Pancreatic Cancer
The pancreas contains two different kinds of glands. The exocrine glands make pancreatic "juice" that has enzymes which break down fats and proteins in foods so the body can use them. Most of the cells in the pancreas are part of the exocrine system. A smaller number of cells in the pancreas are endocrine cells. These cells are arranged in clusters called islets. They make hormones (such as insulin) that help balance the amount of sugar in the blood.
Types of Tumors of the Pancreas
Both the exocrine and endocrine cells of the pancreas can form tumors, but those formed by the exocrine pancreas are much more common.
Exocrine Tumors
Tumors of the exocrine part of the gland are likely to be cancer. Nearly all of these tumors are adenocarcinomas. Treatment of cancer of the exocrine pancreas is mostly based on the stage of the cancer, not its exact type.
Risk Factors for Pancreatic Cancer
Age
The risk of this cancer goes up with age. Almost 90% of patients are older than 55. The average age at the time the cancer is found is 72.
Gender
Men have this cancer slightly more often than women.
Race
African Americans are more likely to have this cancer than are whites.
Smoking
The risk of getting cancer of the pancreas is 2 to 3 times higher among smokers. About 3 out of 10 cases of pancreatic cancer are thought to be caused by smoking.
Diet
There may be a link between pancreatic cancer and high-fat diets that include a lot of red meat and pork, especially processed meat (such as sausage and bacon). Some studies have found that diets high in fruits and vegetables may help reduce the risk of pancreatic cancer. But not all studies have found such links, and the exact role of diet in pancreatic cancer is still under study.
Obesity and Lack of Exercise
Very overweight people are more likely to develop pancreatic cancer, as are those who don't get much exercise.
Diabetes
Pancreatic cancer is more common in people with this disease.
Chronic Pancreatitis
This is a long-term inflammation of the pancreas. It is linked with a slightly higher risk of pancreatic cancer, but most people with this condition do not get pancreatic cancer.
Work Exposure
Heavy exposure at work to certain substances (pesticides, dyes, and chemicals) may increase the risk of getting cancer of the pancreas.
Family History
Cancer of the pancreas seems to run in some families. This may account for about 1 in 10 cases. Changes in DNA that increase the risk for certain other cancers also increase the risk of this cancer.
Stomach Problems
Having too much stomach acid or having a bacteria called H. pylori in the stomach may increase the risk of pancreatic cancer.
Prevention:
There is no sure way to prevent cancer of the pancreas at this time. For now, the best advice is to avoid smoking and to eat a healthy diet with plenty of fruits, vegetables, and whole grains. Cut down on red meats, especially those that are processed or high in fat. Keeping a healthy weight and exercising are also important.
Early Detection:
It is hard to find pancreatic cancer early. By the time a person has symptoms, the cancer is usually large and has spread to other organs. Because the pancreas is deep inside the body, the doctor cannot see or feel tumors during a routine physical exam.
Right now there are no blood tests or other tests that can easily find this cancer early in people without symptoms. Levels of tumor markers such as CA 19-9 and CEA may be higher than normal in people with pancreatic cancer, but the cancer is usually advanced by the time the levels become high.
Symptoms of Pancreatic Cancer
Jaundice
A yellow color of 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. While jaundice can be a sign of cancer, more often it is caused by something else.
Pain
Pain in the belly area (abdomen) or in the middle of the back is a very common sign of advanced pancreatic cancer. Again, such pain is often caused by something other than cancer.
Weight Loss
Losing weight (without trying) over a number of months is very common in patients with this cancer. They may also feel very tired and not feel like eating.
Digestive Problems
If the cancer blocks the release of the pancreatic juice into the intestine, problems such as trouble breaking down fat can result. Stools might be pale, bulky, greasy, and float in the toilet. Other problems may include nausea, vomiting, and pain that tends to be worse after eating.
Swollen Gallbladder
The doctor may find that the gallbladder is enlarged. This can be felt and seen on imaging studies.
Blood Clots
Sometimes substances released by cancer cells can cause blood clots to form in the veins or cause problems with fatty tissue under the skin. Clots can sometimes travel to the lungs and cause trouble with breathing.
Diabetes
This cancer can cause problems with blood sugar. Sometimes (though rarely) it can cause diabetes.
History and Physical Exam
If the doctor has any reason to suspect pancreatic cancer, certain tests will be done to see if the disease is really present. First the doctor will ask questions about your health and do a physical exam. The exam will focus mostly on the belly (abdominal area). Sometimes this type of cancer spreads to the lymph nodes or the liver so the doctor will check these for swelling, too. The skin and the white part of the eyes will be checked for jaundice.
Certain other tests that make pictures of the inside of the body might also be done. These are called imaging tests.
Imaging Tests
CT Scan (Computed Tomography)
This is a special type of x-ray that creates detailed pictures of the inside of the body. CT scans are useful in finding cancer and in seeing how far it has spread. CT scans can also be used to help guide a biopsy needle into the area that might be cancer (see below for more about biopsy).
CT scans take longer than regular x-rays, but they are getting faster. You need to lie still on a table while they are being done.
PET Scan (Positron Emission Tomography)
PET scans involve injecting a form of sugar that contains a radioactive atom into the blood. Cancer cells absorb large amounts of this sugar. A special camera can show where these cells are. This test is useful to see whether the cancer has spread to the lymph nodes or other places.
PET/CT Scan
This new test combines the two types of scans to even better pinpoint the tumor. This test may be especially useful for spotting cancer that has spread beyond the pancreas and can’t be removed by surgery. It may be useful for staging the cancer. And it may even be able to spot early cancer. Because the test is so new, it is still being studied.
