Pancreatic cancer begins when cells in the pancreas start to grow uncontrollably. The pancreas is an organ located behind the stomach. It is shaped a bit like a fish with a wide head, a tapering body, and a narrow, pointed tail. In adults it is about 6 inches long but less than 2 inches wide. The head of the pancreas is on the right side of the abdomen (belly), behind where the stomach meets the duodenum (the first part of the small intestine). The body of the pancreas is behind the stomach, and the tail of the pancreas is on the left side of the abdomen next to the spleen.
The pancreas has 2 main types of cells:
The exocrine cells and endocrine cells of the pancreas form different types of tumors. It’s very important to distinguish between exocrine and endocrine cancers of the pancreas. They have distinct risk factors and causes, have different signs and symptoms, are diagnosed with different tests, are treated in different ways, and have different outlooks.
Exocrine cancers are by far the most common type of pancreas cancer. If you are told you have pancreatic cancer, it is most likely an exocrine pancreatic cancer.
Pancreatic adenocarcinoma:About 95% of cancers of the exocrine pancreas are adenocarcinomas. These cancers usually begin in the ducts of the pancreas. Less often, they develop from the cells that make the pancreatic enzymes, in which case they are called acinar cell carcinomas
Less common types of exocrine cancer:Other, less common exocrine cancers include adenosquamous carcinomas, squamous cell carcinomas, signet ring cell carcinomas, undifferentiated carcinomas, and undifferentiated carcinomas with giant cells.
Less common types of exocrine cancer:Other, less common exocrine cancers include adenosquamous carcinomas, squamous cell carcinomas, signet ring cell carcinomas, undifferentiated carcinomas, and undifferentiated carcinomas with giant cells.
Ampullary cancer (carcinoma of the ampulla of Vater):This cancer starts in the ampulla of Vater, which is where the bile duct and pancreatic duct come together and empty into the small intestine. Ampullary cancers aren’t technically pancreatic cancers, but they are included here because they are treated very similarly.
Ampullary cancers often block the bile duct while they are still small and have not spread far. This blockage causes bile to build up in the body, which leads to yellowing of the skin and eyes (jaundice). Because of this, these cancers are usually found earlier than most pancreatic cancers, and they usually have a better prognosis (outlook).
Tumors of the endocrine pancreas are uncommon, making up less than 5% of all pancreatic cancers. As a group, they are often called pancreatic neuroendocrine tumors (NETs) or islet cell tumors.
Pancreatic NETs can be benign (not cancer) or malignant (cancer). Benign and malignant tumors can look alike under a microscope, so it isn’t always clear if a pancreatic NET is cancer. Sometimes it only becomes clear that an NET is cancer when it spreads outside the pancreas.
There are many types of pancreatic NETs.
Functioning NETs:About half of pancreatic NETs make hormones that are released into the blood and cause symptoms. These are called functioning tumors. Each one is named for the type of hormone the tumor cells make.
Most functioning NETs are gastrinomas or insulinomas. The other types are rare.
Nonfunctioning NETs:These tumors don’t make enough excess hormones to cause symptoms. They are more likely to be cancer than are functioning tumors. Because they don’t make excess hormones that cause symptoms, they can often grow quite large before they are found.
Carcinoid tumors: These NETs are much more common in other parts of the digestive system, although rarely they can start in the pancreas. These tumors often make serotonin (also called 5HT) or its precursor, 5HTP.
A staging system is a standard way for doctors to sum up how large a cancer is and how far it has spread. The system used most often to stage cancers of the pancreas is the American Joint Committee on Cancer (AJCC) TNM system, which is based on 3 key pieces of information:
Numbers or letters appear after T, N, and M to provide more details about each of these factors. Higher numbers mean the cancer is more advanced.
TX:The main tumor cannot be assessed.
T0:No evidence of a primary tumor. Tis:Carcinoma in situ (the tumor is confined to the top layers of pancreatic duct cells). (Very few pancreatic tumors are found at this stage.)
