What
is Pancreatic Cancer?
What are the types of
Pancreatic Cancer?
What are the symptoms of
Pancreatic Cancer?
What procedures are used
to diagnosis Pancreatic Cancer?
What
causes Pancreatic Cancer?
What are the treatment
options for Pancreatic Cancer?
What is the prognosis
for Pancreatic Cancer?
Pancreatic cancer is now the 4th
leading cause of cancer death in the United States. It will cause
more than 30,000 deaths this year in the United States alone.
Pancreatic cancer is difficult to detect, hard to 
diagnose,
early to metastasize (spread) and resistant to treatment.
The most common type of
pancreatic cancer is also known as pancreatic duct adenocarcinoma
or simply pancreatic carcinoma. Other types of pancreatic cancer
can occur as well including those arising from endocrine cells or
exocrine cells. Endocrine cancers are also known as islet cell or
neuroendocrine cancers. These tumors can produce hormones that
produce a variety of symptoms such as 
changes in blood sugar or
diarrhea. Exocrine
pancreatic cancer is a disease in which cancerous cells originate
within the tissues of the pancreas that produce digestive juices.
The following information focuses mainly on pancreatic carcinoma,
the most common cancer of the pancreas.
Pancreatic cancer is sometimes
called a "silent disease" because early pancreatic
cancer often does not cause symptoms. But, as the cancer
grows, symptoms may include:
·
Weight loss
·
Pain in the upper
abdomen or upper back
·
Yellow skin and
eyes, dark urine, and light stool
·
Weakness
·
Loss of appetite
·
Nausea and vomiting
These symptoms are not sure signs of pancreatic cancer. An infection or other problem could also cause these symptoms. Only a doctor can diagnose the cause of a person's symptoms. Anyone with these symptoms should see a doctor so that the doctor can treat any problem as early as possible.
Diagnosis
of Pancreatic Cancer
If a patient has symptoms that
suggest pancreatic cancer, the doctor asks about the patient's
medical history. The doctor may perform a number of procedures,
including one or more of the following:
·
Physical exam
-- The doctor examines the skin and eyes for signs of jaundice.
The doctor then feels the abdomen to check for changes in the area
near the pancreas, liver, and gallbladder. The doctor also
checks for ascites, an abnormal buildup of fluid in the
abdomen.
·
Lab tests
-- The doctor may take blood, urine, and stool samples to check
for bilirubin and other substances. Bilirubin is a
substance that passes from the liver to the gallbladder to the
intestine. If the common bile duct is blocked by a tumor, the
bilirubin cannot pass through normally. Blockage may cause the
level of bilirubin in the blood, stool, or urine to become very
high. High bilirubin levels can result from cancer or from
noncancerous conditions.
·
CT scan
(Computed tomography)
-- An x-ray machine linked to a computer takes a series of
detailed pictures. The x-ray machine is shaped like a donut with a
large hole. The patient lies on a bed that passes through the
hole. As the bed moves slowly through the hole, the machine takes
many x-rays. The computer puts the x-rays together to create
pictures of the pancreas and other organs and blood vessels in the
abdomen.
·
Ultrasonography
-- The ultrasound device uses sound waves that cannot be heard by
humans. The sound waves produce a pattern of echoes as they bounce
off internal organs. The echoes create a picture of the pancreas
and other organs inside the abdomen. The echoes from tumors are
different from echoes made by healthy tissues.
The ultrasound procedure may
use an external or internal device, or both types:
o
Transabdominal
ultrasound: To make
images of the pancreas, the doctor places the ultrasound device on
the abdomen and slowly moves it around.
o
EUS (Endoscopic
ultrasound): The
doctor passes a thin, lighted tube (endoscope) through the
patient's mouth and stomach, down into the first part of the small
intestine. At the tip of the endoscope is an ultrasound device.
The doctor slowly withdraws the endoscope from the intestine
toward the stomach to make images of the pancreas and surrounding
organs and tissues.
·
ERCP (endoscopic
retrograde cholangiopancreatography) -- The doctor passes an endoscope through the patient's mouth and
stomach, down into the first part of the small intestine. The
doctor slips a smaller tube (catheter) through the
endoscope into the bile ducts and pancreatic ducts. After
injecting dye through the catheter into the ducts, the doctor
takes x-ray pictures. The x-rays can show whether the ducts are
narrowed or blocked by a tumor or other condition.
·
PTC (percutaneous
transhepatic cholangiography)
-- A dye is injected through a thin needle inserted through the
skin into the liver. Unless there is a blockage, the dye should
move freely through the bile ducts. The dye makes the bile ducts
show up on x-ray pictures. From the pictures, the doctor can tell
whether there is a blockage from a tumor or other condition.
