Stage 1 Pancreatic Cancer

What Is Stage 1 Pancreatic Cancer?

When malignant cells, also known as cancer cells, begin forming in tissues of the pancreas, the disease is called pancreatic cancer. [¹] Stage 1 pancreatic cancer is characterized by cancer that is found in only the pancreas and hasn’t spread outside the organ. The size of the tumor depends upon the sub-stage, but generally, it is not larger than 4 cm.

Stage 1 of pancreatic cancer is an early and localized cancer stage. It is also known as a resectable or operable cancer because performing surgery is possible. [²]

What Are the subtypes of Stage 1 Pancreatic Cancer?

Staging pancreatic cancer is a way to describe the location of cancer, where it has spread to, and which body parts it is affecting. To recognize a particular stage of cancer, doctors run many diagnostic tests.

Pancreatic cancer is categorized into stages 1 through 4. Stage 1 pancreatic cancer is further subdivided into the following stages according to the size of the tumor.

• Stage IA
• Stage IB.

Pancreatic cancer stages IA and IB are considered resectable [³], and removing the small tumor via surgery can increase the survival rate of the patients.

Stage 1 Pancreatic Cancer Staging and Diagnosis

Pancreatic Cancer Staging

In general, the TNM system is used to describe and classify cancers, including {cancer type}, where:

• T (tumor) describes the size and location of the tumor
• N (nodes) indicates whether or not it has spread to nearby lymph nodes
• M (metastasis) describes if and how far cancer has spread from its origin

How Common Is Stage 1 Pancreatic Cancer?

According to the American Cancer Society, pancreatic cancer makes up 3% of all types of cancers in the United States and accounts for almost 7% of deaths caused by cancer. [⁴] The pancreatic cancer stats provided by National Cancer Institute shows that an estimated 89,248 people [⁵] were living with pancreatic cancer in 2019 in the USA.

Pancreatic cancer patients do not exhibit symptoms until the cancer progresses to an advanced stage, which is why it remains a lethal malignant neoplasm.

Pancreatic cancer is slightly more common in men than women, and the incidence rate in both sexes increases with age. [⁶] The incidence of this cancer is also affected by geographical location, with a greater number of patients appearing in more developed countries.

Pancreatic cancer is mostly diagnosed in people aged between 65 and 74 years. [⁵]

Stage 1 pancreatic cancer is an early-stage, localized, and resectable cancer. Approximately 10 to 15% of the total patients are diagnosed with stage 1 pancreatic cancer.

How Is Stage 1 Pancreatic Cancer Diagnosed?

A doctor performs many diagnostic tests to find and diagnose pancreatic cancer. A biopsy is the most important procedure to retrieve samples of suspected cancerous tissues, but performing biopsies for pancreatic cancer is difficult because of the organ location.

Pancreatic tumors are also often smaller and “diffused” as compared to other tumor types, which is why doctors may suggest other tests besides a biopsy that helps them diagnose the disease.

Pancreatic cancer diagnoses depend on the following factors.

• Age and general health of the patient
• Family history of the patient
• Signs and symptoms
• Medical history

The general tests for diagnosing pancreatic cancer are as below.

Physical Examination

A doctor examines the skin, tongue, and eyes of a patient for signs of jaundice. Tumors in the head of the pancreas can block the normal flow of bile, which causes jaundice.

The doctor also feels changes in the abdomen. A buildup of fluid in the abdomen, called ascites [⁷], is a sign of advanced-stage pancreatic cancer

Blood Tests

Samples of blood are checked for the presence of elevated levels of bilirubin and other substances. Hyperbilirubinemia is a common symptom in the early stages of pancreatic cancer.

Carbohydrate antigen (CA) 19-9 is an important tumor marker for the diagnosis of pancreatic cancer. [¹⁰] Elevated CA 19-9 levels in the blood are an indication of pancreatic cancer, and the levels increase as the cancer progresses. However, the presence of this biomarker is also contributed by non-cancerous diseases like pancreatitis and cirrhosis of the liver.

