Pancreatic Cancer

Pancreatic cancer at a glance

• Pancreatic cancer occurs when cells grow abnormally in the pancreas and often become cancerous tumors.
• This type of cancer occurs rarely, comprising only 3 percent of all cancer cases, yet according to the National Cancer Institute it is one of the leading causes of cancer deaths in the United States.
• Physicians have difficulty detecting symptoms of pancreatic cancer, which leads to many late-stage diagnoses and the high rate of deaths from the cancer.
• Treatment for pancreatic cancer includes surgery, radiation and chemotherapy.

Pancreatic cancer

The pancreas where pancreatic cancer occurs is a small organ, about six inches by two inches, located behind the stomach. The pancreas produces enzymes that aid in food digestion and carry bile from the liver to the small intestine.

When pancreatic cells begin to grow out of control and don’t die as normal cells do, they become cancerous, most often forming tumors. Pancreatic tumors can be either benign or cancerous.

The two types of pancreatic cancer are adenocarcinoma and islet cell cancer. Adenocarcinoma begins in the ducts of the pancreas. Islet cell cancer, also known as pancreatic endocrine cancer, occurs in the enzyme-producing cells of the pancreas. Islet cell cancer is rare, only occurring in approximately 5 percent of pancreatic cancer cases.

According to the NCI, only about 3 percent of cancers diagnosed in the U.S. are pancreatic. Yet, it is one of the deadliest cancers in American men and women behind lung cancer, prostate cancer and breast cancer.

This cancer has such a high death rate because it is often not diagnosed until the later stages of the disease. This is due to the lack of symptoms the cancer causes during its early stages. Also, because the pancreas is located behind other organs, doctors cannot feel a tumor during a routine physical exam.

Pancreatic cancer causes

Scientists and doctors know that mutations in the DNA of pancreatic cells cause this cancer, but they don’t know exactly what causes the mutations. DNA mutations affect cells differently depending on where in the body they occur. In the case of pancreatic cancer, the DNA mutations cause cells to multiply rapidly and live longer than normal. These cells then can cause a tumor over time.

Oncologists know that certain factors may put a person at higher risk for pancreatic cancer. These risk factors include:

• Tobacco smoking
• Obesity
• Diabetes
• Pancreatitis, a chronic inflammation of the pancreas
• African-American race
• Family history of pancreatic cancer
• Genetic diseases such as Lynch syndrome or presence of the BRCA2 gene mutation.

Due to the liver and pancreas being so closely connected, cirrhosis of the liver may be linked to pancreatic cancer. Other possible causes include heavy alcohol use, a diet high in red and processed meats, and exposure to certain environmental elements such as pesticides and chemicals.

Symptoms & diagnosis

Pancreatic cancer often goes undiagnosed in its early stages because symptoms can be nonexistent or extremely vague. Symptoms may include pain in the abdomen, fatigue, weight loss and jaundice (yellowing of the skin and the whites of the eyes).

Because doctors cannot feel or diagnose pancreatic tumors during a physical exam, a combination of blood tests, imaging tests and biopsies are needed to diagnose pancreatic cancer.

Blood tests alone cannot diagnose pancreatic cancer. Oncologists use imaging tests such as sonogram, magnetic resonance imaging (MRI), computed tomography (CT) and proton emission tomography (PET) scans to confirm diagnosis.

Once doctors diagnose pancreatic cancer, they use the imaging scans or a biopsy to determine the extent or stage of the cancer.

Pancreatic cancer stages

Pancreatic cancer can be classified into four stages, varying in degree of tumor size and number of other organs involved.

• • Stage 1: Cancer only in the pancreas
    • Stage 1A: Cancer is smaller than 2 cm
    • Stage 1B: Cancer is larger than 2 cm
  • Stage 2: Cancer has grown into tissue near the pancreas
    • Stage 2A: Cancer may have grown to other tissue, but is not in any blood vessels or lymph nodes.
    • Stage 2B: Cancer may be any size and has grown to other tissue and some nearby lymph nodes. The cancer has not yet involved any major blood vessels.
  • Stage 3: Cancer has grown outside the pancreas, affects major blood vessels and may or may not involve nearby lymph nodes. Stage 3 pancreatic cancer may be referred to as locally advanced cancer.
  • Stage 4: Cancer, sometimes referred to as advanced cancer, has spread to other areas of the body such as the lungs or liver.

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Pancreatic cancer treatments

The type, adenocarcinoma or islet cell, and stage of pancreatic cancer will determine which treatment method oncologists use. Treatment methods include surgery, chemotherapy, radiation chemoradiation therapy and targeted therapy.

Surgery

Surgery is typically used to treat early stage pancreatic cancer. The Whipple procedure is the most common surgery and involves the surgeon removing the cancerous portion of the pancreas, the gall bladder, and portions of the small intestine and stomach.

Other surgical procedures include distal and total pancreatectomy. During a distal pancreatectomy the surgeon will remove parts of the pancreas and the spleen. A total pancreatectomy involves the removal of the entire pancreas, the gall bladder, the spleen, the common bile duct, parts of the small intestine and nearby lymph nodes.

Chemotherapy and radiation

Chemotherapy and radiation are recommended for later stage pancreatic cancer, when surgery is not an option.

Chemotherapy, also called “chemo,” uses medicine to treat cancer. Chemo keeps the cancer from spreading by slowing the growth of and killing cancer cells. Oncologists generally administer chemotherapy systemically, meaning through the entire body via injection into the blood or muscles or via oral pill. They may also implant chemo medication inserts next to the cancer.

Chemotherapy may be the only treatment needed for certain cancers, but it is often used in conjunction with surgery and radiation as part of a cancer treatment plan. Common chemo side effects include:

• Hair loss
• Nausea and vomiting
• Skin issues such as acne, dryness or redness
• Dental issues.

Radiation uses high energy to kill cancer cells and shrink tumors. X-rays, gamma rays and charged particles are all types of energy that can be used to treat cancer. Radiation is often used with chemotherapy and surgery as part of a cancer treatment plan. The risks and side effects of radiation differ depending on the area of the body that is targeted.

Risks of radiation to treat pancreatic cancer include:

• Fatigue
• Nausea and vomiting
• Skin irritation
• Urinary incontinence
• Fibrosis.

Although chemo and radiation are designed to kill cancer cells, they also have the ability to damage healthy cells, which often causes the side effects listed above. Healthy cells often have the ability to grow back over time.