Pancreatic
cancer
Overview
Pancreatic cancer begins in the tissues of
your pancreas — an organ in your abdomen that lies behind the lower part of
your stomach. Your pancreas releases enzymes that aid digestion and produces
hormones that help manage your blood sugar.
Several types of growths can occur in the
pancreas, including cancerous and noncancerous tumors. The most common type of
cancer that forms in the pancreas begins in the cells that line the ducts that
carry digestive enzymes out of the pancreas (pancreatic ductal adenocarcinoma).
Pancreatic cancer is seldom detected at its
early stages when it's most curable. This is because it often doesn't cause
symptoms until after it has spread to other organs.
Pancreatic cancer treatment options are chosen
based on the extent of the cancer. Options may include surgery, chemotherapy,
radiation therapy or a combination of these.
Symptoms
Signs and symptoms of pancreatic cancer often
don't occur until the disease is advanced. They may include:
·
Abdominal pain that
radiates to your back
·
Loss of appetite or
unintended weight loss
·
Yellowing of your skin
and the whites of your eyes (jaundice)
·
Light-colored stools
·
Dark-colored urine
·
Itchy skin
·
New diagnosis of
diabetes or existing diabetes that's becoming more difficult to control
·
Blood clots
·
Fatigue
When to see a doctor
See your doctor if you experience any
unexplained symptoms that worry you. Many other conditions can cause these
symptoms, so your doctor may check for these conditions as well as for pancreatic
cancer.
Causes
It's not clear what causes pancreatic cancer.
Doctors have identified some factors that may increase the risk of this type of
cancer, including smoking and having certain inherited gene mutations.
Understanding your
pancreas
Your pancreas is about 6 inches (15
centimeters) long and looks something like a pear lying on its side. It
releases (secretes) hormones, including insulin, to help your body process
sugar in the foods you eat. And it produces digestive juices to help your body
digest food and absorb nutrients.
How pancreatic cancer
forms
Pancreatic cancer occurs when cells in your
pancreas develop changes (mutations) in their DNA. A cell's DNA contains the
instructions that tell a cell what to do. These mutations tell the cells to
grow uncontrollably and to continue living after normal cells would die. These
accumulating cells can form a tumor. When left untreated, the pancreatic cancer
cells can spread to nearby organs and blood vessels and to distant parts of the
body.
Most pancreatic cancer begins in the cells
that line the ducts of the pancreas. This type of cancer is called pancreatic
adenocarcinoma or pancreatic exocrine cancer. Less frequently, cancer can form
in the hormone-producing cells or the neuroendocrine cells of the pancreas.
These types of cancer are called pancreatic neuroendocrine tumors, islet cell
tumors or pancreatic endocrine cancer.
Risk factors
Factors that may increase your risk of
pancreatic cancer include:
·
Smoking
·
Diabetes
·
Chronic inflammation
of the pancreas (pancreatitis)
·
Family history of
genetic syndromes that can increase cancer risk, including a BRCA2 gene
mutation, Lynch syndrome and familial atypical mole-malignant melanoma (FAMMM)
syndrome
·
Family history of
pancreatic cancer
·
Obesity
·
Older age, as most
people are diagnosed after age 65
A large study demonstrated that the
combination of smoking, long-standing diabetes and a poor diet increases the
risk of pancreatic cancer beyond the risk of any one of these factors alone.
Complications
As pancreatic cancer progresses, it can cause
complications such as:
·
Weight
loss. A number of
factors may cause weight loss in people with pancreatic cancer. Weight loss
might happen as the cancer consumes the body's energy. Nausea and vomiting
caused by cancer treatments or a tumor pressing on your stomach may make it
difficult to eat. Or your body may have difficulty processing nutrients from
food because your pancreas isn't making enough digestive juices.
·
Jaundice. Pancreatic cancer that blocks the
liver's bile duct can cause jaundice. Signs include yellow skin and eyes,
dark-colored urine, and pale-colored stools. Jaundice usually occurs without
abdominal pain.
Your doctor may recommend that a plastic or metal tube (stent)
be placed inside the bile duct to hold it open. This is done with the help of a
procedure called endoscopic retrograde cholangiopancreatography (ERCP).
During ERCP an endoscope is passed down your throat, through your
stomach and into the upper part of your small intestine. A dye is then injected
into the pancreatic and bile ducts through a small hollow tube (catheter)
that's passed through the endoscope. Finally, images are taken of the ducts.
