Pancreas Cancer Facts

The pancreas is an organ found in the abdomen, behind the stomach, and surrounded by the small intestine, liver, and spleen. It produces enzymes and hormones.

Most of the pancreas consists of the exocrine gland. This gland produces enzymes that aid in the breakdown of proteins and fats in foods. A small portion of the pancreas consists of endocrine cells. These cells produce insulin, a hormone that helps balance sugar levels in the blood.

When these cells begin to grow abnormally they can turn into tumors. Both the exocrine and endocrine cells can form tumors. While some tumors are not cancerous (benign), most tumors tend to be cancerous. These tumors often disrupt the normal activity of the cells and can also produce enzymes and hormones that may spread and harm other organs and body functions.

While it is a serious disease, pancreas cancer is rare. The American Cancer Society estimates that nearly 40,000 people in the United States (less than one-tenth of a percent of the population) will be diagnosed with a form of pancreas cancer.

Pancreas cancers are very difficult to detect and are often found in advanced forms. Very little is known about the cause of pancreas cancer, but it tends to be more prevalent in smokers. The majority of cases are found in people over the age of 60.

Most pancreas cancers do not produce symptoms until the cancer has spread to other parts of the body, therefore it is not found until the cancer has spread, making treatment difficult. Most pancreas cancers (tumors) grow large enough to cause extreme discomfort.

Types of Pancreas Cancer

While both portions of the pancreas can form cancer, the majority of cases are found in the exocrine cells. It is important to know in which portion of the pancreas the tumor has formed. There are different treatment strategies and prognoses for each type. Treatment strategies are more often determined by the stage, or how developed the cancer is than by where the cancer is found.

Most pancreas cancers begin in the ducts leading to the bile duct, which empties into the duodenum, the first section of the small intestine. These cancers are called nonendocrine cancers and account for 98 percent of all pancreas cancers. The most common of these types of cancer is adenocarcinoma. Nearly 95 percent of all pancreas cancers are adenocarcinomas.

Tumors found in the endocrine cells are known as islet cell tumors. These tumors are very rare (accounting for only 2 percent of all cases) and are often benign.

There are approximately 20 types of pancreas cancer tumors.

Nonendocrine pancreas cancers include:

Acinar cell carcinomas, which may produce excess amounts of the digestive enzymes normally produced by the pancreas
Denosquamous carcinomas, which are similar to adenocarcinomas because they form in glands
Giant cell tumors, which have unusually large "giant" cells
Mucinous cystadenocarcinomas, which have spaces within a spongy tumor filled with a thick fluid called mucin
Pancreaticoblastoma, which is usually seen in children when it occurs
Papillary epithelial neoplasms, which occurs mostly in young women in their teens and twenties

Endocrine cancers include:

Gastrinoma, which makes large amounts of a hormone called gastrin
Insulinoma, which makes too much of the hormone insulin and causes the body to store sugar instead of burning sugar for energy.

Symptoms

Pancreas cancer is hard to diagnose due to the lack of early warning signs. The disease has often advanced and spread to other parts of the body by the time it is found.

One of the most pronounced symptoms is pain in the upper abdomen and back. At times the cancer may also cause the gallbladder to swell. Because 80 percent of pancreas cancers occur in the head of the pancreas, where they can block the bile duct, jaundice (a yellowing of the skin, or whites of the eyes, and darkening of the urine) is often another sign. Weight loss often occurs when the cancer interferes with the food-processing functions of the pancreas, especially the digestion of fatty foods. This interference can cause stool to be pale and greasy. It can also cause vomiting and nausea after eating.

Diagnosis

No screening tests are available for cancers of the pancreas. CA 19-9, a molecule that is released into the blood cells by some pancreas tumor cells, can be useful in tracking the progression of the disease, but it is only 80 percent accurate in diagnosing pancreas cancer.

Traditionally, patients with pancreas cancer need exploratory surgery to determine whether removal of the pancreas is necessary. Often times this surgery needs six to eight weeks of recovery time, so doctors often opt for less invasive means. If pancreas cancer is suspected, certain imaging tests (pictures of the inside of the body) can be taken in order to make a diagnosis.

The following is a list of imaging tests used to find pancreas cancer:

Computed Tomography Scan (CT Scan) Shows cross-sectional pictures of the body. This test can help a doctor see if there is an abnormal growth on the pancreas.
Laparoscopy A specialized telescope with an attached camera is sent into the abdomen to view the pancreas and surrounding organs. This procedure can allow a doctor to directly view a tumor and help determine the next step.
Magnetic Resonance Imaging (MRI) For patients whose major blood vessels are compressed, or invaded by cancer, this special type of MRI allows the physician to get a picture of the pancreas ducts.
Endoscopic Retrograde Cholangiopancreatography (ERCP) A flexible tube is sent down the throat, through the stomach, and into the small intestine. ERCP can also be used to look at the pancreas; the doctor can inject dye into the tube, allowing the area to be seen more clearly on an X-ray. During an ERCP, the doctor may also put a fine needle or brush into the pancreas in order to take out cells for a biopsy. A needle inserted through the tube can also be used to alleviate jaundice.
Percuteanous Transhepatic Cholangiography (PTC) A thin needle is inserted into the liver through the right side; dye is injected into the bile ducts (in the liver) so that any blockages can be seen on an X-ray. To relieve jaundice, a fine tube is sometimes left on the right side of the liver so it can drain properly.

Risk Factors

Very little is known about the exact cause of pancreas cancer. Many studies have drawn links between the disease and various types of behaviors and genetic groups. There are many studies currently underway that are investigating what causes the DNA of a cell to suddenly tell it to become cancerous.

The following is a list of some of the behaviors and genetic groups that are prone to pancreas cancer more than others:

Smoking – Adenocarcinomas, the most common form of pancreas cancer, is two to three times more common in heavy smokers than in nonsmokers.
Age – While pancreas cancer is sometimes found in young people, the majority of cases are found in people over 60.
Gender – Men are more often diagnosed than women.
Ethnicity – African Americans, Ashkenazi Jews (Jews of European descent), and Native Hawaiians have been found to have the highest rates of pancreas cancer. Asians and Hispanics have been found to have the least.
Diet – A diet high in meats and fats has been linked to an increased risk of pancreas cancers.
Diabetes mellitus – Pancreas cancer has been found to be more common in people with diabetes.
Environment – Studies have shown that people with prolonged exposure to pesticides, dyes, petrochemicals, and other carcinogens are more likely to contract pancreas cancers.
Family history – People who have immediate family (mother, father, or siblings) that have been diagnosed with pancreas cancer are three times more likely to also be diagnosed. A family history of colon or ovarian cancer also increases the risk of pancreas cancer.