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What is Stage 4 Pancreatic Cancer?

In stage 4, pancreatic cancer spreads beyond the pancreas to other organs of the body. An important role of the pancreas is maintaining the digestive system and helping the body control sugar levels. In the United States, Pancreatic cancer accounts for around 3% of all cancers.

Diagnosing pancreatic cancer is difficult in the early stages because the pancreas is positioned deep within the body tissues. Until a tumor grows large in size or cancer cells metastasize to other organs, people usually show no or common symptoms.

According to research conducted in 2015, around 53% of people with pancreatic cancer are diagnosed only when the cancer is in stage 4.

While diagnosing pancreatic cancer, the doctor intends to identify how many cancerous cells are present in the body and whether they have spread past the pancreas or not. This process, known as staging, helps the doctors identify how severe the cancer is and which treatment strategies are most beneficial. Sometimes, the only way to determine the cancer stage is via performing surgery.

There is no such treatment to cure stage 4 pancreatic cancer, but the available ones aim to increase the patient's life span, enhance their quality of life, and control their signs and symptoms.

Spread of Pancreatic Cancer

Pancreatic cancer cells can proliferate in many body organs and tissue areas, which may include the following:

  • Adrenal Glands

  • Lungs

  • Bones

  • Peritoneum, The membrane that lines the abdomen

  • Liver

  • stomach

  • Diaphragm

Symptoms

The early detection of pancreatic cancer can be difficult because it does not usually show any signs and symptoms in its initial stages.

When the pancreatic cancer cells spread and are at a more advanced stage, that is when they may disrupt the functioning of the liver, gall bladder, and bile ducts leading to:

  • Itchy skin

  • Abdominal discomfort

  • Jaundice, which is yellowing of the epidermis of the skin and the whites of the eyes

  • Darkened urine

  • Pale stools

Other Nonspecific Symptoms

Non-specific symptoms are general and can be associated with various other diseases. The symptoms include:

  • Depression

  • Immediate onset of type 2 diabetes that is hard to manage

  • Rapid weight loss

  • A decrease of appetite or feeling full soon after consuming food

  • Dyspepsia

  • Bloating

  • Dizziness and weakness

Stages of Pancreatic Cancer

Pancreatic cancer is categorized into four stages.

Stage 1 refers to the small cancerous cells that do not spread to other regions.

Stages 2 or 3 include large cancerous cells which spread to nearby lymph nodes.

Stage 4 refers to the cells that metastasize to distant body parts, typically the lungs and the liver.

The best course of treatment for patients suffering from stage 4 pancreatic cancer is the management and control of signs and symptoms. In most cases, doctors suggest chemotherapy along with palliative care. Palliative care is specialized medical care that concentrates on improving life quality for those with a severe condition and usually takes place along with curative treatment.

Factors That Affect Survival

A prognosis is a prediction made after the diagnosis. It determines how the disease will progress. Prognostic and predictive factors also assist in developing a treatment plan and predicting the future outcome. The prognosis for every cancer stage is different, and many factors are associated, which are discussed below:

Cancer Staging

Usually, the TNM system is used for the staging of pancreatic cancer. The staging system includes assigning a number or letter to represent the tumor (T), node (N), and metastasis (M) categories:

  • T: The size and extent of spread of the primary or main tumor

  • N: The number of lymph nodes that pancreatic cancer has penetrated

  • M: The number of cancer cells metastasized to other parts of the body and tissues

The TNM system helps doctors determine the growth of cancerous cells and the appropriate treatment plan.

Age

The risk of developing pancreatic cancer increases with age. Many people develop pancreatic cancer at the age of 45. According to statistical data, 90% of people are older than 55, and 70% are over 65. Despite the age, adults of any age can be diagnosed with any stage of pancreatic cancer.

Gender

According to research and analysis data, more men are diagnosed with pancreatic cancer than women.

Race/Ethnicity

Black people are at a higher threat of developing pancreatic cancer than Hispanic, Asian, or white people. People with Ashkenazi Jewish roots are also more prone to develop an advanced stage of pancreatic cancer.

Smoking

The risk of pancreatic cancer escalates with the use of tobacco. People who smoke regularly 2 to 3 times a day are more likely to develop pancreatic cancer than those who do not smoke.