Medical History

A doctor asks about the medical history and possible risk factors [⁸] that can contribute to the development of pancreatic cancer in an individual. [⁹]

After the initial examination raises suspicion of the presence of the disease, the doctor order further tests that confirm the diagnosis.

Imaging Tests

Imaging tests help doctors find the location and growth of cancer. Pancreatic cancer is often smaller and spread out in the initial stages, which is why it is sometimes difficult to detect it on imaging tests.

However, advanced tests and procedures make it easier to find pancreatic tumors. Some of the imaging tests are as follows:

CT Scan

Computed tomography, or CT scan, is used to capture cross-sectional images of the body which clearly show the pancreas.

CT scan tests use high-speed x-rays to give detailed images that show abnormalities in the pancreas. CT scan shows the size and location of the tumor and the possibility that it might have spread to lymph nodes and other parts of the body.

A pancreatic protocol CT scan is a special type of CT scan that takes pictures of the pancreas at different times after IV injection of contrast medium. The test results can show the position of the tumor in relation to nearby blood vessels and organs and whether it is possible to remove the tumor with surgery.

PET Scan

PET scans create multicolored images of tissues and organs in the body. This is achieved by injecting a small amount of tracer, or radioactive sugar, inside the body, which is taken up by the active cancer cells. The tracer used in PET scans, fluorodeoxyglucose or FDG, is detected by the PET scanner, which produces images of the areas with high metabolic activity or radioactivity.

PET scans are used alongside CT scans so that the doctor can compare the anatomy of the tumor along with the higher radioactivity, which helps determine the stage of pancreatic cancer.

MRI

MRI scans create detailed images of the body, which are used to measure the size of the tumor. The special types of MRI scans for the diagnosis of pancreatic cancer are:

• Magnetic resonance cholangiopancreatography (MRCP): MRCP is an important MRI exam for early diagnosis and evaluation of pancreatic cancer. [¹¹]
• MR angiography (MRA): MRA evaluates blood vessels to detect any abnormalities. [¹²]

Ultrasound Tests

Ultrasound tests are used to create images of organs in the body, such as the pancreas. Two different types of ultrasound tests are used for the diagnosis of pancreatic cancer.

• Abdominal Ultrasound Exam: This is the first preferred test to examine the abdominal organs. It is a non-invasive procedure and doesn’t expose the patient to radiation. a
• Endoscopic ultrasound (EUS): It is a test combining two techniques to help doctors evaluate and diagnose pancreatic cancer. [¹³] A small ultrasound probe on the tip of an endoscope is used to look inside the gut and get biopsy samples. EUS is better at detecting small tumors as compared to spiral CT and MRI.

Abdominal ultrasound is an initial diagnostic test for pancreatic cancer, but the sensitivity of ultrasound tests for the diagnosis of pancreatic tumors less than 3 cm is low.

However, a doctor should confirm the diagnosis when the sample of the tumor is retrieved during a biopsy or surgery.

Biopsy

Removal and examination of a small amount of cancerous tissue are essential for a definite diagnosis.

Endoscopic Ultrasound-Guided Fine-Needle Aspiration (EUS-FNA)

It is a safe and accurate method to diagnose suspected pancreatic cancer tissues. Fine needle aspiration biopsy collects cancerous tissue from the pancreas. It is more accurate than a CT scan or MRI to detect pancreatic lesions [¹⁴] and to confirm the diagnosis of pancreatic cancer. [¹⁵]

Core Needle Biopsy

Core needle biopsy is more sensitive for diagnosing pancreatic cancer as compared to FNA. CNB uses a larger needle to retrieve tissues from the pancreas, which increases the risk of bleeding and pancreatitis.