T1:The cancer has not grown outside the pancreas and is 2 centimeters (cm) (about ¾ inch) or less across.
T2:The cancer has not grown outside the pancreas but is larger than 2 cm across.
T3:The cancer has grown outside the pancreas into nearby surrounding structures but not into major blood vessels or nerves.
T4:The cancer has grown beyond the pancreas into nearby large blood vessels or nerves.
NX:Nearby (regional) lymph nodes cannot be assessed.
N0:The cancer has not spread to nearby lymph nodes.
N1:The cancer has spread to nearby lymph nodes.
M0:The cancer has not spread to distant lymph nodes (other than those near the pancreas) or to distant organs such as the liver, lungs, brain, etc.
M1:The cancer has spread to distant lymph nodes or to distant organs.
Stages of pancreatic cancer
Once the T, N, and M categories have been determined, this information is combined to assign an overall stage of 0, I, II, III, or IV (sometimes followed by a letter).
|Stage||Stage grouping||Stage description|
|0||Tis, N0, M0||The tumor is confined to the top layers of pancreatic duct cells and has not invaded deeper tissues. It has not spread outside of the pancreas. These tumors are sometimes referred to as pancreatic carcinoma in situ or pancreatic intraepithelial neoplasia III (PanIn III).|
|IA||T1, N0, M0||The tumor is confined to the pancreas and is 2 cm across or smaller (T1). The cancer has not spread to nearby lymph nodes (N0) or distant sites (M0).|
|IB||T2, N0, M0||The tumor is confined to the pancreas and is larger than 2 cm across (T2). The cancer has not spread to nearby lymph nodes (N0) or distant sites (M0).|
|IIA||T3, N0, M0||The tumor is growing outside the pancreas but not into major blood vessels or nerves (T3). The cancer has not spread to nearby lymph nodes (N0) or distant sites (M0).|
|IIB||T1T3, N1, M0||The tumor is either confined to the pancreas or growing outside the pancreas but not into major blood vessels or nerves (T1T3). The cancer has spread to nearby lymph nodes (N1) but not to distant sites (M0).|
|III||T4, Any N, M0||The tumor is growing outside the pancreas and into nearby major blood vessels or nerves (T4). The cancer may or may not have spread to nearby lymph nodes (Any N). It has not spread to distant sites (M0).|
|IV||Any T, Any N, M1||The cancer has spread to distant sites (M1)|
Pancreatic cancer may go undetected until it’s advanced. By the time symptoms occur, diagnosing pancreatic cancer is usually relatively straightforward. Unfortunately, a cure is rarely possible at that point.
(This section focuses on pancreatic adenocarcinoma, which account for more than 95% of pancreatic cancer. Other forms of pancreatic cancer are mentioned at the end.)
Diagnosing pancreatic cancer usually happens when someone comes to the doctor after experiencing weeks or months of symptoms.Pancreatic cancer symptoms frequently include abdominal pain, weight loss, itching, or jaundice (yellow skin). A doctor then embarks on a search for the cause, using the tools of the trade:
Based on a person’s exam, lab tests, and description of symptoms, a doctor often orders an imaging test:
If imaging studies detect a mass in the pancreas, a pancreatic cancer diagnosis is likely, but not definite. Only a biopsy taking actual tissue from the mass can diagnose pancreatic cancer. Biopsies can be performed in several ways:
If pancreatic cancer seems very likely, and the tumor appears removable by surgery, doctors may recommend surgery without a biopsy.
Depending on the type and stage of the cancer and other factors, treatment options for people with pancreatic cancer can include:
Pain control is also an important part of treatment for many patients.
Sometimes, the best option might include more than one type of treatment. To learn about the most common approaches to treating these cancers, see Treating pancreatic cancer, based on the extent of the cancer.