·
Pain. A growing tumor may press on nerves in
your abdomen, causing pain that can become severe. Pain medications can help
you feel more comfortable. Treatments, such as radiation and chemotherapy,
might help slow tumor growth and provide some pain relief.
In severe cases, your doctor might recommend a procedure to
inject alcohol into the nerves that control pain in your abdomen (celiac plexus
block). This procedure stops the nerves from sending pain signals to your
brain.
·
Bowel
obstruction. Pancreatic
cancer that grows into or presses on the first part of the small intestine
(duodenum) can block the flow of digested food from your stomach into your
intestines.
Your doctor may recommend that a tube (stent) be placed in your
small intestine to hold it open. In some situations, it might help to have
surgery to place a temporary feeding tube or to attach your stomach to a lower
point in your intestines that isn't blocked by cancer.
Prevention
You may reduce your risk of pancreatic cancer
if you:
·
Stop
smoking. If you smoke,
try to stop. Talk to your doctor about strategies to help you stop, including
support groups, medications and nicotine replacement therapy. If you don't
smoke, don't start.
·
Maintain
a healthy weight. If you are at a
healthy weight, work to maintain it. If you need to lose weight, aim for a
slow, steady weight loss — 1 to 2 pounds (0.5 to 1 kilogram) a week. Combine
daily exercise with a diet rich in vegetables, fruit and whole grains with
smaller portions to help you lose weight.
·
Choose
a healthy diet. A diet full of
colorful fruits and vegetables and whole grains may help reduce your risk of
cancer.
Consider meeting with a genetic counselor if
you have a family history of pancreatic cancer. He or she can review your
family health history with you and determine whether you might benefit from a
genetic test to understand your risk of pancreatic cancer or other cancers.
Diagnosis
If your doctor suspects pancreatic cancer, he
or she may have you undergo one or more of the following tests:
·
Imaging
tests that create pictures of your internal organs. These tests help your doctors visualize
your internal organs, including the pancreas. Techniques used to diagnose
pancreatic cancer include ultrasound, computerized tomography (CT) scans,
magnetic resonance imaging (MRI) and, sometimes, positron emission tomography
(PET) scans.
·
Using
a scope to create ultrasound pictures of your pancreas. An endoscopic ultrasound (EUS) uses an
ultrasound device to make images of your pancreas from inside your abdomen. The
device is passed through a thin, flexible tube (endoscope) down your esophagus
and into your stomach in order to obtain the images.
·
Removing
a tissue sample for testing (biopsy). A biopsy is a procedure to remove a small sample of tissue
for examination under a microscope. Most often the tissue is collected
during EUS by passing special tools through the endoscope. Less
often, a sample of tissue is collected from the pancreas by inserting a needle
through your skin and into your pancreas (fine-needle aspiration).
·
Blood
test. Your doctor may
test your blood for specific proteins (tumor markers) shed by pancreatic cancer
cells. One tumor marker test used in pancreatic cancer is called CA19-9. It may
be helpful in understanding how the cancer responds to treatment. But the test
isn't always reliable because some people with pancreatic cancer don't have
elevated CA19-9 levels, making the test less helpful.
If your doctor confirms a diagnosis of
pancreatic cancer, he or she tries to determine the extent (stage) of the
cancer. Using information from staging tests, your doctor assigns your
pancreatic cancer a stage, which helps determine what treatments are most
likely to benefit you.
The stages of pancreatic cancer are indicated
by Roman numerals ranging from 0 to IV. The lowest stages indicate that the
cancer is confined to the pancreas. By stage IV, the cancer has spread to other
parts of the body.
The cancer staging system continues to evolve
and is becoming more complex as doctors improve cancer diagnosis and treatment.
Don't hesitate to ask your doctor about his or
her experience with diagnosing pancreatic cancer. If you have any doubts, get a
second opinion.
Treatment
Treatment for pancreatic cancer depends on the
stage and location of the cancer as well as on your overall health and personal
preferences. For most people, the first goal of pancreatic cancer treatment is
to eliminate the cancer, when possible. When that isn't an option, the focus
may be on improving your quality of life and limiting the cancer from growing
or causing more harm.
Treatment may include surgery, radiation,
chemotherapy or a combination of these. When pancreatic cancer is advanced and
these treatments aren't likely to offer a benefit, your doctor will focus on
symptom relief (palliative care) to keep you as comfortable as possible for as
long as possible.
