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The pancreas is really 2 separate glands inside the same organ. The exocrine gland makes pancreatic juice that has enzymes to break down fats and proteins in foods so the body can use them. Most of the cells in the pancreas are part of the exocrine system. A smaller number of cells in the pancreas are endocrine cells. These cells are arranged in clusters called islets (or islets of Langerhans). They make hormones (such as insulin) that help balance the amount of sugar in the blood.
Types of Pancreatic Tumors
Both the exocrine and endocrine cells of the pancreas can form tumors. But those formed by the exocrine pancreas are much more common. Not all of these tumors are cancer. A small number of tumors are benign (not cancer).
It is important to know whether a tumor is from the exocrine or endocrine part of the gland. Each type of tumor has distinct signs and symptoms, is found using different tests, is treated in different ways, and has a different outlook for survival (prognosis).
Tumors of the exocrine part of the gland are likely to be cancer. These cancers are called adenocarcinomas. About two thirds of these cancers are found in the head of the pancreas; the rest are in the tail.
A special type of cancer (ampullary cancer) can occur where the bile duct (from the liver) and the pancreatic duct empty into the small intestine. Because this type of cancer often causes signs such as yellowing of the skin and eyes, it is usually found at an earlier stage than most pancreatic cancers. Finding it early means that the chances of successful treatment are better.
The information in this section refers only to exocrine cancer and ampullary cancer.
Facts about Pancreatic Cancer,- Pancreatic cancer is very difficult to detect because there are currently no screenings available.
- The American Cancer Society predicts that, in 2006, about 33,730 people in the United States will be found to have pancreatic cancer and about 32,300 will die of the disease.
Risk Factors
We still do not know exactly what causes most cases of pancreatic cancer. Several risk factors have been linked to the disease.
Age: The risk of this cancer goes up with age. Almost 90% of patients are older than 55.
Gender: Men have this cancer more often than women.
Race: African Americans are more likely to have this cancer than are whites.
Smoking: The risk of this cancer is higher among smokers. Heavy smoking raises the risk 2 to 3 times. About 3 out of 10 cases of pancreatic cancer are thought to be caused by smoking.
Obesity: Very overweight people are 20% more likely to develop pancreatic cancer.
Diabetes: Pancreatic cancer is more common in people with this disease.
Family history: Cancer of the pancreas seems to run in some families. It seems to account for about 1 in 10 cases. Changes in DNA that increase the risk for certain other cancers also increase the risk of this cancer.
How is Pancreatic Cancer Found?
The following can be symptoms of pancreatic cancer:
Jaundice: A yellow color of the eyes and skin is called jaundice. It is caused by a buildup of a substance (bilirubin) that is made in the liver. At least half of all people with pancreatic cancer have jaundice. While jaundice can be a sign of cancer, more often it is caused by something else.
Pain: Pain in the belly area (abdomen) or in the middle of the back is a very common sign of advanced pancreatic cancer. Again, such pain is often caused by something other than cancer.
Weight loss: Losing weight (without trying) over a number of months is very common in patients with this cancer. They may also feel very tired and have a loss of appetite.
Digestive problems: If the cancer blocks the release of the pancreatic juice into the intestine, problems such as trouble breaking down fat can result. Stools might be pale, bulky, greasy, and float in the toilet. Other problems may include nausea, vomiting, and pain that tends to be worse after eating.
Diagnostic Tests
CT scan (computed tomography): This is a special type of x-ray that creates detailed pictures of the inside of the body. CT scans are useful in finding cancer and in seeing how far it has spread. CT scans can also be used to help guide a biopsy needle into the precise area that might be cancer (see below for more about biopsy).
PET scan (positron emission tomography): PET scans use a form of sugar that contains a radioactive atom. Cancer cells absorb large amounts of this sugar. A special camera can show where these cells are. This test is useful to see whether the cancer has spread to the lymph nodes or other places.
Ultrasound: This test uses sound waves to produce pictures of the inside of the body. The pictures are combined by a computer to give a detailed image. This test can help tell what kind of a tumor is in the pancreas. Endoscopic ultrasound is done with a probe placed through the mouth or nose into the stomach. The probe can be pointed toward the pancreas. This gives a very good picture and is better than CT scans for spotting small tumors. Patients are sedated for this type of ultrasound.
ERCP (endoscopic retrograde cholangiopancreatography): In this test, a flexible tube is passed down the throat, all the way into the small intestine. The doctor can see through the end of the tube and find where the common bile duct opens into the small intestine. A small amount of harmless dye is then injected through the tube into the ducts. This dye helps outline the ducts on x-rays. The pictures can show narrowed or blocked ducts that might be caused by a cancer of the pancreas. The doctor doing this test can also put a small brush through the tube to get cells to look at under a microscope to see whether they appear to be cancer.
Treatment
The treatment for pancreatic cancer is generally based upon the stage of the cancer and the general condition of the patient. Stage refers to how far the cancer has progressed. In early stages, (cancer is confined to the pancreas) in an otherwise healthy patient, there may be a role for surgery, chemotherapy and radiation therapy. In more advanced stages (e.g. cancer has spread to the liver) the appropriate treatment may be chemotherapy or radiation therapy alone. These decisions can be complex and should be explained by a treating physician.
Surgery
Surgery is often considered for patients with early stage pancreatic cancer. Surgery can be undertaken with the hope for cure, or may be offered as a means for alleviating symptoms. Surgery for pancreatic cancer does have risks and should be performed by an experienced pancreatic surgical specialist.
Chemotherapy
There are a number of different chemotherapy medications that can be used to treat pancreatic cancer. The selection of a particular type of chemotherapy is generally based upon the stage of the cancer and the overall physical condition of the patient. In some cases chemotherapy is given with radiation therapy with the goal of shrinking the cancer to make it amenable to surgical removal. This is known as "neoadjuvant chemoradiation". In other instances chemotherapy is given alone with the hope of shrinking the cancer and preventing or delaying cancer growth and spread. Chemotherapy alone is the most common method of treating pancreatic cancer once it has spread to other organs. Chemotherapy does have side effects, which should be discussed with your physician.
Radiation Therapy
In early stage pancreatic cancer radiation therapy is often used after successful surgery to treat the area around the pancreas with the goal of preventing a recurrence. Radiation therapy is also commonly used when the cancer cannot be surgically removed but is still confined to the area around the pancreas. In these two situations radiation therapy can be given together with chemotherapy, enhancing the effectiveness of the treatment. Special three-dimensional treatment planning techniques are required to ensure that the organs near the pancreas (e.g. kidneys and liver) are not damaged by the treatment. Radiation therapy can have side effects, which should be discussed with your physician.
Marin Cancer Institute Multidisciplinary Treatment for Pancreatic Cancer
The treatment of pancreatic cancer requires a group of specialist working together to offer any of a number of treatment combinations. At the Marin Cancer Institute we have partnered with surgical colleagues at UCSF and Stanford to offer the full range of diagnostic procedures and treatment options, including access to a large number of investigations treatments. Each case is presented at our Gastrointestinal Cancer Case Conference/Tumor Board to ensure that all of the available services are considered and the most appropriate treatments offered to each patient.
*Statistics provided by the American Cancer Society. Revised 4/28/06
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