Pancreatic Cancer

What is pancreatic cancer?

Pancreatic cancer is the fourth most common cause of cancer death in men and women in the US. According to the American Cancer Society, it is estimated that there will be 37,170 new cases of pancreatic cancer in 2007, and 33,370 deaths are expected. Pancreatic cancer occurs when malignant cells grow out of control.

What is a risk factor?

A risk factor is anything that may increase a person's chance of developing a disease. It may be an activity, such as smoking, diet, family history, or many other things. Different diseases, including cancers, have different risk factors.

Although these factors can increase a person's risk, they do not necessarily cause the disease. Some people with one or more risk factors never develop the disease, while others develop disease and have no known risk factors.

But, knowing your risk factors to any disease can help to guide you into the appropriate actions, including changing behaviors and being clinically monitored for the disease.

Risk factors for pancreatic cancer, according to the National Cancer Institute, include:

• age - most pancreatic cancer occurs in people over the age of 60.
• smoking - heavy cigarette smokers are two or three times more likely than non-smokers to develop pancreatic cancer.
• diabetes - pancreatic cancer occurs more often in people who have diabetes than in those who do not.
• gender - more men than women are diagnosed with pancreatic cancer.
• race - African Americans are more likely than Asians, Hispanics, or Caucasians to be diagnosed with pancreatic cancer.
• family history - the risk for developing pancreatic cancer triples if a person's mother, father, or a sibling had the disease.
• chronic pancreatitis - this condition of the pancreas has been linked with increased risk for pancreatic cancer.

There are several types of pancreatic cancers, including the following:

• adenocarcinoma of the pancreas - the most common pancreatic cancer, which occurs in the lining of the pancreatic duct.
• cystadenocarcinoma - a rare pancreatic cancer.
• acinar cell carcinoma - a rare pancreatic cancer.

Some benign (non-cancerous) tumors in the pancreas include the following:

• insulinoma - a rare pancreatic tumor that secretes insulin, the hormone that lowers glucose levels in the blood.
• gastrinoma - a tumor that secretes above average levels of gastrin, a hormone which stimulates the stomach to secrete acids and enzymes. Gastrinoma can cause peptic ulcers.
• glucagonoma - a tumor that secretes glucagon, a hormone which raises levels of glucose in the blood, leading to a rash.

What are the symptoms of pancreatic cancer?

The following are the other most common symptoms of pancreatic cancer. However, each individual may experience symptoms differently. Symptoms may include:

• pain in the upper abdomen or upper back
• loss of appetite
• weight loss
• jaundice (yellow skin and eyes, and dark urine)
• indigestion
• nausea
• vomiting

The symptoms of pancreatic cancer may resemble other conditions or medical problems. Always consult your physician for a diagnosis.

How is pancreatic cancer diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for pancreatic cancer may include the following:

• ultrasound (Also called sonography.) - a diagnostic imaging technique that uses high-frequency sound waves to create an image of the internal organs. Ultrasounds are used to view internal organs of the abdomen such as the liver, pancreas, spleen, and kidneys and to assess blood flow through various vessels. The ultrasound may be performed using an external or internal device:
  
  • transabdominal ultrasound - the physician places an ultrasound device on the abdomen to create the image of the pancreas.
  • endoscopic ultrasound (EUS) - the physician inserts an endoscope, a small, flexible tube with an ultrasound device at the tip, through the mouth and stomach, and into the small intestine. As the physician slowly withdraws the endoscope, images of the pancreas and other organs are made.
• computed tomography scan (CT or CAT scan) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.
• magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
• endoscopic retrograde cholangiopancreatography (ERCP) - a procedure that allows the physician to diagnose and treat problems in the liver, gallbladder, bile ducts, and pancreas. The procedure combines x-ray and the use of an endoscope - a long, flexible, lighted tube. The scope is guided through the patient's mouth and throat, then through the esophagus, stomach, and duodenum. The physician can examine the inside of these organs and detect any abnormalities. A tube is then passed through the scope, and a dye is injected which will allow the internal organs to appear on an x-ray.
• percutaneous transhepatic cholangiography (PTC) - a needle is introduced through the skin and into the liver where the dye (contrast) is deposited and the bile duct structures can be viewed by x-ray.
• pancreas biopsy - a procedure in which a sample of pancreatic tissue is removed (with a needle or during surgery) for examination under a microscope.
• special blood tests
• positron emission tomography (PET) - a type of nuclear medicine procedure. This means that a tiny amount of a radioactive substance, called a radionuclide (radiopharmaceutical or radioactive tracer), is used during the procedure to assist in the examination of the tissue under study. Specifically, PET studies evaluate the metabolism of a particular organ or tissue, so that information about the physiology (functionality) and anatomy (structure) of the organ or tissue is evaluated, as well as its biochemical properties. Thus, PET may detect biochemical changes in an organ or tissue that can identify the onset of a disease process before anatomical changes related to the disease can be seen with other imaging processes such as computed tomography (CT) or magnetic resonance imaging (MRI).

Treatment for pancreatic cancer:

Specific treatment for pancreatic cancer will be determined by your physician based on:

• your age, overall health, and medical history
• extent of the disease
• type of cancer
• your tolerance of specific medicines, procedures, or therapies
• expectations for the course of the disease
• your opinion or preference

Treatment may include:

• surgery - may be necessary to remove the tumor - a section or entire pancreas and/or the small intestine. The type of surgery depends on the stage of the cancer, the location and size of the tumor, and the person’s health. Types of surgery for pancreatic cancer include the following:
  
  • Whipple procedure - if the tumor is located at the head of the pancreas (the widest part), the head of the pancreas, part of the small intestine, bile duct, and stomach, and other tissues will be removed.
  • distal pancreatectomy - if the tumor is located in the body and tail of the pancreas, both of these sections of the pancreas will be removed, along with the spleen.
  • total pancreatectomy - the entire pancreas, part of the small intestine and stomach, the common bile duct, the spleen, the gallbladder, and some lymph nodes will be removed.
• external radiation (external beam therapy) - a treatment that precisely sends high levels of radiation directly to the cancer cells. The machine is controlled by the radiation therapist. Since radiation is used to kill cancer cells and to shrink tumors, special shields may be used to protect the tissue surrounding the treatment area. Radiation treatments are painless and usually last a few minutes. Radiation therapy may be given alone, or in combination with surgery and chemotherapy.
• chemotherapy - the use of anticancer drugs to treat cancerous cells. In most cases, chemotherapy works by interfering with the cancer cell’s ability to grow or reproduce. Different groups of drugs work in different ways to fight cancer cells. The oncologist will recommend a treatment plan for each individual. Chemotherapy may be given alone, or in combination with surgery and radiation therapy.
• medication (to relieve or reduce pain)

Long-term prognosis for individuals with pancreatic cancer depends on the size of the tumor, lymph node involvement, and degree of metastases (spreading) at the time of diagnosis.