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Pancreatic Cancer 

Introduction
Pancreatic cancer results when the cells in the pancreas grow abnormally and out of control instead of dividing in an orderly manner.  The exact cause of pancreatic cancer is unknown.  Although the vast majority of pancreatic tumors are cancerous, some are not cancerous.  Pancreatic cancer that is diagnosed and treated early is associated with the best outcomes.  Treatments for pancreatic cancer include surgery, radiation therapy, chemotherapy, or a combination of therapies. 

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Anatomy
Your pancreas is a gland.  It is located in your upper abdomen behind your stomach.  Your pancreas assists with digesting the food that you eat.  It produces digestive fluids and digestive hormones.

When you eat, the exocrine gland in your pancreas produces digestive enzymes and bicarbonates.  They travel through the pancreatic duct to your small intestine.  Your small intestine breaks down the liquefied food from your stomach even further so that your body can absorb the nutrients.  The enzymes break down the proteins, carbohydrates, and fats in the food that you eat.  The bicarbonates protect your small intestine from the irritating digestive acids produced by the stomach.  The remaining waste products from the small intestine travel to the large intestine.
 
The endocrine cells in your pancreas produce digestive hormones.  The endocrine cells are arranged in clusters called islets.  They release insulin and glucagon into your bloodstream.  These digestive hormones help to control your blood sugar (glucose) levels.  Your body uses blood sugar for energy.

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Causes
The exact cause of pancreatic cancer is unknown.  Tumors can develop in the pancreas when cells grow abnormally and out of control, forming tumors.  Pancreatic tumors may or may not be cancerous.  Tumors may originate in the exocrine or endocrine cells.  Another type of cancer, ampullary cancer, can occur at the location where the pancreatic duct and the liver bile duct empty into the small intestine. 
 
Cancer originates more frequently in the exocrine cells; however, not all tumors that develop in the exocrine are cancerous.  Exocrine tumors most commonly occur in the tail or head of the pancreas.  Exocrine cancers are referred to as adenocarcinomas, and there are several subtypes.

Endocrine cell tumors are less common.  They may also be referred to as islet tumors.  Although some endocrine tumors may be cancerous, the majority of them are not.

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Symptoms
Pancreatic cancer may cause abdominal or back pain, nausea, vomiting, and diarrhea.  You may lose your appetite and lose weight without trying.  Jaundice may cause your eyes and skin to appear yellow.  You may feel weak, tired, and depressed.  Less common symptoms of pancreatic cancer are diabetes and blood clots.

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Diagnosis

A doctor can begin to diagnose pancreatic cancer by reviewing your medical history and conducting some tests and a physical examination that focuses on the abdominal area.  Imaging tests may be used to help identify the cancer and to see if it has spread.

Computed tomography (CT) scans and magnetic resonance imaging (MRI) scans are used to take pictures of the pancreas and internal organs.  Positron emission tomography (PET) scans use a radioactive sugar substance that cancer cells absorb.  The substance makes the location of pancreatic cancer and spreading cancer appear on the photos.  CT and PET scans may be used together to help stage cancer and identify early cancers.  An ultrasound is an imaging test that uses sound waves to create a picture of the internal organs.  An angiography is used to see if a tumor is blocking the blood flow in your pancreas.

An endoscopic retrograde cholangiopancreatography (ERCP) uses a probe that is inserted through the mouth into the stomach.  An ERCP uses a dye to view the pancreas, bile ducts, and nearby structures.  An endoscope is a thin tube with a light and a viewing instrument at the end of it.  After you are sedated, the tube is passed through your mouth and into your small intestine.  An endoscopic ultrasound (EUS) is a similar device which uses sound waves to create a picture of your pancreas and surrounding structures.  A biopsy forceps may be passed through the EUS to take a sample of the tissue to be examined under the microscope.

Blood tests are used to evaluate your pancreas and liver functioning.  A biopsy may be used to determine if the cells in a suspected area are cancerous or not.  A biopsy entails obtaining a tissue or fluid sample for examination.  A laparoscopy, also referred to as keyhole surgery, involves inserting a thin instrument into the abdomen to identify the size of a tumor and whether it has spread.

If you have pancreatic cancer, your doctor will assign your cancer a classification stage based on the results of all of your tests.  Staging describes the cancer and how it has metastasized.  Cancer that has spread from its original site to other parts of the body is termed metastatic cancer.  Staging is helpful for treatment planning and recovery prediction.