Stage 1 Pancreatic Cancer Symptoms

The most common and initial symptom of pancreatic cancer is a dull pain in the upper abdomen that comes and goes. The pain can also appear in the middle or upper back.

Early signs of stage 1 pancreatic cancer may include:

• Digestive problems such as nausea, vomiting, and abnormal stools.
• Dark-colored urine.
• Appetite loss.
• Fever.
• Itchy skin.
• Weight loss.
• Swollen gallbladder, which is detected during a physical exam.

Stage 1 Pancreatic Cancer Treatment

Resectable pancreatic cancer means that the cancer is contained within the pancreas and hasn’t grown to structures outside the pancreas, such as the bile duct, stomach, or small bowel. Stage 1 pancreatic cancer is an early-stage and resectable cancer, which means that treatment options include surgical removal and chemotherapy.

Stage 1 Pancreatic Cancer Surgery

If pancreatic cancer is detected before it has spread beyond the organ, it can be removed completely by surgery. Surgical procedure depends on the patient’s eligibility and the location of the tumor. If a patient is not eligible for surgery, then other treatment options like chemotherapy and radiation are used.

The surgical procedure to remove pancreatic tumor include:

Whipple Procedure

Whipple procedure is the most common pancreatic surgery and involves the removal of the following;

• Head of the pancreas
• Gallbladder
• Part of the stomach and small intestine
• Bile duct

Total Pancreatectomy

Total pancreatectomy involves the removal of;

• The pancreas.
• Some of the stomach and small intestine.
• Common bile duct.
• Gallbladder.
• Spleen.
• Nearby lymph nodes.

Distal Pancreatectomy

Distal pancreatectomy surgery is performed to remove the body and tail of the pancreas. Furthermore, the spleen may be removed if cancer has spread to it.

After the surgery is performed, a few cancer cells can remain behind and spread to form other cancerous tumors. This is why further treatment is recommended after surgery to prevent cancer from returning.

Adjuvant Treatment for Stage 1 Pancreatic Cancer

Chemotherapy

Chemotherapy depends on how well the patient has recovered from the surgery. Chemotherapy is performed after surgery to ensure that cancer doesn’t come back.

The following types of chemotherapy are given to stage 1 pancreatic cancer patients.

• Adjuvant Gemcitabine and Capecitabine.
• FOLFIRINOX for resectable pancreatic cancer. [¹⁶]
• Gemcitabine alone.

Can Stage 1 Pancreatic Cancer be Cured?

A very early diagnosis of pancreatic cancer means that the disease is potentially curable. [¹⁷] Surgery is a lifesaving treatment and the only potential cure for pancreatic cancer patients who receive an early diagnosis. Cancer hasn’t spread around the body, and it is treatable.

However, only a fraction of patients (only 10%) is diagnosed in time for treatment and surgery.

Prognosis: Stage 1 Pancreatic Cancer Survival Rate

Pancreatic cancer is aggressive cancer that spreads quickly. It is located deep within the body, which means that routine physical exams cannot detect it.

This is why early pancreatic tumors remain undiagnosed until cancer has become large or spread to other parts of the body. Surgical resection is the only treatment option that provides prolonged survival. [¹⁹]

Pancreatic cancer staging is a strong prognostic factor that determines the size and location of pancreatic tumors and appropriate treatment. The prognosis also depends on the lymph node involvement and how much cancer has spread during the diagnosis.

Even though the five-year survival rates are defined for each stage, different patients show different representations of cancer. Some patients can outlive their prognosis, and some can even become diseases free.

Stage 1 pancreatic cancer is a localized and early-stage cancer and has the potential to be curable if found very early. This is because cancer contained within the pancreas can be resected or surgically removed.

