Pancreatic cancer gives different findings than other cancers due to the location of the pancreatic organ. The pancreas has both a section that produces hormone and enzyme secretions and a duct section that allows these secretions to be poured into the intestines. The course and findings of two different cancers originating from these two different parts are different from each other.

Pancreatic cancer puts pressure on and narrows the bile ducts in the head of the pancreas, which is adjacent to the main bile duct. As a result, the pigment that gives yellow color to the bile, which we call bilirubin, which cannot be excreted into the intestine with bile, increases in the blood and ultimately causes jaundice in the skin and eyes, causing it to be diagnosed relatively earlier than cancers in other parts of the pancreas. can be done. Pancreatic cancer is diagnosed at a very advanced stage and treatment is delayed because the location of the organ is very deep and posterior, and the cancer does not cause symptoms when it is located in parts other than the head of the pancreas. While making a diagnosis during this silent period is of great importance, it is often not detected in the check-up tests and ultrasonography performed during this period. Therefore, check-up packages must include medicated computed tomography imaging of the abdominal area.

In addition, some symptoms may give an early warning in the early stages of the disease:

-Pain in the abdomen and back

-Extreme fatigue and weakness, depressed mood

-Suppression of appetite, weight loss

-Nausea, vomiting

-Yellowing of the skin and the white part of the eye

-Jaundice with light stools the color of glazier’s paste and dark tea-colored urine (in pancreatic head tumors)

-Itching due to jaundice

-Sudden onset of diabetes, high blood sugar in individuals without a family history and overweight

In addition to tests including full blood, biochemistry and tumor markers, advanced imaging tests such as medicated computed tomography are mandatory for patients presenting with all these symptoms.

If a tumor is detected as a result of all these examinations, a radiological needle biopsy is planned for tissue diagnosis. If the biopsy result is reported as cancer, an examination called PET-CT is performed for staging purposes. In the light of this staging, according to the decision of the tumor council, surgical treatment is planned if surgery is possible. However, if the chance of surgical intervention is lost, oncological treatment with medication and/or radiation is started with the decision of the tumor council. If stage reduction can be achieved with these oncological treatments under close follow-up, surgical treatment can be applied with the decision of the tumor council. In addition to cancers originating from the cells lining the canal as a result of pathology, it can also arise, less commonly, from cells that secrete hormones. We call cancers arising from hormone-secreting cells neuroendocrine tumors.

Although the main lines of treatment for both groups are the same, the main difference is that the second group of cancers have a relatively longer survival time. Cancers originating from hormone-secreting cells benefit greatly from surgical treatment, even if they are at a very advanced stage or have metastasized to the liver. Compared to other duct-derived cancers of the pancreas that we fear, the 5-year survival rate is 95-100% in those without liver metastases, while it remains at 75-80% in those with liver metastases if the metastases are completely removed surgically. In neuroendocrine pancreatic tumors, if the tumor in the pancreas can be completely cleared, but liver metastases recur despite all surgical and oncological treatments, liver transplantation can be applied as the last option. The biggest and most well-known example we can give to this group is Steve Jobs, the founder of Apple. Steve Jobs, who was struggling with pancreatic neuroendocrine tumor, underwent all treatments, including liver transplantation, and his survival time was 8 years. Of course, this patient is a very tragic example. Unfortunately, when the tumor was around 2 cm in diameter in the initial stage, he unfortunately refused medical treatment and wasted time with alternative medicine treatments. If surgery had been performed while the disease was a local disease, perhaps Steve Jobs would be among us today. Because survival after surgical treatment is quite high in neuroendocrine pancreatic tumors detected at an early stage, with a 20-year survival rate being approximately 95%. It’s a classic sentence, but I can truly say that early diagnosis saves lives.

As a surgeon who has worked in an oncology hospital for many years, my advice is that choosing methods that can take in-depth images in check-up screening programs is of vital importance in prolonging survival with appropriate surgical treatment by ensuring early diagnosis, especially in silent, deep-seated organ cancers such as the pancreas.