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Pancreatic Cancer

Definition

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

The Pancreas
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Causes

Cancer occurs when cells in the body 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 growths. These growths can invade nearby tissues. Cancer that has invaded nearby tissues can then spread to other parts of the body.

It is not clear exactly what causes these problems in the cells, but it is probably a combination of genetics and environment.

Risk Factors

Pancreatic cancer is more common in men, and in people aged 40 years and older. Other factors that may increase your chance of pancreatic cancer include:

  • Smoking and using smokeless tobacco, such as chewing tobacco
  • Alcohol abuse
  • Diabetes
  • Chronic pancreatitis, hereditary pancreatitis, or 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 gene, which is associated with breast cancer
  • High-fat diet
  • Overweight or obese, which may also reduce your chance of survival from pancreatic cancer

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. Pancreatic cancer may cause:

  • 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, lightheadedness, chills, muscle spasms, diarrhea—especially if the cancer involves the islet cells that make insulin and other hormones

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done. The doctor may order blood and urine tests, as well as check for hidden blood in your stool.

Imaging tests evaluate the pancreas and surrounding structures:

Your doctor may also want to take a biopsy (removal of a sample of pancreatic tissue to test for cancer cells).

The physical exam combined with all of your test results, will help to determine the stage of cancer you have. Staging is used to guide your treatment plan. Like other cancers, breast cancer is staged from I-IV. Stage I is a very localized cancer, while stage IV indicates a spread to other parts of the body.

Treatment

Treatments for pancreatic cancer depends on the stage of the cancer. Treatments include:

Surgery

Removal of the cancerous tumor and nearby tissue may be done. Nearby lymph nodes may also need to be removed. In pancreatic cancer, surgery may also be performed to relieve symptoms. 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

This is the use of radiation to kill cancer cells and shrink tumors. Radiation therapy may be:

  • External—radiation directed at the tumor from a source outside the body
  • Internal—radioactive materials placed into the body in or near the cancer cells

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. It may be given in many forms including pill, injection, and via a catheter. The drugs enter the bloodstream. Chemotherapy also affects healthy cells.

Biological Therapy

The use of medications or substances made by the body. They can increase or restore the body's natural defenses against cancer. It is also called biologic response modifier (BRM) therapy.

Combined Modality Therapy

Most times, pancreatic cancer is discovered at an advanced stage. Surgery may not be appropriate in this case. If surgery cannot be done, then chemotherapy and radiation are offered together to prolong survival.

Surgery would be appropriate in about a quarter of people with this disease in the early stage. In these cases, the person would benefit from surgery. After surgery, follow-up chemotherapy and radiation therapy have been found to prolong survival in some cases.

Prevention

To help reduce your chance of pancreatic cancer:

  • Talk to your doctor about how you can successfully quit smoking
  • Drink alcohol in moderation, which is 2 drinks or less per day for men and 1 drink per day for women
  • Lose or maintain a healthy weight
  • Eat a healthful diet
  • If possible, minimize exposure to cancer-causing agents, especially if you work in the petroleum or dry-cleaning industries

Revision Information

  • American Cancer Society

    http://www.cancer.org

  • Pancreatic Cancer Action Network

    http://www.pancan.org

  • Canadian Cancer Society

    http://www.cancer.ca

  • Pancreatic Cancer Canada

    http://www.pancreaticcancercanada.ca

  • All about pancreatic cancer. American Cancer Society website. Available at: http://www.cancer.org/acs/groups/cid/documents/webcontent/003131-pdf.pdf. Accessed August 25, 2014.

  • Pancreatic cancer. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated August 12, 2014. Accessed August 25, 2014.

  • Pancreatic cancer. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/types/pancreatic. Accessed August 25, 2014.

  • 9/23/2008 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Boffetta P, Hecht S, Gray N, Gupta P, Straif K. Smokeless tobacco and cancer. Lancet Oncol. 2008;9:667-675.

  • 7/21/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Li D, Morris JS, Liu J, et al. Body mass index and risk, age of onset, and survival in patients with pancreatic cancer. JAMA. 2009;301:2553-2562.

  • 3/5/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Tramacere I, Scotti L, Jenab M, et al. Alcohol drinking and pancreatic cancer risk: a meta-analysis of the dose-risk relation. Int J Cancer. 2010;126(6):1474-1486.


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