Pancreatic Cancer

Pancreatic cancer is an abnormal growth of tissue (tumor) in the pancreas that is cancerous (malignant). Unlike noncancerous (benign) tumors, malignant tumors can spread to other parts of your body. The pancreas is a gland located deep in the abdomen, between the stomach and the spine. The pancreas makes insulin and other hormones. These hormones help the body use or store the energy that comes from food. The pancreas also makes pancreatic juices. These juices contain enzymes that help digest food.

Most pancreatic cancers begin in the ducts that carry pancreatic juices. When cancer of the pancreas spreads (metastasizes) outside the pancreas, cancer cells are often found in nearby lymph nodes. If the cancer has reached these nodes, it means that cancer cells may have spread to other lymph nodes or other tissues, such as the liver or lungs. Sometimes cancer of the pancreas spreads to the peritoneum. This is the tissue that lines the abdomen.

CAUSES

The exact cause of pancreatic cancer is unknown.

RISK FACTORS

There are a number of risk factors that can increase your chances of getting pancreatic cancer. They include:

  • Age. The likelihood of developing pancreatic cancer increases with age. Most pancreatic cancers occur in people older than 60 years.

  • Smoking. Cigarette smokers are 2 to 3 times more likely than nonsmokers to develop pancreatic cancer.

  • Diabetes, especially if you were diagnosed as an adult.

  • Being male.

  • Being African American.

  • Family history. The risk for developing pancreatic cancer triples if a person's mother, father, sister, or brother had the disease. Also, a family history of colon cancer or ovarian cancer increases the risk of pancreatic cancer.

  • Chronic pancreatitis. Chronic pancreatitis is a painful condition of the pancreas.

  • Exposure to certain chemicals in the workplace.

  • Being obese or eating a diet high in fat and red meat.

SYMPTOMS

Pancreatic cancer is sometimes called a "silent disease." This is because early pancreatic cancer often does not cause symptoms. As the cancer grows, symptoms may include:

  • Weakness.

  • Abdominal pain.

  • Diarrhea.

  • Depression.

  • Loss of appetite.

  • Indigestion.

  • Pain in the upper abdomen or upper back.

  • Nausea and vomiting.

  • Yellowing of the skin or eyes (jaundice).

  • Back pain.

  • Weight loss.

  • Fatigue.

  • Clay-colored stools.

  • Unexplained blood clots.

  • Dark urine.

DIAGNOSIS

Your caregiver will ask about your medical history. He or she may also perform a number of procedures, such as:

  • A physical exam. Your skin and eyes will be examined for signs of jaundice. The abdomen will be checked for changes in the area near the pancreas, liver, and gallbladder. Your caregiver will also check for an abnormal buildup of fluid in the abdomen (ascites).

  • Lab tests. Your caregiver may take blood and urine samples to check for bilirubin and other substances. Bilirubin is a substance that passes from the liver to the intestine through the gallbladder and bile duct. If the bile duct is blocked by a tumor, the bilirubin cannot pass through normally. Blockage of the bile duct may cause the level of bilirubin in the blood and urine to become very high.

  • Computed tomography (CT). An X-ray machine linked to a computer takes a series of detailed pictures of the pancreas and other organs and blood vessels in the abdomen.

  • Ultrasonography. The ultrasound device uses sound waves to produce pictures of the pancreas and other organs inside the abdomen.

  • Endoscopic retrograde cholangiopancreatography. A lighted tube (endoscope) is passed through the patient's mouth and stomach, down into the small intestine. Then a smaller tube (catheter) is inserted through the endoscope into the bile ducts and pancreatic ducts. A dye is injected through the catheter into the ducts and X-rays are taken. The X-rays can show whether the ducts are narrowed or blocked by a tumor.

  • Endoscopic ultrasonography. An endoscope is passed through the patient's mouth and stomach, down into the small intestine. An ultrasound device is placed down the endoscope to produce pictures of the area, including the pancreas.

  • Percutaneous transhepatic cholangiography. A dye is injected through a thin needle into the liver and X-rays are taken. Unless there is a blockage, the dye should move freely through the bile ducts. From the X-rays, your caregiver can tell whether there is a blockage from a tumor.

  • Taking a tissue sample (biopsy) from the pancreas. The sample is examined under a microscope to look for cancer cells.

Your cancer will be staged according to its severity and extent. Staging is a careful attempt to categorize your cancer to help determine which treatment will be most appropriate. Factors involved in staging include the size of the tumor, whether the cancer has spread, and if so, to what parts of the body it has spread. You may need to have more tests to determine the stage of your cancer. The test results will help determine what treatment plan is best for you.

STAGES

  • Stage I. The cancer is only found in the pancreas.

  • Stage II. The cancer has spread to nearby tissues and possibly to the lymph nodes, but not to the blood vessels.

  • Stage III. The cancer is surrounding the major blood vessels beside the pancreas and has possibly spread to the lymph nodes.

  • Stage IV. The cancer has spread to other parts of the body, such as the liver, lungs, or peritoneum.

TREATMENT

Treatment generally begins within several weeks after the diagnosis. There will be time to talk with your caregiver about treatment choices, get a second opinion, and learn more about the disease. Your caregiver may refer you to a cancer specialist (oncologist).

  • Cancer of the pancreas is very hard to control with current treatments. For that reason, many caregivers encourage patients with this disease to consider taking part in a clinical trial. Clinical trials are an important option for people with all stages of pancreatic cancer.

  • At this time, pancreatic cancer can be cured only when it is found at an early stage, before it has spread. However, other treatments may be able to control the disease and help patients live longer and feel better. When a cure or control of the disease is not possible, some patients choose palliative therapy. Palliative therapy aims to improve quality of life by controlling pain and other problems caused by this disease, but it does not cure the disease.

Depending on the type and stage, pancreatic cancer may be treated with surgery, radiation therapy, or chemotherapy. Some patients have a combination of these therapies.

  • Surgery may be done to remove all or part of the pancreas. Sometimes the cancer cannot be completely removed. However, if the tumor is blocking the common bile duct or duodenum, the surgeon can place a mesh tube (stent) in the blocked area. This helps keep the duct or duodenum open.

  • Radiation therapy uses high-energy rays to kill cancer cells.

  • Chemotherapy is the use of drugs to kill cancer cells. Caregivers also give chemotherapy to help reduce pain and other problems caused by pancreatic cancer.

HOME CARE INSTRUCTIONS

  • Only take over-the-counter or prescription medicines for pain, discomfort, or fever as directed by your caregiver.

  • Maintain a healthy diet.

  • Consider joining a support group. This may help you learn to cope with the stress of having pancreatic cancer.

  • Seek advice to help you manage treatment side effects.

  • Keep all follow-up appointments as directed by your caregiver.

SEEK IMMEDIATE MEDICAL CARE IF:

  • You have a sudden increase in pain.

  • Your skin or eyes turn more yellow.

  • You lose weight without trying.

  • You have a fever, especially during chemotherapy treatment or after stent placement.

  • You notice new fatigue or weakness.