For pancreatic neuroendocrine tumors (NETs), treatment options might include surgery, ablation or embolization treatments, radiation therapy, or different types of medicines. For more on how these tumors are treated, see Treating pancreatic neuroendocrine tumors, based on the extent of the tumor.
The pancreas is an oblong flattened gland located deep in the abdomen. It is an integral part of the digestive system. It 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 produces insulin and other hormones. These hormones help the body use or store the energy that comes from food. The pancreas also makes pancreatic juices which 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.
Cancer is the illness or condition that is caused when cells multiply uncontrollably forming a growth or tumor and destroying healthy tissue.
Benign tumors are not cancer and are usually not life threatening. In most cases, benign tumors can be removed and do not come back. Cells from benign tumors do not spread to tissues around them or to other parts of the body. Malignant tumors are cancer. The term malignant is used to describe a tumor that invades the tissue around it and may spread to other parts of the body. Malignant tumors are more serious and may be life threatening.
Cancer cells can break away from a malignant tumor and enter the bloodstream or lymphatic system. That is how cancer cells metastasize, or spread from the original cancer (primary tumor) to form new tumors in other organs.
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 that begins in the cells that make insulin and other hormones.
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.
No. Cancer does not spread from person to person.
No one knows the exact causes of pancreatic cancer though research has shown that people with certain risk factors are more likely to develop pancreatic cancer. Risk factors include:
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.
In the early stages, pancreatic cancer is extremely difficult to detect because often there are no symptoms. But, as the cancer grows, symptoms may include:
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.
Pancreatic cancer can be difficult to detect and diagnose. A variety of techniques can be used to establish a diagnosis. These techniques include lab tests, CT scan, endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP).
Although all of these techniques may reveal a suspicious mass in the pancreas, by far the best diagnostic method remains histopathology.
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 xray machine linked to a computer takes a series of detailed pictures. The xray 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 xrays. The computer puts the xrays together to create pictures of the pancreas and other organs and blood vessels in the abdomen.
Ultrasonography -The ultrasound device uses sound waves to 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 xray pictures. The xrays 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 xray 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 fineneedle aspiration. The doctor uses xray 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.
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 results of various diagnostic tests will indicate how far the cancer has progressed and determine the stage. Subsequent decisions about treatment will be based upon the stage assigned.
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 doctorto take part in the discussion, to take notes, or just to listen. Always remember that the doctor is there to answer your questions dont be afraid to voice your opinion or question any action or procedure.
If you are meeting with a surgeon or oncologist for the first time, you may want to ask:
At any point in the relationship with your physician, you have the right to ask
Do not forget to ask about the things that are most important to you:
Finally and most importantly ask these questions of YOURSELF:
If you are uncomfortable with the results of some of these questions, you may want to reevaluate your choice of physician or get a second opinion.
Cancer of the pancreas is very hard to control with current treatments. For that reason, many doctors encourage patients with this disease to consider taking part in a clinical trial. Clinical trials are an important option for people with all stages of pancreatic cancer. For more information on Clinical Trials click here.
Palliative therapy aims to improve quality of life by controlling pain and other problems caused by pancreatic cancer.
An oncologist is a doctor who specializes in treating cancer. Specialists who treat pancreatic cancer includesurgeons, medical oncologists, and radiation oncologists.
Yes. While 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. But in most cases, a brief delay to get another opinion will not make therapy less helpful.
There are a number of ways to find a doctor for a second opinion:
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. For more information, click here.
Generally if the cancer is localized, surgical treatment, via resection or removal of the tumor, can be pursued. This means that the cancer has not spread to any blood vessels, distant lymph nodes or other organs, such as the liver or lung. These characteristics are determined through various diagnostic techniques.