Ultrasound
This test uses sound waves to produce pictures of the inside of the body. The pictures are combined by a computer to give a detailed image. This test can help tell what kind of a tumor is in the pancreas. Endoscopic ultrasound is done with a probe placed through the mouth or nose into the stomach. The probe can be pointed toward the pancreas. This gives a very good picture and is better than CT scans for spotting small tumors. Patients are given medicine to make them sleepy (sedated) for this type of ultrasound.
MRI (Magnetic Resonance Imaging)
This test uses radio waves and strong magnets instead of x-rays to make cross-sectional pictures of the body. MRI scans are helpful in looking at the brain and spinal cord.
ERCP (Endoscopic Retrograde Cholangiopancreatography)
For this test patients are given medicine to make them sleepy (sedated) and a flexible tube is passed down the throat, all the way into the small intestine. The doctor can see through the end of the tube and find where the common bile duct opens into the small intestine. A small amount of harmless dye is then injected through the tube into the ducts. This dye helps outline the ducts on x-rays. The pictures can show narrowed or blocked ducts that might be caused by a cancer of the pancreas. The doctor doing this test can also put a small brush through the tube to remove cells to look at under a microscope to see whether they look like cancer. ERCP can also be used to place a small tube (stent) into the bile duct to keep it open if a nearby tumor is pressing on it.
Angiography
This is a type of x-ray used to look at blood vessels. This test can show whether blood flow in an area is blocked or slowed by a tumor. It can also show if there are any abnormal blood vessels. The results help the doctor decide whether the cancer can be removed and to plan the surgery.
Angiography can be uncomfortable because the radiologist who performs it has to put a small catheter into the artery leading to the pancreas. Usually the catheter is put into an artery in your inner thigh and threaded up to the pancreas. A local anesthetic is often used to numb the area before putting in the catheter. Then the dye is injected quickly to outline all the vessels while the x-rays are being taken.
There are several other tests, including blood tests, the doctor might use to learn more about a tumor. But the only way to know for sure if cancer is really present is with a biopsy.
Biopsy
During a biopsy a sample of tissue from the tumor is removed and looked at under a microscope to see if there are cancer cells present. There are several types of biopsies that might be done. In the past, a biopsy was often done as part of surgery. Now, however, the FNA (fine needle aspiration) biopsy is the more usual method. For this test, the doctor inserts a thin needle through the skin and into the pancreas to remove small pieces of tissue. Ultrasound might be used to place the needle through the wall of the intestine into the tumor. This test can be done with the patient awake. It rarely causes side effects.
Another approach is “keyhole surgery” (laparoscopy). Patients are given drugs that make them sleep, and the surgeon inserts small, thin, telescope-like instruments into the abdomen. One of them may be connected to a video screen. The surgeon can look at the abdomen and see how big the tumor is and whether it has spread. Biopsy samples of suspicious areas can also be taken.
Most doctors who treat people with pancreatic cancer try to avoid surgery unless it looks like an operation might be able to remove all of the cancer. Even so, there are times when the doctor starts an operation only to find that the cancer has spread too far to be completely removed. In these cases, the doctor just takes a sample of the tumor and the rest of the operation is stopped.
Treatment:
There are three main types of treatment for cancer of the pancreas: surgery, radiation therapy, and chemotherapy (often called just "chemo"). Depending on the stage of the cancer, some or even all of these types of treatment could be combined.
Surgery
There are two general types of surgery used for cancer of the pancreas:
- Potentially curative surgery is used when it looks like it is possible to remove all the cancer.
- Palliative surgery may be done if tests show that the tumor is too widespread to be completely removed. Surgery is done to relieve symptoms or to prevent certain problems, such as blockage of the bile ducts or the intestine by the cancer.
Surgery to Attempt to Cure the Cancer
- The type of surgery most often done if it looks like the cancer can be cured is called the Whipple procedure.
Palliative Surgery
- Because pancreatic cancer can progress quickly, most doctors do not advise surgery to relieve symptoms. However, sometimes surgery may be tried in the hope of curing the patient, but during the operation the surgeon discovers this is not possible. In this case, the surgeon may continue the operation as a palliative procedure to relieve or prevent symptoms. For example, surgery can be used to relieve blockage of the bile duct. When this duct is blocked, the result can be pain and problems with digestion.
Radiation Therapy
- Radiation therapy is treatment with high energy rays (such as x-rays) to kill or shrink cancer cells. The radiation is given much like a regular x-ray although it takes longer. Treatment is usually given 5 times a week for several weeks or months. Sometimes the radiation is given before surgery, sometimes after. Radiation (often combined with chemotherapy) can also be used for patients whose tumors are too widespread to be removed by surgery.
- Side effects of radiation therapy could include mild skin changes that look like sunburn or suntan, upset stomach, loose bowels, weight loss, or tiredness.
Chemotherapy
- Chemotherapy using drugs is use when cancer has spread.
Treatment Centers in Georgia:
Support Groups:
Curtis and Elizabeth Anderson Cancer Institute - Memorial Health University Medical Center. Pancreatic Cancer Support Group.
- When: Last Wednesday of each month, 4:00 - 5:00 pm
- Where: Conference Room, 4700 Waters Avenue, Savannah, GA 31404
- Phone: Please RSVP with Jennifer Currin at 912-350-7845
- Contact: Joann Bishop at 912.596.8807 or jbishop@pancan.org
- Website: http://www.memorialhealth.com/aci/support_services.html
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