Pancreatic Cancer


General Information

What is pancreatic cancer?

Pancreatic cancer is a disease in which malignant (cancer) cells form in the tissues of the pancreas. The pancreas is a gland about 6 inches long that is shaped like a thin pear lying on its side. The wider end of the pancreas is called the head, the middle section is called the body, and the narrow end is called the tail. The pancreas lies behind the stomach and in front of the spine.

The pancreas has two main jobs in the body:

1.To produce juices that help digest (break down) food.
2.To produce hormones, such as insulin and glucagon, that help control blood sugar levels. Both of these hormones help the body use and store the energy it gets from food.

The digestive juices are produced by exocrine pancreas cells and the hormones are produced by endocrine pancreas cells. About 95% of pancreatic cancers begin in exocrine cells.

This summary provides information on exocrine pancreatic cancer. Refer to Islet Cell Carcinoma (Endocrine Pancreas) Treatment for information on endocrine pancreatic cancer.

Smoking and health history can affect the risk of developing pancreatic cancer. The following are possible risk factors for pancreatic cancer:

-Smoking.
-Long-standing diabetes.
-Chronic pancreatitis.
-Certain hereditary conditions such as hereditary pancreatitis, multiple endocrine neoplasia type 1 syndrome, hereditary nonpolyposis colon cancer (HNPCC; Lynch syndrome), von Hippel-Lindau syndrome, ataxia-telangiectasia, and the familial atypical mole melanoma syndrome.

Possible signs of pancreatic cancer include jaundice, pain, and weight loss. These symptoms can be caused by pancreatic cancer or other conditions. A doctor should be consulted if any of the following problems occur:

-Jaundice (yellowing of the skin and whites of the eyes).
-Pain in the upper or middle abdomen and back.
-Unexplained weight loss.
-Loss of appetite.
-Fatigue.

Pancreatic cancer is difficult to detect and diagnose for the following reasons:

-There aren't any noticeable signs or symptoms in the early stages of pancreatic cancer.
-The signs of pancreatic cancer, when present, are like the signs of many other illnesses.
-The pancreas is hidden behind other organs such as the stomach, small intestine, liver, gallbladder, spleen, and bile ducts.

Tests that examine the pancreas are used to detect (find), diagnose, and stage pancreatic cancer. Pancreatic cancer is usually diagnosed with tests and procedures that produce pictures of the pancreas and the area around it. The process used to find out if cancer cells have spread within and around the pancreas is called staging. Tests and procedures to detect, diagnose, and stage pancreatic cancer are usually done at the same time. In order to plan the best treatment, it is important to know the stage of the disease and whether or not the pancreatic cancer can be removed by surgery. The following tests and procedures may be used:

Chest x-ray: Brief exposure of the chest to radiation to produce an image of the chest and its internal structures.

Physical exam: A check of general signs of health, including looking for anything unusual such as lumps or growths.

CT scan (CAT scan): A CT scan creates a series of pictures of areas inside the body, taken from different angles. The pictures are created by a computer linked to an x-ray machine. This test is also called computed tomography, computerized tomography, or computerized axial tomography. A spiral or helical CT scan takes detailed pictures of areas inside the body as it scans the body in
a spiral path.

MRI (magnetic resonance imaging): A procedure in which a magnet linked to a computer is used to create detailed pictures of areas inside the body. This test is also called nuclear magnetic resonance imaging (NMRI).

PET scan (positron emission tomography scan): A PET scan creates a picture showing the location of tumor cells in the body. A substance called radionuclide glucose (sugar) is injected into a vein and the PET scanner rotates around the body to create the picture. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells.

Endoscopic ultrasound (EUS): A test that uses sound waves to create images of body tissues. High-energy sound waves are bounced off internal tissues and organs. The echoes are changed into pictures called sonograms. An endoscopic ultrasound uses an endoscope (a flexible tube inserted into the body).

Laparoscopy: A laparoscope (a thin, lighted tube) is inserted through an incision in the abdominal wall to determine if the cancer is within the pancreas only or has spread to nearby tissues and if it can be removed by surgery later. Tissue samples may be removed for biopsy.

ERCP (endoscopic retrograde
cholangiopancreatography): A procedure to x-ray the ducts (tubes) that carry bile from the liver to the gallbladder and from the gallbladder to the small intestine. Pancreatic cancer can cause these ducts to narrow and block or slow the flow of bile, causing jaundice. In ERCP, an endoscope (a thin, lighted tube) is passed through the mouth, esophagus, and stomach into the first part of the small intestine. A catheter (a smaller tube) is then inserted through the endoscope into the pancreatic ducts. A dye is injected through the catheter into the ducts and an x-ray is taken. If the ducts are blocked by a tumor, a stent (a thin tube) may be inserted into the duct to unblock it. The stent may be left in place to keep the duct open. Tissue samples may also be taken with a fine needle or a brush like a pipecleaner.

