In the United States, cancer of the pancreas is diagnosed in more than 29,000 people every year. It is the fifth leading cause of cancer death.

The Pancreas

The pancreas is a gland located deep in the abdomen between the stomach and the spine (backbone). The liver, intestine, and other organs surround the pancreas.

The pancreas is about 6 inches long and is shaped like a flat pear. The widest part of the pancreas is the head, the middle section is the body, and the thinnest part is the tail.

The pancreas makes insulin and other hormones. These hormones enter the bloodstream and travel throughout the body. They help the body use or store the energy that comes from food. For example, insulin helps control the amount of sugar in the blood.

The pancreas also makes pancreatic juices. These juices contain enzymes that help digest food. The pancreas releases the juices into a system of ducts leading to the common bile duct. The common bile duct empties into the duodenum, the first section of the small intestine

Most pancreatic cancers begin in the ducts that carry pancreatic juices. Cancer of the pancreas may be called pancreatic cancer or carcinoma of the pancreas.

A rare type of pancreatic cancer begins in the cells that make insulin and other hormones. Cancer that begins in these cells is called islet cell cancer.

When cancer of the pancreas spreads (metastasizes) outside the pancreas, cancer cells are often found in nearby lymph nodes. If the cancer has reached these nodes, it means that cancer cells may have spread to other lymph nodes or other tissues, such as the liver or lungs. Sometimes cancer of the pancreas spreads to the peritoneum, the tissue that lines the abdomen.

When cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary tumor. For example, if cancer of the pancreas spreads to the liver, the cancer cells in the liver are pancreatic cancer cells. The disease is metastatic pancreatic cancer, not liver cancer. It is treated as pancreatic cancer, not liver cancer.

Pancreatic Cancer: Who's at Risk?

No one knows the exact 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.
• Male - More men than women are diagnosed with pancreatic cancer.
• 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.
• 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.

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. Back to Top

Symptoms

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:

• Pain in the upper abdomen or upper back
• Yellow skin and eyes, and dark urine from jaundice
• Weakness
• Loss of appetite
• Nausea and vomiting
• Weight loss

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. Back to Top

Diagnosis

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 non-cancerous 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

• Transabdominal ultrasound - To make images of the pancreas, the doctor places the ultrasound device on the abdomen and slowly moves it around.
• 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. Yet another way is to open the abdomen during an operation. Back to Top

Staging

When pancreatic cancer is diagnosed, the doctor needs to know the stage, or extent, of the 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.

The doctor may determine the stage of pancreatic cancer at the time of diagnosis, or the patient may need to have more tests. Such tests may include blood tests, a CT scan, ultrasonography, laparoscopy (a surgical procedure in which a small camera is inserted into the chest or abdomen through a small skin incision, about 1 inch), or angiography (an x-ray of the blood vessels and nearby organs taken once a dye has been injected into an artery. A blockage may indicate a tumor. The test results will help the doctor decide which treatment is appropriate.

Treatment

People with pancreatic cancer may have several treatment options. Depending on the type and stage, pancreatic cancer may be treated with surgery, radiation therapy, or chemotherapy. Some patients have a combination of therapies.

Surgery may be used alone or in combination with radiation therapy and chemotherapy. 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.
• Distal pancreatectomy: The surgeon removes the body and tail of the pancreas if the tumor is in either of these parts. The surgeon 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. But if the tumor is blocking the common bile duct or duodenum, the surgeon can create a bypass. A bypass allows fluids to flow through the digestive tract. It can help relieve jaundice and pain resulting from a blockage.

The doctor sometimes can relieve blockage without doing bypass surgery. The doctor 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.

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 is local therapy. It 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.

Doctors may use radiation to destroy cancer cells that remain in the area after surgery. They also use radiation to relieve pain and other problems caused by the cancer.

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. It may be given alone, with radiation, or with surgery and radiation.

Chemotherapy is systemic therapy. The doctor usually gives the drugs by injection. Once in the bloodstream, the drugs travel throughout the body.

Usually chemotherapy is an outpatient treatment given at the hospital, clinic, doctor's office, or home. However, depending on which drugs are given and the patient's general health, the patient may need to stay in the hospital. Back to Top

Pain Control

Pain is a common problem for people with pancreatic cancer. The tumor can cause pain by pressing against nerves and other organs.

The patient's doctor or a specialist in pain control can relieve or reduce pain in several ways:

• Pain medicine -- Medicines often can relieve pain. (These medicines may make people drowsy and constipated, but resting and taking laxatives can help.)
• Radiation -- High-energy rays can help relieve pain by shrinking the tumor.
  Nerve block -- The doctor may inject alcohol into the area around certain nerves in the abdomen to block the feeling of pain.
• Surgery -- The surgeon may cut certain nerves to block pain.
  The doctor may suggest other ways to relieve or reduce pain. For example, massage, acupuncture, or acupressure may be used along with other approaches to help relieve pain. Also, the patient may learn relaxation techniques such as listening to slow music or breathing slowly and comfortably.