Definition
Pancreatic cancer begins in the tissues of your pancreas — an organ in your abdomen that lies horizontally behind the lower part of your stomach. Your pancreas secretes enzymes that aid digestion and hormones that help regulate the metabolism of sugars.
Pancreatic cancer often has a poor prognosis, even when diagnosed early. Pancreatic cancer typically spreads rapidly and is seldom detected in its early stages, which is a major reason why it's a leading cause of cancer death. Signs and symptoms may not appear until pancreatic cancer is quite advanced and complete surgical removal isn't possible.
Symptoms
Signs and symptoms of pancreatic cancer often don't occur until the disease is advanced. When signs and symptoms do appear, they may include:
· Upper abdominal pain that may radiate to your back
· Yellowing of your skin and the whites of your eyes (jaundice)
· Loss of appetite
· Weight loss
· Depression
· Blood clots
Causes
Pancreatic cancer occurs when cells in your pancreas develop mutations in their DNA. These mutations cause cells to grow uncontrollably and to continue living after normal cells would die. These accumulating cells can form a tumor.
Most pancreatic cancer begins in the cells that line the ducts of the pancreas. This type of cancer is called pancreatic adenocarcinoma or pancreatic exocrine cancer.
Rarely, cancer can form in the hormone-producing cells of the pancreas. This type of cancer is called islet cell cancer or pancreatic endocrine cancer.
Risk factors
Factors that may increase your risk of pancreatic cancer include:
· African-American race
· Excess body weight
· Chronic inflammation of the pancreas (pancreatitis)
· Diabetes
· Family history of genetic syndromes that can increase cancer risk,
· Personal or family history of pancreatic cancer
· Smoking
Complications
As pancreatic cancer progresses, it can cause complications such as:
· Jaundice. Pancreatic cancer that blocks the liver's bile duct can cause jaundice. Signs include yellow skin and eyes, dark-colored urine, and pale-colored stools.
Your doctor may recommend that a plastic or metal tube (stent) be placed inside the bile duct to hold it open. In some cases a bypass may be needed to create a new way for bile to flow from the liver to the intestines.
· Pain. A growing tumor may press on nerves in your abdomen, causing pain that can become severe. Pain medications can help you feel more comfortable. Radiation therapy may help stop tumor growth temporarily to give you some relief.
· Bowel obstruction. Pancreatic cancer that grows into or presses on the small intestine (duodenum) can block the flow of digested food from your stomach into your intestines.
· Weight loss. A number of factors may cause weight loss in people with pancreatic cancer.
The cancer itself may cause weight loss. Nausea and vomiting caused by cancer treatments or a tumor pressing on your stomach may make it difficult to eat. Or your body may have difficulty properly processing nutrients from food because your pancreas isn't making enough digestive juices.
Tests and diagnosis
Diagnosing pancreatic cancer
If your doctor suspects pancreatic cancer, you may have one or more of the following tests to diagnose the cancer:
· Imaging tests to create pictures of your internal organs. Imaging tests help your doctor visualize your internal organs, including your pancreas. Imaging tests used to diagnose pancreatic cancer include ultrasound, computerized tomography (CT) scan and magnetic resonance imaging (MRI).
· Using a scope to create ultrasound pictures of your pancreas. An endoscopic ultrasound (EUS) uses an ultrasound device to make images of your pancreas from inside your abdomen. The ultrasound device is passed through a thin, flexible tube (endoscope) down your esophagus and into your stomach in order to obtain the images. Your doctor may also collect a sample of cells (biopsy) during EUS.
· Using a scope to inject dye into the pancreatic ducts.Endoscopic retrograde cholangiopancreatography (ERCP) uses a dye to highlight the bile ducts in your pancreas.
During ERCP, an endoscope is passed down your throat, through your stomach and into the upper part of your small intestine. A dye is then injected into the pancreatic and bile ducts through a small hollow tube (catheter) that's passed through the endoscope. Finally, X-rays are taken of the ducts.
A tissue or cell sample (biopsy) can be collected during ERCP.
· Removing a tissue sample for testing (biopsy). A biopsy is a procedure to remove a small sample of tissue from the pancreas for examination under a microscope.
A biopsy sample can be obtained by inserting a needle through your skin and into your pancreas (fine-needle aspiration). Or it can be done using endoscopic ultrasound to guide special tools into your pancreas where a sample of cells can be obtained for testing.
Staging pancreatic cancer
Once a diagnosis of pancreatic cancer is confirmed, your doctor will work to determine the extent (stage) of the cancer. Your cancer's stage helps determine what treatments are available to you. In order to determine the stage of your pancreatic cancer, your doctor may recommend:
· Using a scope to see inside your body. Laparoscopy uses a lighted tube with a video camera to explore your pancreas and surrounding tissue. The surgeon passes the laparoscope through an incision in your abdomen. The camera on the end of the scope transmits video to a screen in the operating room. This allows your doctor to look for signs cancer has spread within your abdomen.
· Imaging tests. Imaging tests may include CT and MRI.
· Blood test. Your doctor may test your blood for specific proteins (tumor markers) shed by pancreatic cancer cells.
Stages of pancreatic cancer
Using information from staging tests, your doctor assigns your pancreatic cancer a stage. The stages of pancreatic cancer are:
· Stage I. Cancer is confined to the pancreas.
· Stage II. Cancer has spread beyond the pancreas to nearby tissues and organs and may have spread to the lymph nodes.
· Stage III. Cancer has spread beyond the pancreas to the major blood vessels around the pancreas and may have spread to the lymph nodes.
· Stage IV. Cancer has spread to distant sites beyond the pancreas, such as the liver, lungs and the lining that surrounds your abdominal organs (peritoneum).
Treatments and drugs
Treatment for pancreatic cancer depends on the stage and location of the cancer as well as on your age, overall health and personal preferences.
The first goal of pancreatic cancer treatment is to eliminate the cancer, when possible. When that isn't an option, the focus may be on preventing the pancreatic cancer from growing or causing more harm.
When pancreatic cancer is advanced and treatments aren't likely to offer a benefit, your doctor will help to relieve symptoms and make you as comfortable as possible.
Surgery
Surgery may be an option if your pancreatic cancer is confined to the pancreas. Usually is a major one and has long term feeding difficulties and need dietitian care to avoid malnourishment.
Radiation therapy
Radiation therapy uses high-energy beams, such as X-rays, to destroy cancer cells. You may receive radiation treatments before or after or instead of cancer surgery, often in combination with chemotherapy.
Chemotherapy
Chemotherapy uses drugs to help kill cancer cells. Chemotherapy can be injected into a vein or taken orally. You may receive only one chemotherapy drug, or you may receive a combination of chemotherapy drugs.
Chemotherapy can also be combined with radiation therapy (chemoradiation). In people with advanced pancreatic cancer, chemotherapy may be used alone or it may be combined with targeted drug therapy.
Targeted therapy
Targeted therapy uses drugs that attack specific abnormalities within cancer cells. The targeted drug erlotinib (Tarceva) blocks chemicals that signal cancer cells to grow and divide. Erlotinib is usually combined with chemotherapy for use in people with advanced pancreatic cancer.
