Pancreatic cancer (PCa) is a malignant neoplasm that originates in the tissues of the pancreas, the organ responsible for producing digestive enzymes and hormones such as insulin. This form of cancer has a high mortality rate and is usually diagnosed at a late stage, making treatment difficult and worsening the prognosis. The main type of pancreatic cancer is adenocarcinoma, which accounts for about 90% cases. External and internal factors can influence the development of the disease, and early symptoms often go unnoticed due to their subtle nature. As the disease progresses, symptoms become more severe, including abdominal pain, jaundice, loss of appetite, and unexplained weight loss.
History of the disease and interesting historical facts
The history of pancreatic cancer research spans several centuries. The first descriptions of neoplasms in the pancreas appeared in medical literature in the 17th-18th centuries. However, serious research began only at the beginning of the 20th century, when scientists began to systematize data on the spread and pathogenesis of this disease. One of the first to identify pancreatic cancer as a separate nosological entity was S.R. Kaplan in 1940. It is important to note that until the mid-20th century, pancreatic cancer was considered a rare disease, but with the increase in life expectancy of the population, as well as with changes in lifestyle, the incidence rate has increased significantly. In the 1970s, active research into the molecular mechanisms of carcinogenesis began, which led to the identification of a number of genes and biomarkers associated with this disease.
Epidemiology (statistics of disease occurrence)
The rise in pancreatic cancer is a concern for the medical community. According to the World Health Organization (WHO), pancreatic cancer was the seventh leading cause of cancer death in 2020, with approximately 466 cases worldwide. The incidence varies across countries, with the highest number of cases reported in North America and Europe. It is estimated that by 2030, pancreatic cancer could become the second leading cause of cancer death in high-income countries. Importantly, statistics show that men are more likely to develop this cancer than women, with a ratio of 1.5 to 1.
Genetic predisposition to this disease
Research shows that genetic predisposition plays a significant role in the development of pancreatic cancer. Certain hereditary syndromes, such as Li-Fraumeni syndrome and hereditary pancreatitis, increase the risk of developing this disease. A link has been found between mutations in the BRCA2, CDKN2A and PALB2 genes and pancreatic cancer. Mutations in the KRAS gene are found in more than 90% cases of pancreatic cancer, which emphasizes its importance in carcinogenesis. Research also shows that the presence of pancreatic cancer in family history increases the risk of the disease, which further confirms the importance of genetic factors in the etiology of prostate cancer.
Risk factors for the development of this disease
There are several risk factors that may contribute to the development of pancreatic cancer:
- Smoking. Smoking has been shown to increase the risk of pancreatic cancer by 2-3 times.
- Obesity: People who are overweight have an increased risk of developing PCa due to metabolic changes associated with obesity.
- Chronic pancreatic diseases. Chronic pancreatitis and type II diabetes mellitus are associated with an increased risk of prostate cancer.
- Age: The incidence of pancreatic cancer increases with age, especially after age 60.
- Alcohol consumption: Frequent and excessive alcohol consumption is a known risk factor for pancreatic cancer.
Diagnosis of this disease
Diagnosis of pancreatic cancer is based on a combination of clinical presentation, laboratory and radiological examinations. The main symptoms that may indicate the presence of the disease include:
- Pain in the upper abdomen, often radiating to the back.
- Jaundice caused by blockage of the bile ducts.
- Loss of appetite and unexplained weight loss.
Laboratory tests may include blood tests for tumor markers such as CA 19-9. Radiologic tests such as ultrasound, CT, and MRI are key to visualizing the tumor and its spread. In some cases, a biopsy may be needed to confirm the diagnosis. Differential diagnosis includes other diseases of the pancreas and abdominal organs.
Treatment
Treatment for pancreatic cancer depends on the stage of the disease and the patient's general condition. The main treatment methods include:
- Surgical treatment: resection of the pancreas (pancreaticoduodenectomy or distal pancreatectomy) can be performed in the early stages when the tumor can be removed.
- Pharmacological treatment: includes chemotherapy (eg, combination of gemcitabine and nab-paclitoxel) and targeted therapy.
- Radiation therapy: can be used alone or in combination with surgical and pharmacological treatments, especially to reduce the size of the tumor before surgery.
- Palliative care: used for inoperable cancer to relieve symptoms and improve quality of life.
List of medications used to treat this disease
The main drugs used in the treatment of pancreatic cancer include:
- Gemcitabine (Gemzar)
- Nab-paclitaxel (Abraxane)
- Folfirinox (a combination of fluorouracil, leucovorin, iropulser and oxaliplatin)
- Everolimus (Afinitor)
- Sematinib (Keytruda)
Disease monitoring
Monitoring of patients with pancreatic cancer includes regular examinations to assess the effectiveness of treatment and detect recurrence of the disease. The prognosis is usually poor - five-year survival is about 10%. Complications include tumor recurrence, metastasis to distant organs, and the development of various comorbidities such as diabetes and chronic liver disease.
Age-related features of the disease
Pancreatic cancer is most often diagnosed in people over 60 years of age. In older people, the disease may proceed more aggressively, which is associated with concomitant pathologies, reduced body reserves, and a lower ability to tolerate chemotherapy and surgery. Pancreatic cancer is less common in younger patients, and in most cases this is due to hereditary factors and carcinogenic effects.
Questions and Answers
- What is pancreatic cancer? This is a malignant neoplasm that occurs in the tissues of the pancreas, which can have serious consequences and high mortality.
- What are the main risk factors for pancreatic cancer? Major risk factors include smoking, obesity, chronic pancreatic disease, age and alcohol consumption.
- What symptoms may indicate pancreatic cancer? The main symptoms include upper abdominal pain, jaundice, loss of appetite and unexplained weight loss.
- How is pancreatic cancer diagnosed? Diagnosis includes clinical examination, laboratory tests for tumor markers, and radiological studies such as ultrasound, CT, and MRI.
- What treatment is used for pancreatic cancer? Treatment may include surgery, chemotherapy, radiation therapy, and palliative care.