PTC (percutaneous transhepatic cholangiography): A procedure to x-ray the liver and common bile ducts. A thin needle is inserted through the skin below the ribs and into the liver. Dye is injected into the liver or bile ducts and the ducts are then x-rayed to find the blockages. To relieve jaundice, a stent (a thin tube) is sometimes left in the liver to drain bile into the small intestine or a collection bag outside the body. This test is done only if ERCP cannot be done.

Biopsy: Cells, tissues, or fluid are removed and viewed under a microscope to see if cancer cells are present. There are several ways to do a biopsy for pancreatic cancer. A fine needle may be inserted into the pancreas during an x-ray or ultrasound to remove cells. Tissue may also be removed during a laparoscopy (a surgical incision made in the wall of the abdomen).

Certain factors affect treatment options and prognosis (chance of recovery). The treatment options and prognosis (chance of recovery) depend on the stage of the cancer (the size of the tumor and whether the cancer has spread outside the pancreas to nearby tissues or lymph nodes or to other places in the body) and the patient's general health. Lymph nodes are small, bean-shaped structures found throughout the body. They filter substances in a fluid called lymph and help fight infection and disease.

Pancreatic cancer can be controlled only if it is found before it has spread, when it can be removed by surgery. If the cancer has spread, palliative treatment can improve the quality of life by controlling the symptoms and complications of this disease.

Taking part in one of the clinical trials being done to improve treatment should be considered.

Stages of Pancreatic Cancer:

Tests and procedures to stage pancreatic cancer are usually done at the same time as diagnosis.

The following stages are used for pancreatic cancer:

Stage I
In stage I, cancer is found in the pancreas only.

Stage II
In stage II, cancer has spread to nearby tissue and organs, such as bile ducts or the small intestine.

Stage III
In stage III, cancer has spread to lymph nodes near the pancreas and may have spread to nearby tissue and organs, such as bile ducts or the small intestine.

Stage IV
In stage IV, cancer has spread to other parts of the body. Stage IV is divided into stage IVA and stage IVB, depending on where the cancer has spread.

Stage IVA: Cancer has spread to organs and tissues that are near the pancreas (such as the stomach, spleen, or colon), but has not spread to distant organs (such as the lungs). The cancer may have spread to lymph nodes near the pancreas.

Stage IVB: Cancer has spread to distant organs (such as the lungs). It may have also spread to organs and tissues near the pancreas or to lymph nodes.

Recurrent Pancreatic Cancer
Recurrent pancreatic cancer is cancer that has recurred (come back) after it has been treated. Recurrent pancreatic cancer may come back in the pancreas or in other parts of the body.

Treatment Option Overview

There are different types of treatment for patients with pancreatic cancer. Different types of treatment are available for patients with pancreatic cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the "standard" treatment, the new treatment may become the standard treatment.

Clinical trials are taking place in many parts of the country. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.

Three types of standard treatment are used:

Surgery
One of the following types of surgery may be used to take out the tumor:

Whipple procedure: The head of the pancreas, the gallbladder, part of the stomach, part of the small intestine, and the bile duct are removed. Enough of the pancreas is left to produce digestive juices and insulin.

Total pancreatectomy: This operation removes the whole pancreas, part of the stomach, part of the small intestine, the common bile duct, the gallbladder, the spleen, and nearby lymph nodes.

Distal pancreatectomy: The body and the tail of the pancreas and usually the spleen are removed.

If the cancer has spread and cannot be removed, the following types of palliative surgery may be done to relieve symptoms:

Surgical biliary bypass: If cancer is blocking the small intestine and bile is building up in the gallbladder, a biliary bypass may be done. During this operation, the doctor will cut the gallbladder or bile duct and sew it to the small intestine to create a new pathway around the blocked area.

Endoscopic stent placement: If the tumor is blocking the bile duct, surgery may be done to put in a stent (a thin tube) to drain bile that has built up in the area. The doctor may place the stent through a catheter that drains to the outside of the body or the stent may go around the blocked area and drain the bile into the small intestine.

Gastric bypass: If the tumor is blocking the flow of food from the stomach, the stomach may be sewn directly to the small intestine so the patient can continue to eat normally.

Radiation therapy
Radiation therapy is the use of x-rays or other types of radiation to kill cancer cells and shrink tumors. Radiation therapy may use external radiation (using a machine outside the body) or internal radiation. Internal radiation involves putting radioisotopes (materials that produce radiation) through thin plastic tubes into the area where cancer cells are found. Both external and internal radiation therapy may be used to treat pancreatic cancer.

Chemotherapy
Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be taken by mouth, or it may be put into the body by inserting a needle into a vein or muscle. Either type of chemotherapy is called systemic treatment because the drugs enter the bloodstream, travel through the body, and can kill cancer cells throughout the body.

