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What is Pancreatic Cancer?

The pancreas is a gland that is located deep in the abdomen, against the spine. Its job is to aid in food digestion and help maintain blood sugar levels.

Pancreatic cancer is diagnosed in more than 29,000 people in the United States every year. Most pancreatic cancers occur in people over the age of 55. This cancer is seldom caught early because the signs and symptoms often do not appear until the disease is advanced.

Risk Factors

Research is improving our understanding of pancreatic cancer and its causes. The following are known risk factors for the disease:

  • Age/Gender - Most people who are diagnosed with pancreatic cancer are 55 or older. It is more common in men than women.
  • Being Overweight - Overweight people are more likely to develop pancreatic cancer.
  • Chronic Pancreatitis - Long-term swelling of the pancreas is linked with a slightly higher risk of pancreatic cancer.
  • Cirrhosis of the Liver - People who have cirrhosis, the scarring of the liver, may have an increased risk of pancreatic cancer.
  • Diabetes - Pancreatic cancer is more common among people with type 2 diabetes. Diabetes can also be a symptom of pancreatic cancer.
  • Family History - Pancreatic cancer can run in families.
  • Stomach Issues - Having too much stomach acid or bacteria (H. pylori) in the stomach may increase your risk of pancreatic cancer.
  • Tobacco Products - Smoking accounts for nearly 30% of pancreatic cancer cases. People who use smokeless (spit or chew) tobacco are also more likely to get pancreatic cancer.
  • Work Exposure to Chemicals - Exposure at work to certain pesticides, dyes, and chemicals may increase your risk pancreatic cancer.

Signs and Symptoms

Pancreatic Cancer is very difficult to diagnose in its early stages. As it develops, the following symptoms may appear:

  • Blood Clots - Blood clots may form in the veins or fatty tissue under the skin. They can travel to the lungs and cause breathing problems.
  • Diabetes - Pancreatic cancer can interfere with blood sugar levels.
  • Digestive Abnormalities - Stools might be pale, bulky, greasy and float in the toilet. Other problems may include nausea, vomiting and pain that gets worse after eating.
  • Jaundice - A yellow color in the eyes and skin is called jaundice. It is caused by a build-up of a substance (bilirubin) that is made in the liver. At least half of all people with pancreatic cancer have jaundice.
  • Pain - Pain in the abdomen or in the middle of the back is a common sign of advanced pancreatic cancer.
  • Swollen Gallbladder - During an exam, your doctor may find that the gallbladder is enlarged.
  • Weight Loss - Weight loss is a very common symptom.

Diagnosis

Pancreatic cancer is sometimes referred to as a “silent disease” because its symptoms are usually not noticed until it is advanced. If symptoms are seen, a doctor may perform one or more of the following procedures:

  • Physical Exam - A doctor examines the skin and eyes for signs of jaundice (yellow color) and feels the abdomen, looking for abnormalities near the pancreas, liver and gallbladder.
  • Lab Test - Samples of blood, urine and stool are checked for bilirubin and other substances. High bilirubin levels may suggest a blockage that could be caused by cancer or another condition.
  • CT Scan - An x-ray machine takes detailed pictures of the pancreas and surrounding organs and blood vessels.
  • Ultrasound - Sound waves and a computer are used to create a picture of the pancreas and surrounding organs.
  • ERCP (Endoscopic Retrograde Cholangiopancreatography) - An endoscope is passed through the mouth and stomach into the small intestine. A tube injects a dye through the endoscope into the bile and pancreatic ducts. The dye shows up on x-rays and can reveal blockages, which may be caused by tumors.
  • PTC (Percutaneous Transhepatic Cholangiography) - A dye injected into the liver and x-rays are used to highlight blockages caused by tumors.
  • Biopsy - A pathologist looks at a sample of tissue from the pancreas under a microscope to check for cancer cells.

Helpful Questions to Ask Your Health Care Team About Diagnostic Procedures:

  • Why is this procedure being used?
  • What can I expect to happen during this procedure?
  • What should I do to prepare for this procedure?
  • What can I expect after the procedure?
  • What complications can occur with this procedure?
  • How does this procedure compare to other ways to diagnose pancreatic cancer?
  • Where do I go for this procedure?

