Pancreatic Cancer

What is pancreatic cancer?

The pancreas (PAN-cree-us) is an organ that sits deep in your belly. The pancreas has two main functions. It makes digestive enzymes (proteins that break down food) and hormones that regulate blood sugar, such as insulin.

Pancreatic (PAN-cree-at-ick) cancer occurs when abnormal cells grow uncontrolled in the pancreas. Most pancreatic cancers occur in the part of the pancreas that produces digestive fluids (specifically, in the cells lining the ducts of the pancreas). A small number of pancreatic cancers occur in a part of the pancreas that helps regulate blood sugar. This type of cancer is called either an insulinoma or a neuroendocrine tumor.

It is very important that your doctor finds out which kind of pancreatic cancer you have, because the two types have different treatments. This article will focus on the first type, which is called adenocarcinoma (add-en-oh-car-cin-oh-mah).

The problem with pancreatic cancer is that it usually spreads before any symptoms appear. Doctors aren’t sure what causes pancreatic cancer, but they know it is more common in

smokers
men
people with diabetes
African Americans
people who work in occupations that expose them to certain chemicals, such as the dry cleaning industry.

People who have had surgery for stomach ulcers or who have had chronic inflammation of the pancreas (chronic pancreatitis) are also more likely to develop this cancer. And this type of cancer may run in families.

Another risk factor for invasive pancreatic cancer is condition called intraductal papillary mucinous neoplasm (IPMN). These tumors grow and produce thick mucus inside the pancreatic ducts. They have the potential to become malignant and invade the rest of the pancreas. People with IPMN need to undergo regular screening.

Symptoms of pancreatic cancer

Symptoms of pancreatic cancer may not show up right away. And when they do, they can look like other digestive problems. The most common signs of pancreatic cancer are:

back or abdominal pain
weight loss
yellowing of the skin (jaundice)
itching
brown urine
very light colored bowel movements
nausea
vomiting
loss of appetite.

Jaundice occurs if the pancreatic cancer blocks the bile duct. Bile is a digestive juice that is made in the liver and is greenish to yellowish in color. A blocked bile duct causes the breakdown product of bile called bilirubin to accumulate in the blood. It gets deposited in the skin, causing jaundice.

Diagnosing pancreatic cancer

If your doctor thinks you may have pancreatic cancer, he or she may suggest the following tests:

Blood tests. Simple tests can help rule out other possible causes of your symptoms. Some blood tests can hint at pancreatic cancer, but can’t confirm if you have it.
Ultrasound. In this test, sound waves create a picture of internal organs. This test is also most useful in ruling out other causes of your symptoms (for example, gallbladder disease or cysts in the pancreas).
Endoscopic ultrasound. For this test, your doctor threads a tube through your digestive tract so the sound waves can get closer to the pancreas. He or she can use a special instrument to take small samples of the pancreas for further testing (biopsy).
Computed tomography (CT) scan. A CT or “CAT” scan is usually a good way to get a picture of what is happening in the abdomen and can help detect pancreatic cancer. CT scans can also show if cancer has spread to nearby organs, lymph nodes, or distant organs.
Magnetic resonance imaging (MRI) scan. This test uses magnetic fields and radio waves to produce images of organs in the body. Your doctor may order a special type of MRI to look more closely at the structures around the pancreas. It’s called magnetic resonance cholangiopancreatography (MRCP).
Positron emission tomography (PET) scanning. Doctors use this test to see if pancreatic cancer is growing or has spread. PET scans use a form of radioactive sugar. Certain types of cancers, such as pancreatic cancer take up more sugar that the surrounding tissues and can be seen with special cameras.
Endoscopic retrograde cholangiopancreatography. This test looks for blockages in the pancreatic tubes that carry digestive enzymes. The doctor threads a tube through your mouth into the small intestine. She or he then injects a special dye that will show up on x-rays. If the x-ray shows a blockage or tumor, the doctor can take tissue samples to test for cancer. This test can be very useful and is generally safe, but it comes with some risks. Only highly experienced doctors should do it.
Angiography. This test looks at the blood supply to pancreatic tumors. This can help doctors determine if it is possible to remove the cancer with surgery.
CT-guided biopsy. A CT scan is used to guide the biopsy needle to the right spot for obtaining samples of suspicious tissue. Rarely, surgery may be needed to make the diagnosis.
Staging laparoscopy. Sometimes doctors want to get a direct look at the pancreas. During this surgical procedure, a tube with a small camera and light attached to it is inserted into the abdomen. This allows the doctor to see the pancreas and surrounding organs without major surgery. He or she may take samples of the pancreas to help determine how aggressive the cancer is (including whether it has spread within the abdominal cavity).