Other types of treatment are being tested in clinical trials.

Biological therapy
Biological therapy is treatment to stimulate the ability of the immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against disease. Biological therapy is sometimes called biological response modifier (BRM) therapy or immunotherapy.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

There are treatments for pain caused by pancreatic cancer. Pain can occur when the tumor presses on nerves or other organs near the pancreas. When pain medicine is not enough, there are treatments that act on nerves in the abdomen to relieve the pain. The doctor may inject medicine into the area around affected nerves or may cut the nerves to block the feeling of pain. Radiation therapy with or without chemotherapy can also help relieve pain by shrinking the tumor.

Patients with pancreatic cancer have special nutritional needs. Surgery to remove the pancreas may interfere with the production of pancreatic enzymes that help to digest food. As a result, patients may have problems digesting food and absorbing nutrients into the body. To prevent malnutrition, the doctor may prescribe medicines that replace these enzymes.

Treatment Options By Stage

Stage I Pancreatic Cancer
Treatment of stage I pancreatic cancer may include the following:

1.Surgery alone.
2.Surgery with chemotherapy and radiation therapy.
3.A clinical trial of surgery followed by radiation therapy with chemotherapy. 4.Chemotherapy is given before, during, and after the radiation therapy.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

Stage II Pancreatic Cancer
Treatment of stage II pancreatic cancer may include the following:

1.Surgery with or without chemotherapy and radiation therapy.
2.Radiation therapy with chemotherapy.
3.Palliative surgery to bypass blocked areas in ducts or the small intestine.
4.A clinical trial of surgery followed by radiation therapy with chemotherapy. 5.Chemotherapy is given before, during, and after the radiation therapy.
6.A clinical trial of radiation therapy combined with chemotherapy and/or radiosensitizers (drugs that make cancer cells more sensitive to radiation so more tumor cells are killed), followed by surgery.
7.A clinical trial of chemotherapy.
8.A clinical trial of radiation therapy given during surgery or internal radiation therapy.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

Stage III Pancreatic Cancer
Treatment of stage III pancreatic cancer may include the following:

1.Surgery with or without chemotherapy and radiation therapy.
2.Radiation therapy with chemotherapy.
3.Palliative surgery or stent placement to bypass blocked areas in ducts or the small intestine.
4.A clinical trial of surgery followed by radiation therapy with chemotherapy. 5.Chemotherapy is given before, during, and after the radiation therapy.
6.A clinical trial of radiation therapy combined with chemotherapy and/or radiosensitizers, followed by surgery.
7.A clinical trial of chemotherapy.
8.A clinical trial of radiation therapy given during surgery or internal radiation therapy.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

Stage IVA Pancreatic Cancer
Treatment of stage IVA pancreatic cancer may include the following:

1.Surgery with or without chemotherapy and radiation therapy.
2.Radiation therapy with chemotherapy.
3.Palliative surgery or stent placement to bypass blocked areas in ducts or the small intestine.
4.A clinical trial of surgery followed by radiation therapy with chemotherapy. 5.Chemotherapy is given before, during, and after the radiation therapy.
6.A clinical trial of radiation therapy combined with chemotherapy and/or radiosensitizers, followed by surgery.
7.A clinical trial of chemotherapy.
8.A clinical trial of radiation therapy given during surgery or internal radiation therapy.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

Stage IVB Pancreatic Cancer
Treatment of stage IVB pancreatic cancer may include the following:

1.Chemotherapy.
2.Palliative treatments for pain, such as nerve blocks, and other supportive care.
3.Palliative surgery or stent placement to bypass blocked areas in ducts or the small intestine.
4.Clinical trials of chemotherapy or biological therapy.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

Treatment Options for Recurrent Pancreatic Cancer

Treatment of recurrent pancreatic cancer may include the following:

1.Chemotherapy.
2.Palliative surgery to bypass blocked areas in ducts or the small intestine.
3.Palliative radiation therapy.
4.Other palliative medical care to reduce symptoms, such as nerve blocks to relieve pain.
6.Clinical trials of chemotherapy or biological therapy.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.






The information on this page was obtained from the National Cancer Institute. The National Cancer Institute provides accurate, up-to-date information on many types of cancer, information on clinical trials, resources for people dealing with cancer, and information for researchers and health professionals.

The National Cancer Institute is in no way affiliated with the Mary Stolfa Cancer Foundation.

The information on this web site is provided for general information only. It is not intended as medical advice, and should not be relied upon as a substitute for consultations with qualified health professionals who are familiar with your individual medical needs. The MSCF disclaims all obligations and liabilities for damages arising from the use or attempted use of the information, including but not limited to direct, indirect, special, and consequential damages, attorneys' and experts' fees and court costs. Any use of the information will be at the risk of the user.





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