is one of the few types of cancer that haven’t improved in terms of survival rates over the years, according to the Hirshberg Foundation for Pancreatic Cancer Research. In fact, the foundation said the mortality rate is 93-percent within 5-years of diagnosis. And 71-percent will die in first year.  Usually people diagnosed with this disease are told they have 6 months to 1 year survival rate.  There are the few for the many that live longer but know this the major depending factor is also the stage level of cancer your in (I, II, III & IV).  The higher the worse the metastasis.

These stats point to why it’s important to raise awareness about this killer cancer, and to outline some facts and figures. In honor of Pancreatic Cancer Awareness Month in November, here are six things to know, thanks to Jeff Hayward on November 1 informed the world of this information on his blog with facts…

1. Their are Risk Factors

The American Cancer Society says that the average lifetime risk of developing cancer of the pancreas in both men and women is 1 in 65. However, there are certain factors that might make you more likely to face the disease.

Cancer Treatment Centers of America notes that these risk factors include age (most pancreatic cancers form at age-55 or older), gender (males are slightly more likely to develop it), obesity, diabetes, smoking, and more.

2. Heredity

Cancer Treatment Centers of America also notes that about 10-percent of pancreatic cancer cases are thought to be genetic, or passed down from a parent.

These genetic mutations include hereditary breast and ovarian cancer syndrome (BRCA2), familial melanoma (p16), familial pancreatitis (PRSS1), and neurofibromatosis type-1 (NF1), adds the source. Other “inherited syndromes” can raise risks including Lynch syndrome (hereditary nonpolyposis colorectal cancer), Peutz-Jeghers Syndrome, and Von Hippel-Lindau Syndrome.

3. For 2021 the statistics of pancreatic cancer are:

The American Cancer Society estimates death rates are proportionate for both, according to additional statistics from the cancer society.

The American Cancer Society’s estimates for pancreatic cancer in the United States for 2021 are:

• About 60,430 people (31,950 men and 28,480 women) will be diagnosed with pancreatic cancer.
• About 48,220 people (25,270 men and 22,950 women) will die of pancreatic cancer.

Pancreatic cancer accounts for about 3% of all cancers in the US and about 7% of all cancer deaths.

It is slightly more common in men than in women.

4. One of Most Prevalent Cancers in the World

The World Cancer Research Fund International notes that pancreatic cancer shares 10th-place in global prevalence with kidney cancer. Worldwide, there were 338,000 cases of pancreatic cancers diagnosed in 2012 alone, notes the source.

Looking at a breakdown of the disease’s age-standardized rates by country, the U.S. comes in 20th at 7.5-cases per 100,000. The top two countries in the world for cancer of the pancreas are Czech Republic (9.7-per 100,000) and Slovakia (9.4-per 100,000).

5. It Often Causes Symptoms When it’s Too Late

Scientific American talks about why this type of cancer is so deadly in a 2011 article making reference to Apple founder Steve Jobs, who died from the cancer.

It notes that patients sometimes don’t seek treatment right away, because symptoms including weight loss, jaundice and abdominal pain don’t begin until the later stages. “They usually start after the tumor is a significant size. By then, chances are, it has metastasized (that is, spread to other parts of the body),” explains the article.

6. There’s More than One Type

The American Cancer Society explains the overwhelmingly common form of this cancer is pancreatic adenocarcinoma, which makes up 95-percent of all cases. These begin in the ducts of the pancreas and sometimes develop from the cells that form pancreatic enzymes, according to the source.

The “other” type of cancer of the pancreas is pancreatic endocrine tumors, otherwise known as neuroendocrine tumors, explains the cancer society. These tumors can be cancerous or benign, and are subdivided into other categories including “functioning NETs” (including gastrinomas, insulinomas and glucagonomas), and “non-functioning NETs” which are actually more likely to cause cancer because they can grow larger before they’re discovered.

Know how it works you have a pancreas medically noted in Anatomy and Physiology as having a head, neck, body and tail.  The location of the cancer can play a major role especially if diagnosed earlier, depending on the location for some.

The head is the widest part of the pancreas. The head of the pancreas is found in the right side of abdomen, nestled in the curve of the duodenum body and tail.  Worse place for pancreas since this allows metastasis faster than other areas of the pancreas. Know this in some cases caught early can make a major change in a longer life for some.

The neck is the thin section of the gland between the head and the body of the pancreas.

The body is the middle part of the pancreas between the neck and the tail. The superior mesenteric artery and vein run behind this part of the pancreas.  This is not connected like the head and if caught early results can be better.

The tail is the thin tip of the pancreas in the left side of the abdomen, in close proximity with the spleen. This is the end of the pancreas connected to nothing, no ducts or other tissues nearby or connected to it compared to other parts of the pancreas and best place for area of the cancer especially if it is only in the tail, in most cases.

“This year’s flu season will be particularly brutal, experts say. Usually, flu seasons are easier to handle when some portion of the population has a natural immunity, due to getting infected the previous year. But since many Americans spent last fall and winter relentlessly washing hands and socially distancing, fewer people than normal got the flu. That means an above-average number of people are at risk now, especially as more Americans have let down their guard against Covid in recent months.  The best way to prevent getting the flu is to get the flu vaccine,”.

CNBC Make It (https://www.cnbc.com)

“Autumn is here, the coronavirus pandemic is dragging on and — if that wasn’t enough — peak season for yet another infectious disease looms just around the corner: influenza, a viral infection that attacks the nose, throat and lungs.”.

Cleveland Clinic (https://health.clevelandclinic.org/how-to-prepare-for-flu-season-in-the-time-of-covid-19)

“Classifying the type of seizure a patient has helps the healthcare team choose the right therapy for that patient.  Seizure types are divided into two major groups that are called 1.) Generalized-Seizures produced by widespread abnormal electrical impulses present throughout the entire brain.  and 2.) Partial-Seizures produced by electrical impulses that generate from a relatively small or “localized” part of the brain (referred to as the focus).”.

Cleveland Clinic (https://my.clevelandclinic.org)