Expected duration of pancreatic cancer

Because symptoms don’t show up until the cancer has spread, this disease is hard to cure. But treatment can help control your symptoms and improve length of survival and quality of life. How well it can do that depends on many things: how much the cancer has spread, your age and general health, and how well your body responds to treatment.

Preventing pancreatic cancer

For most types of pancreatic cancer, there is no proven way to prevent it. You can decrease your risk of getting this cancer by not smoking. Cigarette smoking is the most significant risk factor associated with pancreatic cancer. If you smoke, quit. If you don’t smoke, don’t start.

Also you may decrease your risk of developing pancreatic cancer by:

eating a diet rich in fruits and vegetables
staying physically active and engaging in daily exercise
maintaining a healthy weight.

Cancer researchers are making progress to discover effective ways to screen for pancreatic cancer. However, at the current time, there is no proven method of screening people at average risk for pancreatic cancer so that it can be caught and treated early.

People with intraductal papillary mucinous neoplasm (IPMN) could potentially have periodic blood tests for a cancer protein called CA 19-9 and scans to detect early transition to invasive pancreatic cancer.

Pancreatic cancer can run in families, and it almost surely has a hereditary cause. Cancer researchers are studying what methods of screening may be effective for people with this kind of family history. Some people might be at increased risk of pancreatic cancer because of a family history of the disease (or a family history of certain other cancers). Sometimes this increased risk is due to a specific genetic syndrome.

Some genetic tests can look for mutations associated with an increased risk of pancreatic cancer. (These tests do not look for pancreatic cancer itself.) Your doctor may discuss potential screening options if your genetic testing suggests a higher than average cancer risk.

Treating pancreatic cancer

If your doctor confirms that you have pancreatic cancer, he or she will do tests to see how aggressive the cancer is and how much it has spread. This is called staging. Your treatment depends on the cancer's stage. Treatment may include:

surgically removing all or part of the pancreas (and any cancer that has spread nearby)
cancer-killing drugs (chemotherapy)
radiation to kill cancer cells and control symptoms
targeted therapy
ablation and embolization treatments to destroy pancreatic cancer that has spread to other organs.

In some cases, your doctor may suggest you enroll in a clinical trial. Clinical trials test promising but unproven treatments in patients.

In the rare case that the cancer has not spread outside the pancreas, doctors try to remove the cancer surgically. They may also recommend chemotherapy and or radiation as part of the treatment.

When the cancer has spread beyond the pancreas to nearby organs or other parts of the body, complete cure is unlikely. However, multiple treatments are available to decrease symptoms and prolong survival. You and your cancer specialist can consider how to proceed. Treatment options include:

radiation and/or chemotherapy
surgery or other procedures to reduce symptoms. In the past, this type of surgery was very extensive. There are now methods where minimally invasive surgical procedures can be provided that are less debilitating than the larger types of operations that were required previously.
new drugs and treatments still in the testing phase — for example, drugs that make cancer cells more vulnerable to radiation.

Even when the cancer appears to be completely removed by surgery, it can come back, either in the pancreas or elsewhere in the body. If it does recur, the cancer can be treated with the same options as listed above.

When to call a professional

If you notice any symptoms of pancreatic cancer, call your doctor right away. He or she may suggest that you see a specialist to help determine if you have this disease.

Prognosis

Pancreatic cancer remains one of the challenging cancers, with a low five-year survival rate. The best outcomes occur when the diagnosis is made before pancreatic cancer has spread. New research suggests that advances in treatment, including new targeted therapies, immunotherapy, and pancreatic cancer vaccines may lead to an improved prognosis.