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What is Pancreatic Cancer?

Pancreatic cancer is cancer of the pancreas, an organ that sits behind the stomach. The pancreas makes hormones and fluids that help your body to digest food and use it for energy.

There are two different types of cells that can become tumors in the pancreas:

  • Exocrine (ek-suh-krin). These cells make the fluids (enzymes) that help to digest food. Most pancreatic cancers are from tumors in these cells.
  • Neuroendocrine (noo r-oh-en-duh-krin), also called NETs or islet (ahy-lit) cells. These cells make insulin and glucagon, which help control blood sugar levels and turn food into energy for the body. Tumors in these cells are rare (fewer than 5 out of 100 pancreatic cancers). Some of them are cancerous and some are not. Usually, a person with this kind of tumor has a better prognosis (outlook) than someone with an exocrine tumor.

Symptoms

Most pancreatic cancers have no symptoms until the cancer spreads. That’s why most pancreatic cancers (8 out of 10) are diagnosed only after the cancer has spread to other parts of the body. When pancreatic cancer is found early, it’s usually because it was found when a person was having a CT scan or imaging for something else.

Although most pancreatic cancers have no symptoms, some may have these symptoms:

  • Jaundice. Jaundice is when the eyes and skin turn more yellow because bilirubin (bil-uh-roo-bin) builds up in the body. Usually, the liver turns bilirubin into bile and sends it to the intestines so the body can get rid of it. A person can become jaundiced if a pancreatic tumor blocks the bile duct (opening) or the cancer spreads to the liver. The person may also notice dark urine and pale, greasy stool that floats.
  • Nausea and vomiting, especially after eating. A person may have pain, nausea, and vomiting if the tumor is putting pressure on the stomach. For rare neuroendocrine cancers, a person may have trouble digesting food because they don’t have enough stomach acid, or severe pain and ulcers from too much stomach acid.
  • Unintended weight loss. A person may lose their appetite if the tumor presses on their stomach.
  • Stomach or back pain. The exact location of the pain will depend on where the tumor is pressing.
  • Blood clot. A blood clot can cause pain, swelling, and redness when it’s in the leg. It can cause shortness of breath when it is in the lungs.
  • Fatigue (tiredness).

When to See a Doctor

See a doctor if you become jaundice (yellowish skin and eyes), or if you are having pain, problems digesting your food, or any of the symptoms listed. Most of the time, these symptoms will not be from pancreatic cancer, but it helps to have them checked and find out what is causing them.

Causes

Like other cancers, pancreatic cancer is caused by changes, or mutations, to the DNA that makes up your genes. Researchers don’t know what causes this to happen in the pancreas, but they have found these risk factors for pancreatic cancer:

  • Age. The risk of pancreatic cancer increases with age.
  • Smoking. The risk of pancreatic cancer is double in those who smoke compared to those who have never smoked.
  • Obesity. People who are obese have a greater risk of pancreatic cancer.
  • Diabetes, especially Type 2. We don’t know why, but people with Type 2 Diabetes have a higher risk of pancreatic cancer.
  • Chronic pancreatitis or long-term inflammation of the pancreas, especially in smokers, has been linked to an increased risk for pancreatic cancer.
  • Certain chemicals. Exposure to chemicals used for dry cleaning and metalworking can increase risk for people who worked with or near these chemicals.
  • Genetic syndromes. People with certain genetic syndromes have a greater risk of pancreatic cancer. These syndromes include hereditary breast and ovarian cancer (BRCA1, BRCA2), Lynch syndrome, familial pancreatitis, Peutz-Jeghers syndrome, Von Hippel-Lindau syndrome, and familial atypical multiple mole melanoma (FAMMM) syndrome.

Diagnosis and Tests

The doctor will talk to you to find out more about your symptoms and what you are feeling and noticing. The doctor will also ask about your family’s health history. The doctor will examine you to check for jaundice and unusual bumps or swelling in your belly.

Once your doctor suspects that pancreatic cancer is possible, the doctor will have you get one or more these tests to diagnose it.

  • CT scan. CT scans usually show the pancreas clearly, so this test is often used to check for tumors on the pancreas. This scan uses x-rays to make pictures of the inside of the body. The doctor may do a special type of CT scan in which the patient receives an injection of dye before getting the scan.
  • Abdominal ultrasound. This ultrasound is done on the outside of the abdomen. The sound waves make a picture of the organs inside the abdomen. It is used to find a tumor.
  • Endoscopic ultrasound. For this ultrasound, the doctor looks inside the digestive tract with a thin tube that has a small ultrasound probe. After giving the patient anesthesia so they do not feel the procedure,the doctor puts the tube into the stomach and small intestine by passing it through the throat. The ultrasound can get very close to the pancreas, so this test is more accurate than an abdominal ultrasound. The scope can also have a small needle to get a biopsy of the tumor to find out if it’s cancerous.
  • MRI. This test makes pictures of the inside of the body by using a magnet and radio waves. CT scans rather than MRIs are usually preferred for finding pancreatic cancer, but the doctor may do some special MRI tests that check pancreatic and bile ducts.
  • PET scan. For a PET scan, the patient is given glucose (sugar) mixed with a small amount of radioactive material. The PET scanner can then find cancer cells because they use glucose faster than other cells.
  • Endoscopic retrograde cholangiopancreatography (ko-lan-jee-oh-pang-kree-uh-tog-ruh-fee) (ERCP): This test uses X-rays to look at the bile ducts, which are tubes that allow bile to go from the liver to the gallbladder to the small intestine. An endoscope (thin tube) goes through the throat down to the stomach and small intestine. A dye is put into the ducts and an X-ray is taken to see if the ducts are narrowed or blocked. The doctor may un-block the bile ducts during this procedure if needed.
  • Percutaneous transhepatic cholangiography (ko-lan-jee-og-ruh-fee) (PTC). For this test, dye is injected into the liver or bile ducts through a thin needle that’s put into the liver through the skin below the ribs. The doctor will do this test only if the ERCP can’t be done.
  • Blood tests. The doctor may take blood so the lab can look for signs of pancreatic cancer.
  • Biopsy. If any scan or image shows a tumor, the doctor will remove some or all of the tumor to see if it is cancerous.

Treatments

Treatment depends on the type of pancreatic cancer and how much it has spread. The list below shows some treatments that may be used:

  • Surgery to remove the tumor and all or part of the organs involved. This may include part or all of the pancreas, gallbladder, spleen, part of stomach, part of small intestine, and bile duct.
  • Radiation therapy to kill cancer cells or keep them from growing. This therapy uses high energy X-rays (radiation) aimed at cancer cells from outside or inside the body.
  • Chemotherapy to stop the cancer cells from growing. Chemotherapy may be delivered straight to the abdomen where the cancer is. Or it may go throughout the whole body if the cancer has spread.
  • Targeted therapy to attack cancer cells without hurting healthy cells. This therapy uses drugs (like erlotinib for pancreatic cancer) that block signals that tumors need in order to grow.

Prevention

There is no known way to prevent pancreatic cancer, but you can reduce your risk by

  • Maintaining a healthy weight
  • Not smoking
  • Limiting alcoholic drinks
  • Avoiding exposure to toxic chemicals