This depends where the tumor is located within the pancreas. The five parts of the pancreas are reviewed below. For a detailed explanation and illustrations of a particular surgical procedure, click on the name of the procedure. Cancer in the Head, Neck or Uncinate Process of the Pancreas: The Whipple Procedure Cancer in the Body or Tail of the Pancreas: Distal Pancreatectomy and Splenectomy
Questions to ask the doctor before surgery:
Radiation therapy (also referred to as radiotherapy) uses highenergy rays to kill cancer cells. Radiation therapy may be administered alone, or in combination with surgery, chemotherapy, or both.
Questions to ask the doctor before radiation therapy:
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 in combination with surgery and radiation. Chemotherapy is systemic therapy and is most often delivered intravenuously. Once in the bloodstream, the drugs travel throughout the body. Usually chemotherapy is an outpatient treatment. However, depending on which drugs are given and the patient’s general health, the patient may need to stay in the hospital.
Questions to ask before chemotherapy:
Because cancer treatment may damage healthy cells and tissues, unwanted side effects are common. These side effects depend on many factors, including the type and extent of the treatment. Side effects may not be the same for each person, and they may even change from one treatment session to the next. The health care team will explain possible side effects and how they will help the patient manage them.
The side effects of surgery depend on the extent of the operation, the person’s general health, and other factors. Most patients have pain for the first few days after surgery. Pain can be controlled with medicine, and patients should discuss pain relief with the doctor or nurse.
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.
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. Radiation Therapy
Radiation therapy may cause patients to become very tired as treatment continues. Rest is important, but doctors usually advise patients to try to stay as active as possible. 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.
The side effects of chemotherapy depend on the drugs and the doses the patient receives as well as how the drugs are administered. As with other types of treatment, side effects vary from patient to patient. Patients who undergo chemotherapy may also be more likely to get infections, bruise or bleed easily, and may have less energy. Since systemic therapy affects rapidly dividing cells, 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.
The management of pain for patients with pancreatic cancer is one of the most important aspects of their care. Pain is a common symptom that can be successfully controlled. The best management of pain is aggressive therapy with constant assessment. The patient with pancreatic cancer who is experiencing pain can maintain his/her quality of life. Pain can be relieved or reduced in several ways:
The use of opioids (or narcotics, the strongest pain relievers available) is the main way to treat pain from pancreatic cancer. Other types of medicines used to relieve pain that are not opioids are: acetaminophen and nonsteroidal antiinflammatory drugs (NSAIDs). At times, medicines called adjuvant analgesics are also used. These are medicines used for purposes other than the treatment of pain but help in relieving pain in some situations.
Types of Opioids Recommended for Pain of Pancreatic Cancer
NONOPIOIDS RECOMMENDED FOR PAIN OF PANCREATIC CANCER
Radiation Highenergy 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.
Questions to ask your doctor about pain control:
Living with a serious disease such as pancreatic cancer is not easy. Some people find they need help coping with the emotional and practical aspects of their disease. Support groups can help. In these groups, patients or their family members get together to share what they have learned about coping with their disease and the effects of treatment. 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. 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. For more information or assistance please call (310) 4735121.
Doctors in clinics and hospitals are searching for a cure. In their efforts, they often conduct clinical trials. These are research studies in which people take part voluntarily. In these trials, researchers are studying ways to treat pancreatic cancer. Research already has led to advances in treatment methods, and researchers continue to search for more effective approaches to treat this disease.
Patients who join clinical trials have the first chance to benefit from new treatments that have shown promise in earlier research. They also make an important contribution to medical science by helping doctors learn more about the disease.
Although clinical trials may pose some risks, researchers take very careful steps to protect their patients. In trials with people who have pancreatic cancer, doctors are studying new drugs, new combinations of chemotherapy, and combinations of chemotherapy and radiation before and after surgery. For more information on clinical trials, click here.
Biological therapy is also under investigation. Scientists are studying several cancer vaccines to help the immune system fight cancer. Other studies use monoclonal antibodies to slow or stop the growth of cancer. Further information on alternative treatments available at: Homeopathic / Alternative Approaches