·
Biopsy
-- In some cases, the doctor may remove tissue. A pathologist
then uses a microscope to look for cancer cells in the tissue. The
doctor may obtain tissue in several ways. One way is by inserting
a needle into the pancreas to remove cells. This is called fine-needle
aspiration. The doctor uses x-ray or ultrasound to guide the
needle. Sometimes the doctor obtains a sample of tissue during EUS
or ERCP. Another way is to open the abdomen during an operation.
Most of the time, biopsies are done without the need for surgery.
Biopsies may not be required before proceeding with surgery if
there is a high likelihood that a pancreatic cancer is present.
Many people diagnosed with
pancreatic cancer want to take an active part in making decisions
about their medical care. They want to learn all they can about
their disease and their treatment choices. However, the shock and
stress that people may feel after a diagnosis of cancer can make
it hard for them to think of everything they want to ask the
doctor. Often it helps to make a list of questions before an
appointment. To help remember what the doctor says, patients may
take notes or ask whether they may use a tape recorder. Some
patients also want to have a family member or friend with them
when they talk to the doctor-to take part in the discussion, to
take notes, or just to listen.
Before starting treatment, a patient may want a second opinion about the diagnosis and the treatment plan. Some insurance companies require a second opinion; others may cover a second opinion if the patient requests it. Gathering medical records and arranging to see another doctor may take a little time. In most cases, a brief delay to get another opinion will not make therapy less helpful. Always feel free to seek a second opinion.
Causes,
incidence, and risk factors of
Pancreatic Cancer
Despite advances in medical
science, we still have a poor understanding of the causes of
pancreatic cancer. Doctors can seldom explain why one person gets
pancreatic cancer and another does not. However, it is clear that
this disease is not contagious. No one can "catch"
cancer from another person.
Research has shown that people
with certain risk factors are more likely than others to
develop pancreatic cancer. A risk factor is anything that
increases a person's chance of developing a disease.
Studies have found the
following risk factors:
·
Age
-- The likelihood of developing pancreatic cancer increases with
age. Most pancreatic cancers occur in people over the age of 60.
·
Smoking
-- Cigarette smokers are two or three times more likely than
nonsmokers to develop pancreatic cancer.
·
Diabetes
-- Pancreatic cancer occurs more often in people who have diabetes
than in people who do not.
·
Being male
– Slightly more men than women are diagnosed with pancreatic
cancer.
·
Being African
American -- African
Americans are more likely than Asians, Hispanics, or Whites to get
pancreatic cancer.
·
Family history
-- The risk for developing pancreatic cancer triples if a person's
mother, father, sister, or brother had the disease. Also, a family
history of colon or ovarian cancer increases the risk of
pancreatic cancer.
·
Chronic pancreatitis
-- Chronic pancreatitis is a painful condition of the pancreas.
Some evidence suggests that chronic pancreatitis may increase the
risk of pancreatic cancer. The risk of pancreatic cancer is
increased more than fifty fold in persons with certain forms of
inherited pancreatitis.
Other studies suggest that
exposure to certain chemicals in the workplace or a diet high in
fat may increase the chance of getting pancreatic cancer.
Despite this, most people with known risk factors do not get pancreatic cancer. On the other hand, many who do get the disease have none of these factors. People who think they may be at risk for pancreatic cancer should discuss this concern with their doctor. The doctor may suggest ways to reduce the risk and can plan an appropriate schedule for checkups.
Treatment
of
Pancreatic Cancer
When pancreatic cancer is
diagnosed or even suspected, the doctor needs to know the extent
also known as the stage of disease to plan the best treatment.
Staging is a careful attempt to find out the size of the tumor in
the pancreas, whether the cancer has spread, and if so, to what
parts of the body. At the time of diagnosis, only about 20%
of pancreatic cancers can be removed by surgery.
Surgery for pancreatic cancer is a major operation. The surgeon may remove all
or part of the pancreas. The extent of surgery depends on the
location and size of the tumor, the stage of the disease, and the
patient's general health.
·
Whipple
procedure: If the
tumor is in the head (the widest part) of the pancreas, the
surgeon removes the head of the pancreas and part of the small
intestine, bile duct, and stomach. The surgeon may also remove
other nearby tissues such as lymph nodes.
·
Distal
pancreatectomy: The
surgeon removes the body and tail of the pancreas if the tumor is
in either of these parts. The surgeon commonly also removes the spleen.