Surgery
Operations used in people with pancreatic
cancer include:
·
Surgery
for tumors in the pancreatic head. If your cancer is located in the head of the pancreas, you
may consider an operation called a Whipple procedure (pancreaticoduodenectomy).
The Whipple procedure is a technically difficult operation to
remove the head of the pancreas, the first part of the small intestine
(duodenum), the gallbladder, part of the bile duct and nearby lymph nodes. In
some situations, part of the stomach and colon may be removed as well. Your surgeon
reconnects the remaining parts of your pancreas, stomach and intestines to
allow you to digest food.
·
Surgery
for tumors in the pancreatic body and tail. Surgery to remove the left side (body and tail) of the
pancreas is called distal pancreatectomy. Your surgeon may also need to remove
your spleen.
·
Surgery
to remove the entire pancreas. In some people, the entire pancreas may need to be
removed. This is called total pancreatectomy. You can live relatively normally
without a pancreas but do need lifelong insulin and enzyme replacement.
·
Surgery
for tumors affecting nearby blood vessels. Many people with advanced pancreatic cancer aren't
considered eligible for the Whipple procedure or other pancreatic surgeries if
their tumors involve nearby blood vessels. At highly specialized and
experienced medical centers, surgeons may offer pancreatic surgery operations
that include removing and reconstructing affected blood vessels.
Each of these surgeries carries the risk of
bleeding and infection. After surgery some people experience nausea and
vomiting if the stomach has difficulty emptying (delayed gastric emptying).
Expect a long recovery after any of these procedures. You'll spend several days
in the hospital and then recover for several weeks at home.
Extensive research shows pancreatic cancer
surgery tends to cause fewer complications when done by highly experienced
surgeons at centers that do many of these operations. Don't hesitate to ask
about your surgeon's and hospital's experience with pancreatic cancer surgery.
If you have any doubts, get a second opinion.
Chemotherapy
Chemotherapy uses drugs to help kill cancer
cells. These drugs can be injected into a vein or taken orally. You may receive
one chemotherapy drug or a combination of them.
Chemotherapy can also be combined with
radiation therapy (chemoradiation). Chemoradiation is typically used to treat
cancer that hasn't spread beyond the pancreas to other organs. At specialized
medical centers, this combination may be used before surgery to help shrink the
tumor. Sometimes it is used after surgery to reduce the risk that pancreatic
cancer may recur.
In people with advanced pancreatic cancer and
cancer that has spread to other parts of the body, chemotherapy may be used to
control cancer growth, relieve symptoms and prolong survival.
Radiation therapy
Radiation therapy uses high-energy beams, such
as those made from X-rays and protons, to destroy cancer cells. You may receive
radiation treatments before or after cancer surgery, often in combination with
chemotherapy. Or your doctor may recommend a combination of radiation and
chemotherapy treatments when your cancer can't be treated surgically.
Radiation therapy usually comes from a machine
that moves around you, directing radiation to specific points on your body
(external beam radiation). In specialized medical centers, radiation therapy
may be delivered during surgery (intraoperative radiation).
Traditional radiation therapy uses X-rays to
treat cancer, but a newer form of radiation using protons is available at some
medical centers. In certain situations, proton therapy can be used to treat
pancreatic cancer and it may offer fewer side effects compared with standard
radiation therapy.
Clinical trials
Clinical trials are studies to test new
treatments, such as systemic therapy, and new approaches to surgery or
radiation therapy. If the treatment being studied proves to be safer and more
effective than current treatments, it can become the new standard of care.
Clinical trials for pancreatic cancer might give
you a chance to try new targeted therapy, chemotherapy drugs, immunotherapy
treatments or vaccines.
Clinical trials can't guarantee a cure, and
they might have serious or unexpected side effects. On the other hand, cancer
clinical trials are closely monitored to ensure they're conducted as safely as
possible. And they offer access to treatments that wouldn't otherwise be
available to you.
Talk to your doctor about what clinical trials
might be appropriate for you.
Supportive
(palliative) care
Palliative care is specialized medical care
that focuses on providing relief from pain and other symptoms of a serious
illness. Palliative care is not the same as hospice care or end-of-life care.
Palliative care is provided by teams of doctors, nurses, social workers and
other specially trained professionals. These teams aim to improve the quality
of life for people with cancer and their families.
Palliative care specialists work with you,
your family and your other doctors to provide an extra layer of support that complements
your ongoing medical care. It's often used while undergoing aggressive
treatments, such as surgery, chemotherapy and radiation therapy.