There is more than one type of staging system for cancer, and you should make sure that you and your doctor are referring to the same one.  Generally, lower numbers in a classification system indicate a less serious cancer and higher numbers indicate a more serious cancer.  The stages may be subdivided into classifications that use letters and numbers.

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Treatment
Treatment for pancreatic cancer depends on the type, extent, and location of the cancer.  Pancreatic cancer may be treated with surgery, radiation therapy, chemotherapy, or a combination of treatments.  The goal of pancreatic cancer treatments is to cure the cancer and relieve symptoms.  If a cure is not possible, the goal of treatments is to relieve symptoms and improve the quality of life.

Surgery may be used to remove pancreatic tumors.  A Whipple procedure, a pancreaticoduodenectomy, is a surgery that removes the head of the pancreas, sections of the stomach and small intestine, common bile duct, gallbladder, and regional lymph nodes.  The pancreas and common bile duct are reattached to the small intestine.  Another type of surgery may be used for people with a bile obstruction.  Surgery and the placement of a biliary stent may be used to relieve an obstruction or blockage.

Radiation therapy uses high energy X-rays to kill cancer cells and shrink tumors.  Radiation therapy may be received before a surgery to reduce the size of a tumor.  It may be received after surgery to help prevent the cancer from returning.  Radiation therapy and chemotherapy may be used to treat cancer that has spread.

Chemotherapy uses drugs to kill cancer cells.  It may be used alone to treat early stage pancreatic cancer or in combination with other treatment methods.  Chemotherapy may be combined with targeted therapy drugs for people with advanced pancreatic cancer.

The experience of cancer and cancer treatments may be a very emotional experience for you and your loved ones.  It is important to embrace positive sources of support.  Some people find comfort in their families, friends, co-workers, counselors, and faith.  Cancer support groups are a helpful resource where you can receive support, information, and understanding from people with similar experiences.  Ask your doctor for support groups near you.

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Prevention
There is no way to prevent pancreatic cancer at this time.  It may be helpful to reduce the risk factors that you can control, such as quitting smoking, maintaining a healthy weight, and eating a well-balanced diet.

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Am I at Risk

Risk factors may increase your likelihood of developing pancreatic cancer, although some people that develop pancreatic cancer do not have any risk factors.  People with all of the risk factors may never develop the disease; however, the chance of developing pancreatic cancer increases with the more risk factors you have.  You should tell your doctor about your risk factors and discuss your concerns.

Risk factors for pancreatic cancer:

_____ The risk of pancreatic cancer increases with age.  The majority of pancreatic cancers occur in people that are over age 55.
_____ Men experience pancreatic cancer more frequently than women.
_____ African Americans experience the most cases of pancreatic cancer.
_____ Smoking is a significant risk factor for pancreatic cancer.
_____ Researchers believe that there might be a link between eating a lot of red meat, pork, or processed meats, such as bacon or sausage, and pancreatic cancer.
_____ People that are very overweight or obese have a higher risk of pancreatic cancer.
_____ Diabetes increases the risk of pancreatic cancer.
_____   Chronic pancreatitis, a long-term inflammation of the pancreas, is a risk factor for
pancreatic cancer.
_____ Exposure to certain chemicals, such as bug spray, dyes, or gasoline products may increase the risk of pancreatic cancer.
_____ It appears that some types of pancreatic cancer may be inherited.  If your family members have had pancreatic cancer, ask your doctor about your risk.  Genetic tests or tumor marker tests may be used to help show if you have a high risk of developing pancreatic cancer.

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Complications
Pancreatic cancer can be associated with other significant medical problems, including blood clots, weight loss, liver dysfunction, infections, pain, and depression.  Pancreatic cancer may spread beyond the pancreas.  Unfortunately, most pancreatic cancers have spread by the time they are diagnosed.  Pancreatic cancer is generally associated with a poor prognosis.

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Advancements
Researchers are working on ways to identify pancreatic cancer early, before it causes symptoms or spreads.  Tumor marker tests may show higher levels of CA 19-9 and CEA in some people with pancreatic cancer.  Genetic tests are available to show if you have a high risk of pancreatic cancer.  These tests are not used to screen the general population for pancreatic cancer, but may be an option for people with a strong family history.
 
Researchers are studying ways to boost the immune system to fight cancer and new cancer treatments that combine chemotherapy, radiation, and other treatment methods.  Clinical trials are in progress for new medications called anti-angiogenesis factors.  Anti-angiogenesis factors block the growth of the blood vessels that support the cancer tumors and essentially starve the tumor.

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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on April 13th, 2016. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.