Pancreatic Cancer

What is pancreatic cancer?

Cancer of the pancreas is an abnormal growth of cells in the pancreas. The pancreas is behind the stomach. It makes juices to help break down food in the small intestine for absorption of the nutrients. The pancreas also makes hormones, such as insulin. The hormones help the body use and store the energy it gets from food. The cancer usually begins in the ducts that carry pancreatic juices.

How does it occur?

Exactly what causes pancreatic cancer is not known. Most cases of pancreatic cancer occur in older adults. Some things that may increase the risk of this disease are:

• smoking (up to one third of pancreatic cancers are thought to be due to tobacco exposure)
• diabetes
• chronic pancreatitis (irritation of the pancreas—for example by alcohol—that doesn't go away)
• obesity
• high-fat diet that includes a lot of meat.

Rarely, some families have inherited conditions that increase the risk for pancreatic cancer.

What are the symptoms?

Pancreatic cancer has been called a silent disease because it usually does not cause symptoms early on. When symptoms do appear, they may be so vague that they may be ignored or appear to be some other disease.

Some symptoms of pancreatic cancer are:

• yellowing of the skin and eyes, called jaundice
• pain in the upper or middle belly and mid-back
• weight loss for no known reason
• loss of appetite
• tiredness.

How is it diagnosed?

This cancer usually cannot be detected early, unlike other cancers such as breast and colon cancer, because the pancreas is tucked away, deep in the abdomen. It can be hard to diagnose. Your healthcare provider will ask about your symptoms. You will have a physical exam. Your provider may feel a hard lump in your belly. Your liver or gallbladder may be larger than normal.

Tests you may have are:

• blood tests, such as CEA or CA 19-9
• CT scan of the abdomen and pelvis
• endoscopic ultrasound (A thin, flexible, lighted tube is put through the mouth into the stomach. It bounces high-energy sound waves off the organs to create a picture of the organs and structures and helps find the area of cancer.)
• a needle biopsy (After numbing your skin, a thin needle is put through your skin and into the pancreas to remove cells or tissues for lab tests.)
• laparoscopy (A flexible, lighted tube is put into the belly through a small cut to look inside the belly. A sample of tissue may be removed for tests. This is called a biopsy.)
• endoscopic retrograde cholangiopancreatography, or ERCP (This procedure is done using X-rays and a flexible, lighted tube called an endoscope to see the inside of the stomach and the first part of the small intestine. Dye is put in so the pancreas and pancreatic ducts can be seen on X-rays. A sample of tissue may be removed for tests.)

How is it treated?

The treatment depends on whether the cancer has spread and your general health. You may have surgery, chemotherapy, radiation therapy, or a combination of these treatments. Parts or all of the pancreas and some other organs, such as the gallbladder and small intestine, may be removed with surgery. (Rarely is the whole pancreas removed.) Other types of operations may help lessen symptoms if the cancer cannot be removed.

Your provider may give you other treatments to help with pain, such as injecting medicine into the affected nerves or cutting the nerves to block the feeling of pain.

How long will the effects last?

Cancer of the pancreas is very hard to control. Symptoms of pancreatic cancer usually are not recognized until late in the course of the disease, when surgery will not be able to cure the cancer. However, sometimes pancreatic cancer is diagnosed early and cured with surgery. When a cure is not possible, treatment can improve the quality of your life by controlling symptoms and complications of the disease.

How can I take care of myself?

In general, do what you can to control your symptoms. The following may be helpful:

• Follow your healthcare provider's advice about diet.
• Eat small, frequent meals instead of large meals.
• Take pancreatic enzyme pills if your provider prescribes them. These pills replace the enzymes usually made by your pancreas to help digest your food. If the pancreatic duct is blocked by the cancer, taking these pills will help your digestion.
• Get enough rest.
• Take pain medicine as prescribed by your provider when you need it. Don’t delay or avoid taking prescribed drugs.
• Your medicines may make you sleepy. Don't drive or do things that you should be wide awake to do.
• Discuss your symptoms and concerns openly with your provider.
• Ask your provider to recommend a counselor to help deal with your concerns and feelings.

How can I prevent pancreatic cancer?

Since the causes of pancreatic cancer are not known, there is no reliable way to prevent it. General cancer prevention guidelines include eating a healthy diet, maintaining a healthy weight, and avoiding smoking and alcohol. Avoiding tobacco use is the best way to lessen your risk of pancreatic cancer as well as several other cancers.