·
Total
pancreatectomy: The
surgeon removes the entire pancreas, part of the small intestine,
a portion of the stomach, the common bile duct, the gallbladder,
the spleen, and nearby lymph nodes.
Sometimes the cancer cannot be
completely removed. If the tumor is blocking the common bile duct
or small intestine, the surgeon can create a bypass. A bypass
allows fluids to flow through the digestive tract. It can help
relieve jaundice, pain, nausea and vomiting that often result from
a blockage.
The doctor often can relieve
blockage without doing bypass surgery. The doctor (generally, a
specialist known as a gastroenterologist) uses an endoscope to
place a stent in the blocked area. A stent is a tiny
plastic or metal mesh tube that helps keep the duct or duodenum
open.
After surgery, some patients
are fed liquids intravenously (by IV) and through feeding
tubes placed into the abdomen. Patients slowly return to eating
solid foods by mouth. A few weeks after surgery, the feeding tubes
are removed.
Removal of part or all of the
pancreas may make it hard for a patient to digest foods. The
health care team can suggest a diet plan and medicines to help
relieve diarrhea, pain, cramping, or feelings of fullness. During
the recovery from surgery, the doctor will carefully monitor the
patient's diet and weight. At first, a patient may have only
liquids and may receive extra nourishment intravenously or by
feeding tube into the intestine. Solid foods are added to the diet
gradually.
Also, patients may not have
enough pancreatic enzymes or hormones after surgery. Those who do
not have enough insulin may develop diabetes. The doctor can give
the patient insulin, other hormones, and enzymes to help maintain
good nutrition and proper control of the blood sugar.
When a pancreatic cancer is
removed surgically, often additional treatments such as radiation
therapy and chemotherapy are recommended.
Radiation therapy
(also called radiotherapy) uses high-energy rays to kill cancer
cells. A large machine directs radiation at the abdomen. Radiation
therapy may be given alone, or with surgery, chemotherapy, or
both.
Radiation therapy affects
cancer cells only in the treated area. For radiation therapy,
patients go to the hospital or clinic, often 5 days a week for
several weeks. Radiation therapy may cause patients to
become very tired as treatment continues. Resting is important,
but doctors usually advise patients to try to stay as active as
they can. In addition, when patients receive radiation therapy,
the skin in the treated area may sometimes become red, dry, and
tender.
Radiation therapy to the
abdomen may cause nausea, vomiting, diarrhea, or other problems
with digestion. The health care team can offer medicine or suggest
diet changes to control these problems. For most patients, the
side effects of radiation therapy go away when treatment is over.
Chemotherapy
is the use of drugs to kill cancer cells. Doctors also give
chemotherapy to help reduce pain and other problems caused by
pancreatic cancer. The side effects of chemotherapy depend mainly
on the drugs and the doses the patient receives as well as how the
drugs are given. In addition, as with other types of treatment,
side effects vary from patient to patient. It may be given
alone, with radiation, or with surgery and radiation.
Chemotherapy is an outpatient treatment given at the hospital, clinic, or doctor's office. Chemotherapy, mainly given by injection, affects rapidly dividing cells throughout the body, including blood cells. Blood cells fight infection, help the blood to clot, and carry oxygen to all parts of the body. When anticancer drugs damage healthy blood cells, patients are more likely to get infections, may bruise or bleed easily, and may have less energy. Cells in hair roots and cells that line the stomach and intestines also divide rapidly. As a result, patients may lose their hair and may have other side effects such as poor appetite, nausea and vomiting, diarrhea, or mouth sores. Usually, these side effects go away gradually during the recovery periods between treatments or after treatment is over. The health care team can suggest ways to relieve side effects.
Prognosis
of
Pancreatic Cancer
At this time, pancreatic cancer
can be cured only when it is found at an early stage, before it
has spread. However, other treatments may be able to control the
disease and help patients live longer and feel better. People
living with pancreatic cancer may worry about the future. They may
worry about caring for themselves or their families, keeping their
jobs, or continuing daily activities. Concerns about treatments
and managing side effects, hospital stays, and medical bills are
also common.
Palliative therapy may be
chosen for treatment with patients that have incurable or
uncontrollable pancreatic cancer.
Palliative therapy is treatment
given to relieve the symptoms and reduce the suffering caused by
cancer. Palliative therapy
aims to improve quality of life by controlling pain and
other problems caused by this disease.
Doctors, nurses, and other members of the health care team can answer questions about treatment, diet, working, or other matters. Meeting with a social worker, counselor, or member of the clergy can be helpful to those who want to talk about their feelings or discuss their concerns. Often, a social worker can suggest resources for financial aid, transportation, home care, emotional support, or other services.