Pancreatic Cancer

What is pancreatic cancer?

The pancreas is an organ of the digestive system, located behind the stomach.  It has two glands.  The exocrine gland, which accounts for 95 percent of the cells in the pancreas, contains enzymes which aid in digestion.  The endocrine gland regulates blood sugar levels through the release of insulin and glucagon.  Approximately 95 percent of pancreatic cancers are exocrine adenocarcinomas.  Symptoms, diagnosis and treatment are different for pancreatic cancer of the exocrine gland and the endocrine gland.

What are risk factors for pancreatic cancer?

Risk factors increase the chance of getting pancreatic cancer, but not everyone with a risk factor gets pancreatic cancer. 

• Age – The majority of pancreatic cancer occur in people over the age of 50, and particularly over the age of 65.
• Tobacco – Smoking increases the chance of pancreatic cancer up to twice as much as non-smokers.
• Diet – A diet high in meat and fat may increase the risk for pancreatic cancer.
• Diabetes – People with diabetes, especially type II, have a higher risk of pancreatic cancer.
• Chronic pancreatitis – This condition of chronic inflammation of the pancreas, increases the risk for pancreatic cancer.
• Hereditary conditions – Certain heredity conditions such as hereditary nonpolyposis colon cancer, multiple endocrine neopolasia type I syndrome, familial atypical multiple mole melanoma syndrome, ataxia-telangiectasia, von Hippel-Lindau syndrome increases the risk for pancreatic cancer.
  

What are prevention strategies for pancreatic cancers?

While there are no established guidelines to prevent pancreatic cancers, it is beneficial to reduce risk factors.

• Tobacco – Do not smoke or if you smoke, quit smoking (link to tobacco document under prevention). 
• Diet – It is important to eat a diet low in fat and high in fruits and vegetables.  This will help to maintain a healthy body weight and decrease the risk for multiple cancers.
• Family history – If there is a strong family history of pancreatic cancer, it is important to discuss this with your healthcare provider to discuss options for screening.
  

Is screening available?

There are no established national guidelines for pancreatic screening.  It is important if a person is at high risk to discuss options with their healthcare provider.

What are the symptoms of pancreatic cancer?

In early stages of pancreatic cancer, there are often no signs or symptoms.  The following symptoms may also indicate other medical conditions.

• Jaundice – yellowing of the skin and whites of the eyes
• Pain in the upper or middle abdomen and the back
• Unintentional weight loss
• Loss of appetite
• Fatigue
  

How is pancreatic cancer diagnosed?

Pancreatic cancer can be difficult to diagnose due to the location of the pancreas, late onset of symptoms, and symptoms that are similar to other conditions.  Tests that may be used to diagnose pancreatic cancer include:

• History and physical examination – to assess risk factors, family history and gather information gathering on things such as weight, pain, symptoms, and medical condition.
• Computed tomography (CT) scan – This is used in making initial diagnosis and is helpful in staging the cancer.
• Magnetic resonance imaging (MRI) – Like the CT scan, it is helpful with diagnosis and staging.
• Positron emission tomography (PET) scan – Radionuclide glucose is injected into the vein and the scan takes pictures of where the glucose is absorbed.  Malignant tumors show up brighter, because they take up more glucose than normal cells.
• Endoscopic ultrasound – A thin lighted tube is inserted through the mouth, nose or into the stomach and can be used to biopsy the tumor.
• Biopsy – This removes tissue to check for cancer.
• Endoscopic retrograde cholangiopancreatography (ERCP) – This is used to x-ray the ducts, as sometimes pancreatic cancer will cause the ducts to narrow or block and slows the flow of bile which causes jaundice.
• Percutaneous transhepatic cholangiography (PTC) – This procedure x-rays the liver and bile ducts after inserting a needle into the liver and injecting dye.  This can detect blockages in the ducts.  This is generally done only if ERCP cannot be done.
  

What is staging?

Staging describes the extent of the cancer.  It determines if the cancer has spread and if so, what parts of the body are affected.  Staging a cancer is important to assist the doctor to determine the appropriate course of treatment and assess an accurate prognosis. 

The most common staging system is the TNM.

• T – size of the tumor
• N – degree to which regional lymph nodes are involved
• M – the absence or presence of distant metastases

Once the TNM has been determined, then a stage of I, II, III or IV is assigned.

• Stage I – cancers are small and local and usually curable
• Stage II & III – typically these are locally advanced and could involve the lymph nodes
• Stage IV – cancer has metastasized and can be inoperable
  

What are treatment options?

The type of treatment depends on factors such as the stage of cancer.  There are three types of standard treatment.

• Surgery – This is used to take out the tumor or relieve symptoms if the tumor cannot be removed.

• Chemotherapy – This systemic drug is administered through the veins to kill cancer cells.

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

Other treatment that may be used :

• Biological therapy – This form of treatment helps the body’s immune system attack and destroy cancer cells and may help the body recover from some of the side effects of treatment.
  

What clinical trials are available?

Clinical trials are studies that seek to find better ways to prevent, screen, diagnose and treat a disease such as cancer.  Clinical trials test new approaches to treatment, such as new drugs, new approaches to surgery or radiation therapy, or a combination of treatments.

Learn more about clinical trials.

What questions should I ask my doctor?

It is often helpful to make a list of questions before an appointment.  This will help you to remember what the doctor says.  Patients and care givers can write notes or ask if they may use a tape recorder.  Sometimes it is helpful to have a family member or friend at the appointment to take notes, ask questions or just listen.  Below are a few suggested questions a patient may ask their doctor.

Will you please write down the type of cancer that I have?

What stage is my cancer and what does that mean?

What are my treatment options?

What treatment do you recommend and why?

What are the risks and benefits of each treatment?

What are possible side effects of treatment?

How will you help manage my side effects?

How will treatment affect my normal activities?

Are there specific things I must do to get ready for treatment?

Are there other things I can be doing to help with my treatment, such as diet and exercise?

What resources can I use to learn more about my cancer and help me deal with it?

Make an appointment

Resources

American Cancer Society – www.cancer.org, 1-800-ACS-2345

National Cancer Institute – www.cancer.gov, 1-800-4CANCER