Pancreatic cancer is a disease in which cancer cells grow in the pancreas. The pancreas is a long, flattened pear-shaped organ in the abdomen. The pancreas makes digestive enzymes and hormones including insulin.

Cancer occurs when cells in the body (in this case pancreas cells) divide without control or order. Normally, cells divide in a regulated manner. If cells keep dividing uncontrollably when new cells are not needed, a mass of tissue forms, called a growth or tumor. The term cancer refers to malignant tumors, which can invade nearby tissues and spread to other parts of the body. A benign tumor does not invade or spread.

Causes

The cause of pancreatic cancer is unknown. However, research shows that certain risk factors are associated with the disease.

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.

Risk factors include:

• Age: 40 or older

• Sex: Male

• Smoking

• Diabetes

• Chronic pancreatitis, hereditary pancreatitis, family nonpolyposis colon cancer syndrome

• Family or personal history of certain types of colon polyps or colon cancer

• Family history of pancreatic cancer (especially in Ashkenazi Jews with BRCA2 (breast cancer associated)) gene

• High-fat diet

Symptoms

Pancreatic cancer does not cause symptoms in its early stages. The cancer may grow for some time before it causes symptoms. When symptoms do appear, they may be very vague. In many cases, the cancer has spread outside the pancreas by the time it is discovered.

Symptoms will vary depending on the location and size of the tumor. Symptoms include:

• Nausea

• Loss of appetite

• Unexplained weight loss

• Pain–in the upper abdomen, sometimes spreading to the back (a result of the cancer growing and spreading)

• Jaundice–yellowness of skin and whites of the eyes; dark urine (if the tumor blocks the common bile duct); tan stool or stool that floats to the top of the bowl.

• Weakness, dizziness, chills, muscle spasms, diarrhea (especially if the cancer involves the islet cells that make insulin and other hormones)

These symptoms may also be caused by other, less serious health conditions. Anyone experiencing these symptoms should see a doctor.

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam. In addition, the doctor may perform blood and urine tests, as well as checking for hidden blood in bowel movements.

Test may include:

Upper GI Series–a series of x-rays of the upper digestive system taken after drinking a barium solution

CT Scan–a type of x-ray that uses a computer to make pictures of structures inside the abdomen

MRI Scan–a test that uses magnetic waves to make pictures of structures inside the abdomen

Ultrasonography–a test that uses sound waves to find tumors

Endoscopic Retrograde Cholangiopancreatography (ERCP)–a type of x-ray that shows the pancreatic ductal system after dye has been sent through a tube down the throat and into the pancreas

PTC–a type of x-ray test that shows blockages in the bile ducts of the liver

Angiography–x-rays of blood vessels taken after an injection of dye that makes the blood vessels show up on the x-rays

Biopsy–removal of a sample of pancreatic tissue to test for cancer cells

Treatment

Once cancer of the pancreas is found, staging tests are performed to find out if the cancer has spread and, if so, to what extent. Treatments for pancreatic cancer depend on the stage of the cancer.

Treatments include:

Surgery–surgical removal of the cancerous tumor and nearby tissues, and possibly nearby lymph nodes. In pancreatic cancer, surgery may also be performed to relieve symptoms caused by the cancer. Surgeries include:

• Whipple Procedure–removal of the head of the pancreas, part of the small intestine, and some of the tissues around it

• Total Pancreatectomy–removal of the whole pancreas, part of the small intestine, part of the stomach, the bile duct, the gallbladder, spleen, and most of the lymph nodes in the area

• Distal Pancreatectomy–removal of the body and tail of the pancreas

• Radiation Therapy (Radiotherapy)–the use of radiation to kill cancer cells and shrink tumors. Radiation may be:

• • External Radiation Therapy–radiation directed at the tumor from a source outside the body

• • Internal Radiation Therapy–radioactive materials placed into the body in or near the cancer cells

• Chemotherapy–the use of drugs to kill cancer cells. Chemotherapy may be given in many forms including: pill, injection, and via a catheter. The drugs enter the bloodstream and travel through the body killing mostly cancer cells, but also some healthy cells.

• Biological Therapy–the use of medications or substances made by the body to increase or restore the body's natural defenses against cancer. Also called biological response modifier (BRM) therapy.

• Combined Modality Therapy–most times, pancreatic cancer is discovered at an advanced stage and cannot be operated upon. Surgery would be appropriate in only 25% of patients with this disease in the early stage. In these cases, the patient would benefit from surgery. After surgery, follow-up chemotherapy and radiation therapy have been found to prolong survival when the cancer is relatively large or has involved the lymph nodes. If surgery cannot be performed, then chemotherapy and radiation are offered together to prolong survival.

Prevention

There are no guidelines for preventing this disease, because the cause of pancreatic cancer is unknown and symptoms are not present in the early stages. If you think you are at risk for pancreatic cancer, especially because of familial or genetic risks, talk to your doctor about ways to reduce your risk factors and figure out an appropriate schedule for check-ups.

RESOURCES:

American Cancer Society
http://www.cancer.org

CancerCare
http://www.cancercare.org

Pancreatic Cancer Action Network
http://www.pancan.org

References:

American Cancer Society website. Available at: http://www.cancer.org.

National Cancer Institute website. Available at: http://www.cancer.org.