Stages

If pancreatic cancer is diagnosed, the doctor needs to know the stage, or extent, of the disease to determine the best treatment. Staging is used to find out whether the cancer has spread, and if so, to which parts of the body.

Stage 0 (carcinoma in situ) - In stage 0, cancer cells are found in the lining of the pancreas. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.

Stage I - In stage I, cancer is found in the pancreas only. Stage I is divided into stage IA and stage IB, based on the size of the tumor:

  • Stage IA: The tumor is 2 centimeters or smaller.
  • Stage IB: The tumor is larger than 2 centimeters.

Stage II - In stage II, the cancer may have spread to nearby tissue, organs or the lymph nodes near the pancreas. Stage II is divided into stage IIA and stage IIB, based on where the cancer has spread:

  • Stage IIA: Cancer has spread to nearby tissue and organs but not nearby lymph nodes.
  • Stage IIB: Cancer has spread to nearby lymph nodes and may have spread to nearby tissue and organs.

Stage III - In stage III, the cancer has spread to the major blood vessels near the pancreas and possibly nearby lymph nodes.

Stage IV - In stage IV, the cancer has spread to distant organs, such as the liver, lung, and peritoneal cavity.

Treatment

Pancreatic cancer is more treatable when it is found in early stages before it has spread. In later stages, pancreatic cancer can be difficult to control with current treatments. Treatment can help people live longer and relieve symptoms.

Many doctors encourage people with late stage pancreatic cancer to take part in clinical trials. Clinical trials can offer the opportunity to benefit from the latest treatments or combinations of treatments while helping advance knowledge of the disease and its treatment options.

Doctors also recommend palliative therapy to improve quality of life by controlling pain and other symptoms of the disease. Talk through options with your doctors and develop a treatment plan that best fits your needs.

Treatment options depend on the type and stage of cancer, and may include one or more of the following:

Surgery

A surgeon removes all or part of the pancreas. The type of surgery depends on the location and size of the tumor, the stage of the disease and the person's general health.

Types of surgery for pancreatic cancer include.

Whipple Procedure - When the tumor is in the widest part (the head) of the pancreas, the surgeon removes the head of the pancreas, and part of the small intestine, bile duct, stomach and other nearby tissues.

Distal Pancreatectomy - If the tumor is in the body or tail of the pancreas, the surgeon removes the area containing the tumor and the spleen.

Total Pancreatectomy - The surgeon removes the entire pancreas, part of the small intestine, part of the stomach, the common bile duct, gallbladder, spleen and nearby lymph nodes.

After surgery, people may be fed through an IV or feeding tubes in the abdomen before slowly returning to solid foods by mouth.

Radiation Therapy

A large machine directed at the abdomen uses high-energy rays to kill cancer cells. Radiation can be given alone or with chemotherapy, surgery or both. It is used to destroy cancer cells that remain after surgery and to relieve pain caused by cancer.

Chemotherapy

This treatment uses drugs to kill cancer cells. In people with pancreatic cancer, chemotherapy is given alone, or with surgery, radiation or both. Most often, drugs are injected into the veins

Side Effect Management

It helps to learn more about the side effects of treatment(s) before you begin so you will know what to expect. When you know more, you can work with your health care team to manage your quality of life during and after treatment.

There are effective medications to address the traditional side effects of chemotherapy.

Keep in mind that everyone reacts differently to treatment and experiences side effects differently. There are coping mechanisms and strategies that can help.

Side Effects from Pancreatic Treatments

The side effects of treatment for cancers in the abdominal area vary. The following are the most common symptoms:

Radiation Therapy

The side effects of radiation to the abdomen depend on the dose and may include nausea, vomiting, diarrhea or other problems with digestion. Most side effects of radiation are temporary, but some rare serious side effects can be permanent.

Chemotherapy

The side effects of chemotherapy depend on the drugs and the dose and may include hair loss, loss of appetite, nausea and vomiting, diarrhea, fatigue and mouth sores.