Getting the right treatment and drugs according to the cancer staging and patient’s health and nutrition also affects prognosis. [¹⁷]

Doctors are actively researching to learn more about the treatment, prevention, and care of pancreatic cancer. In addition to early detection screening tools and genetic studies, many studies are conducted on other areas of research, such as:

Circulating tumor DNA (ctDNA): ctDNA is a promising biomarker. It is the DNA that is released by tumor cells in the blood. Detecting, analyzing, and studying this DNA is a promising tool for monitoring locally advanced tumors. [²⁰]

Targeted Therapy: Drugs that target and block tumor growth and its spread are being studied as single drugs or part of a combination. A new drug, which is known as MRTX1133, targets the growth of tumors in pancreatic cancers having KRAS G12D mutations. [²¹]

Gene Therapy: In this case report, [²²] genetically engineered T cells were given to a patient with metastatic pancreatic cancer. The gene therapy targeted the mutant KRAS G12D gene in tumors, which resulted in the regression of metastatic pancreatic cancer.

Immunotherapy: Many types of immunotherapies are being studied for the treatment of pancreatic cancer, as chemotherapy often has limited efficacies for patients. [²³]

• Cancer Vaccine: Scientists are working on a novel cancer vaccine that helps the immune system target and fight cancer cells. Johns Hopkins researchers are actively researching vaccine therapy that can enhance the treatment of this disease. The cancer vaccine is made from inactivated pancreatic cells that release a molecule that attracts immune system cells to the cancerous cells. [²³]
• Blocking antibodies against PD-1: This type of immunotherapy uses immune checkpoint inhibitors and is only approved for pancreatic cancer patients with high microsatellite instability. [²⁴]

Stage 1 Pancreatic Cancer Survival Rate

The five-year survival rate for stage 1 pancreatic patients with localized tumors is 44%. [¹⁸] Patients whose pancreatic cancer is detected at stage IA can have a five-year survival of more than 80%.

Stage 1 Pancreatic Cancer Recurrence Rate

Even if it is possible to remove the pancreatic tumor of stage 1 pancreatic cancer with surgery, the disease can often come back. Pancreatic cancer can spread undetected at a rapid pace, and the small size of the tumor makes it difficult to remove it with medicines and surgery. [²³]

Even after receiving the Whipple procedure, tumor recurrences appear in up to 80% of patients. Many recurrences of risk factors have been identified, including lymph vessel invasion. [²⁵]

Stage 1 Pancreatic Cancer Growth Rate

Pancreatic cancer grows at a rapid and aggressive rate. However, it is estimated that initiating pancreatic cancer takes many years to grow and progress into an advanced stage.

Patients with stage 1 pancreatic cancer have a better prognosis outcome than other types of resectable cancers. Detecting small tumors in stage 1 pancreatic cancer is essential because it takes many years and tumor doublings for clinically detectable and early-stage tumors to progress to advanced stages.

In fact, this article [²⁶] suggests that an average T1 stage tumor (stage IA) can progress to an advanced T4 stage (stage III and IV) in just over a year.

Lifestyle Changes for Preventing and Managing Pancreatic Cancer

Many pancreatic cancer risk factors are known to increase the chance of a person getting pancreatic cancer. They include:

• Smoking and tobacco use
• Obesity
• Chronic pancreatitis
• Diabetes
• Family history, etc.

There are other lifestyle modifications that people with a higher risk of pancreatic cancer can bring into their lives.

• Quitting smoking.
• Maintaining a healthy weight.
• Exercising regularly.
• Avoiding processed meats and sugary drinks. [²⁷]
• Avoiding heavy alcohol consumption.
• Limited exposure to carcinogens at the workplace.

Conclusion

Takeaway

Diagnosing pancreatic cancer at stage 1 can ensure higher five-year survival rates in patients. This is because cancer hasn’t spread outside the pancreas, and it can be surgically removed. However, very few people are diagnosed at such an early stage.

Medical researchers are actively looking for better treatment and diagnostic plans for the greater survival of patients. Pancreatic cancer life expectancy is also affected by the overall health, age, and each patient’s individual response to the disease and its treatment.