Pancreatitis and cancer
Pancreatitis is the inflammation of the pancreas, which can manifest in acute or chronic forms. Acute pancreatitis occurs suddenly and can be life-threatening, while chronic pancreatitis leads to ongoing damage to the organ over time. Common risk factors for pancreatitis include alcohol abuse, trauma, and elevated levels of lipids or calcium in the blood. Symptoms often include severe abdominal pain, nausea, and fever, and the diagnosis can be confirmed through physical exams, blood tests, and imaging techniques.
Importantly, pancreatitis is linked to an increased risk of pancreatic cancer, a condition that is difficult to detect in its early stages. The relationship between the two conditions has prompted advancements in diagnostic methods for pancreatic cancer, as well as ongoing research into potential treatments. Current therapies for pancreatitis may involve intravenous fluids, pain management, and, in severe cases, surgical interventions. A deeper understanding of how pancreatitis may lead to cancer could enhance treatment approaches and outcomes for patients suffering from both conditions.
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Subject Terms
Pancreatitis and cancer
ALSO KNOWN AS: Inflammation of the pancreas
RELATED CONDITIONS: Diabetes mellitus, alcoholism, pancreatic cancer, gallstones
DEFINITION: Pancreatitis, inflammation of the pancreas, appears in acute and chronic forms. Acute pancreatitis comes on suddenly and typically resolves quickly, but it may be severe and life-threatening. Chronic pancreatitis slowly destroys the pancreas.
Risk factors: Alcohol abuse, trauma, and high lipid or calcium levels are all associated with pancreatitis.
Etiology and the disease process: The pancreas is a glandular organ that lies behind the stomach. It produces hormones and digestive enzymes. Specialized pancreatic cells produce the hormones glucagon and insulin. Glucagon stimulates the liver to convert stored glycogen into glucose, raising blood glucose (sugar) levels. As blood glucose levels rise, the pancreas responds by secreting insulin. Insulin helps transport glucose into the body’s cells, where it is used for energy. Other cells located throughout the pancreas secrete digestive enzymes. These enzymes are secreted in fluid that travels from the pancreas through the pancreatic duct to the duodenum (portion of the small intestine), where they become activated and aid digestion.
In pancreatitis, the flow of pancreatic enzymes becomes obstructed by gallstones or spasm and edema at the ampulla of Vater, the area where the pancreatic and liver ducts enter the duodenum. The enzymes then begin digesting the pancreas.
Incidence: More than 275,000 people are hospitalized with acute pancreatitis annually; additionally, 86,000 are hospitalized with chronic pancreatitis.
Symptoms: Mild pancreatitis may manifest with upper abdominal pain centered near the umbilicus. As pancreatitis progresses, abdominal pain becomes severe and persistent and may radiate to the back. It commonly occurs after eating a large meal or drinking alcohol. Other symptoms may include abdominal distension and tenderness, bruising in the flank or around the umbilicus, fever, nausea, rapid pulse, and low blood pressure.
Screening and diagnosis: Physical examination, blood tests to detect elevated pancreatic enzyme (amylase and lipase) levels, and abdominal computed scan confirm the diagnosis. Abdominal ultrasonography may detect gallstones.
Treatment and therapy: Treatment depends on the severity of symptoms. Mild pancreatitis may abate without treatment. Severe pancreatitis requires withholding food and fluids, administering replacement fluids and electrolytes intravenously, and inserting a nasogastric tube to decrease abdominal distension. Medications such as hydromorphone or morphine are commonly prescribed to control pain. Surgical drainage of a pancreatic or pseudocyst may be necessary.
Prognosis, prevention, and outcomes: Pancreatitis causes approximately 2,500 deaths annually. The prognosis is good when pancreatitis results from tract disease, but it is poor when it is a complication of alcoholism. Pancreatitis increases the risk of pancreatic cancer. Because of this increased risk, patients with pancreatitis have benefited from developments in diagnosing and treating pancreatic cancer. Scientists are developing blood tests that may catch pancreatic cancer, notoriously hard to diagnose in early states, earlier. Although immunotherapies, targeted therapies, and combination therapies have extended the survival rates of pancreatic cancer patients, understanding the links between pancreatitis and cancer will aid research for all patients with pancreatic conditions. Further, in 2024, several drugs used for other conditions, including pirfenidone, paricalcitol, and pentoxifylline, were under investigation for their efficacy in treating pancreatitis.
Bibliography
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“Pancreas Clinic - Overview.” Mayo Clinic, 30 May 2024, www.mayoclinic.org/departments-centers/pancreas-clinic/overview/ovc-20357801. Accessed 3 July 2024.
“Pancreatic Cancer Risk Factors.” American Cancer Society, 5 Feb. 2024, www.cancer.org/cancer/types/pancreatic-cancer/causes-risks-prevention/risk-factors.html. Accessed 3 July 2024.
“Pancreatitis.” MedlinePlus, 17 Mar. 2016, medlineplus.gov/pancreatitis.html. Accessed 3 July 2024.
“Pancreatitis: Symptoms, Causes & Treatment.” Cleveland Clinic, 12 Jan. 2023, my.clevelandclinic.org/health/diseases/8103-pancreatitis. Accessed 3 July 2024.
Weiss, Frank U. "Pancreatic Cancer Risk in Hereditary Pancreatitis." Frontiers in Physiology, vol. 5, 2014, doi.org/10.3389/fphys.2014.00070. Accessed 3 July 2024.