Obesity, Diet, and Use of Alcohol

Another risk factor involved in developing pancreatic cancer is the Daily intake of foods higher in fat content. Several studies prove that obese people with high BMI levels are at a greater chance of getting diagnosed and dying from pancreatic cancer. The possibilities for pancreatic cancer are also associated with chronic and heavy alcohol use. It can most likely cause recurrent pancreatitis, a condition involving repeated pancreas inflammation.

Diabetes

The risk for developing pancreatic cancer increases because of diabetes. Particularly when a patient has had it for several years. One of the significant symptoms of developing pancreatic cancer is the sudden onset of diabetes in the later stages of adulthood. However, all people diagnosed with diabetes do not develop pancreatic cancer in adulthood.

Family History

Pancreatic cancer can be linked with genetic conditions which run in the family. This condition is called familial pancreatic cancer. The patient and his family may be at higher risk of developing pancreatic cancer if two or more first-degree relatives or almost three family members are already diagnosed with pancreatic cancer. First-degree relatives include children, parents, and siblings.

Rare Inherited Conditions

The threat for pancreatic cancer significantly increases with rare inherited conditions. Many other types of cancers can also be caused due to these conditions, which may include the following:

  • Hereditary pancreatitis (HP): HP is a condition related to recurrent pancreatitis and leads to a significant increase in the risk of pancreatic cancer.

  • Peutz-Jeghers syndrome (PJS)

  • Familial malignant melanoma and pancreatic cancer (FAMM-PC)

  • Hereditary breast and ovarian cancer (HBOC) syndrome

  • Lynch syndrome

Patients with other rare inherited conditions may also have a greater risk of pancreatic cancer, which include:

Chronic Pancreatitis

Pancreatitis is a condition that involves the swelling of the pancreas. It is generally a painful pancreatic disease that can cause discomfort. Some studies show that chronic pancreatitis may raise the chance of developing pancreatic cancer.

Chemicals

When a person is exposed to deadly chemicals such as petrochemicals, certain dyes, benzene, and pesticides, the possibility of developing pancreatic cancer increases significantly.

Bacteria

Helicobacter pylori, also called H. pylori, is a common bacterium that causes inflammation and ulcer formation in the stomach. The chance of pancreatic and stomach cancer increases with infection caused by H. pylori.

However, the onset of stomach cancer is higher than pancreatic cancer.

Hepatitis B Infection

The liver is mainly affected by the Hepatitis viruses. A study shows that people infected by hepatitis B before are more prone to developing pancreatic cancer than people without the infection. However, more research is needed to prove this.

Cirrhosis

When liver cells get damaged and get replaced by scar tissue, cirrhosis develops. Many cases of cirrhosis in the United States are due to the intake of a lot of alcohol regularly. Other causes of cirrhosis include:

  • Viral hepatitis.

  • Accumulation of iron in the liver from a disease known as hemochromatosis.

  • Some other uncommon types of chronic liver disease.

Personalized Treatment for Stage 4 Pancreatic Cancer at Silver Cancer Institute and Center for Chronic Disease

Genomic Personalized Molecular Testing

SCI evaluates specific biomarkers and performs chemosensitivity testing in order to assess which chemotherapy is essential for the patient. Natural testing is also a part of the treatment protocol.

For the use of immunotherapy with checkpoint inhibitors, various tests for tumor mutational burden and microsatellite instability are carried out.

Combination Therapy Works Best

The treatment plan includes:

Personalized Treatment with Targeted Therapies

With the help of chemosensitivity testing, SCI can now use the most efficacious chemotherapy. Chemotherapy is one of the best treatment options administered in low doses. It prevents chemotherapy resistance and avoids suppression of the immune system.

Natural substances are used synergistically to attack the cancer pathways and cause the death of cancerous cells. Moreover, chemotherapy resistance is reversed along with improved immune status.

Immunotherapy with Checkpoint Inhibitors

Checkpoint inhibitors used for pancreatic cancer are not as effective as other cancers. It is due to the suppression of the immune system and the tumor microenvironment.

Immunotherapy with Cancer Vaccines and Supportive Oligonucleotide (SOT)

The optimization of the patient's immune system is critical. New cancer vaccines such as autologous whole cancer vaccines and dendritic cell vaccines are used at SCI to treat pancreatic cancer.

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