When palliative care is used along with other
appropriate treatments — even soon after the diagnosis — people with cancer may
feel better and live longer.
Alternative medicine
Some integrative and alternative medicine
approaches may help with signs and symptoms you experience due to your cancer
or cancer treatments.
Treatments to help you
cope with distress
People with cancer frequently experience
distress. Some research suggests distress is more common in people with
pancreatic cancer than it is in people with other types of cancer.
If you're distressed, you may have difficulty
sleeping and find yourself constantly thinking about your cancer. You may feel
angry or sad.
Discuss your feelings with your doctor.
Specialists can help you sort through your feelings and help you devise
strategies for coping. In some cases, medications may help.
Integrative medicine and alternative therapies
may also help you cope with distress. Examples include:
·
Acupuncture
·
Art therapy
·
Exercise
·
Massage therapy
·
Meditation
·
Music therapy
·
Relaxation exercises
·
Spirituality
Talk with your doctor if you're interested in
these treatment options.
Coping and support
Learning you have a life-threatening illness
can be devastating. Some of the following suggestions may help:
·
Learn
what you need to know about your cancer. Learn enough about your cancer to help you make decisions
about your care. Ask your doctor about the details of your cancer and your
treatment options. Ask about trusted sources of further information.
If you're doing your own research, good places to start include
the National Cancer Institute and the Pancreatic Cancer Action Network.
·
Assemble
a support system. Ask your friends
and family to form a support network for you. They may feel helpless and
uncertain after your diagnosis. Helping you with simple tasks might give them
comfort. And you might find relief in not having to worry about certain tasks.
Think of things you want help with, such as meal preparation or getting to
appointments.
·
Find
someone to talk with. Although friends
and family can be your best allies, in some cases they have difficulty coping
with the shock of your diagnosis. In these cases, talking with a counselor,
medical social worker, or a pastoral or religious counselor can be helpful. Ask
your doctor for a referral.
·
Connect
with other cancer survivors. You may find comfort in talking with other cancer
survivors. Contact your local chapter of the American Cancer Society to find
cancer support groups in your area. The Pancreatic Cancer Action Network can
connect you with a pancreatic cancer survivor who can provide support by phone
or email.
·
Consider
hospice. Hospice care
provides comfort and support to terminally ill people and their loved ones. It
allows family and friends — with the aid of nurses, social workers and trained
volunteers — to care for and comfort a loved one at home or in a hospice
residence. Hospice care also provides emotional, social and spiritual support
for people who are ill and those closest to them.
Preparing for your
appointment
Start by making an appointment with your
doctor if you have any signs or symptoms that worry you. He or she may recommend
tests and procedures to investigate your signs and symptoms. If your doctor
suspects you have pancreatic cancer, he or she might refer you to:
·
A doctor who diagnoses
and treats digestive conditions (gastroenterologist)
·
A doctor who treats
cancer (oncologist)
·
A doctor who uses
radiation to treat cancer (radiation oncologist)
·
A surgeon who
specializes in operations involving the pancreas
What you can do
·
Be
aware of any pre-appointment restrictions, such as restricting your diet.
·
List
your symptoms, including any
that seem unrelated to the reason you scheduled the appointment.
·
List
key personal information, including
any recent changes or stressors.
·
List
all of your medications, vitamins
and supplements, including doses.
·
Ask
a relative or friend to accompany you, to help you remember what the doctor says.
Questions to ask your
doctor
·
Do I have pancreatic
cancer?
·
What is the stage of
my cancer?
·
Will I need additional
tests?
·
Can my cancer be
cured?
·
What are my treatment
options?
·
Can any treatment help
me live longer?
·
What are the potential
risks of each treatment?
·
Is there one treatment
you think is best for me?
·
What advice would you
give a friend or a family member in my situation?
·
What is your
experience with pancreatic cancer diagnosis and treatment? How many surgical
procedures for this type of cancer are done each year at this medical center?
·
I'm experiencing these
signs and symptoms. What can be done to help me feel more comfortable?
·
What clinical trials
are available for pancreatic cancer? Am I eligible for any?
·
Am I eligible for
molecular profiling of my cancer?
·
Do you have any
brochures or other printed material that I can take with me? What websites do
you recommend?
What to expect from
your doctor
Your doctor is likely to ask you a number of questions,
such as:
·
When did you first
begin experiencing symptoms?
·
How severe are your
symptoms? Are they occasional or continuous?
·
Does anything improve
or worsen your symptoms?
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