About Pancreatic Cancer

Risk Factors
Very little is known about the exact cause of pancreatic 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 pancreatic cancer more than others:

• Smoking – Adenocarcinomas, the most common form of pancreatic cancer, is two to three times more common in heavy smokers than in nonsmokers.
• Age – While pancreactic 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 pancreatic 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 pancreatic cancers.
• Diabetes mellitus – Pancreatic 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 pancreatic cancers.
• Family history – People who have immediate family (mother, father, or siblings) that have been diagnosed with pancreatic cancer are three times more likely to also be diagnosed. A family history of colon or ovarian cancer also increases the risk of pancreatic cancer.

Symptoms
Pancreatic 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 pancreatic 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 pancreatic tumor cells, can be useful in tracking the progression of the disease, but is only 80 percent accurate in diagnosing pancreatic cancer.

Traditionally, patients with pancreatic 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 pancreatic 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 pancreatic 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 pancreatic 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.

Treatment
Pancreatic cancer is difficult to diagnose and is often found to be in advanced stages. In most cases the cancer has spread from the pancreas into the surrounding organs. Due to these facts, pancreatic cancer is difficult to treat. It is rare for a person diagnosed to achieve a full recovery.

Most treatment plans are aimed at managing the disease, attempting pain control pain, and prolonging life. Most patients undergo surgery (removal of the cancerous tissue), radiation therapy (using high energy rays to kill cancer cells), and/or chemotherapy (using drugs to kill cancer cells). There are some clinical studies underway that use stem cells and other biological treatments to help boost the immune system and protect the body from chemo and radiation therapy side effects.

Surgery
Two types of surgery can be used in treating pancreatic cancer. If the cancer is found to be contained in the pancreas and has not spread to other organs, the pancreas is often totally removed. This surgery is known as the Whipple procedure. The head if the pancreas and parts of the stomach, gallbladder, and small intestine are removed. Some nearby lymph nodes and the common bile duct are also sometimes removed. The patient is often then treated with chemo or radiation therapy to ensure that the body is free of cancer.

Only 10 percent of diagnosed pancreatic cancer is considered to be contained within the pancreas.

When the cancer has spread the next step is to perform what is called palliative surgery. This surgery is often used to relieve symptoms and pain. The most common goal of this surgery is to unblock the bile duct. This often reduces pain and allows the patient to avoid other associated problems. This surgery is often used in conjunction with chemotherapy and radiation therapy. These approaches rarely result in a full cure and most often are aimed at prolonging life and comfort.

Radiation Therapy
Radiation therapy, usually used in combination with chemotherapy, is often used after surgery to help destroy cancer cells in the tissue from where the tumor was removed. Radiation therapy is also used to help slow the spread of cancer cells to other parts of the body. The most common form of radiation therapy is External Beam Radiation Therapy. At times, a doctor will choose to use Intraoperative Radiation Therapy while still in the operating room, after a tumor has been removed. 

Follow-Up After Treatment
As part of the Survivorship Program at SCCA, a clinic has been developed for general medical oncology survivors treated with conventional therapy. This clinic is the Medical Oncology Survivorship Team (MOST). For more information about the MOST program, click here.

The Cancer Profiler
For more specific information about a specific type and stage of cancer, please try The Cancer Profiler, a free interactive decision support tool brought to you by the Seattle Cancer Care Alliance (SCCA) and NexCura, Inc. The Cancer Profiler enables cancer patients and their physicians to make better informed treatment decisions using information from evidence-based, peer-reviewed medical literature.

 

August 2007