More than 46,000 patients will be diagnosed this year with pancreatic cancer, a malignancy that nearly always affects patients older than age 45, according to the National Cancer Institute. Pancreatic cancer represents less than 3% of new cancers found in a single year. It occurs more in African Americans than in other races, and is more common in men than in women. Patients whose cancer is confined to the pancreas or whose cancer has spread only to regional lymph nodes have a greater chance for survival of 5 years or more.
Exocrine glands in the pancreas produce enzymes that help break down food. Endocrine glands in the pancreas produce hormones such as insulin that balance blood glucose levels. Cancer found in the exocrine cells is more common than those found in endocrine cells. Exocrine tumors usually begin with adenocarcinomas. Endocrine tumors are more likely to be benign, and those that are malignant are more likely to respond to treatment.
Risk factors for pancreatic cancer include tobacco use, obesity, diabetes, chronic pancreatitis, cirrhosis of the liver, Helicobacter pylori infection causing stomach ulcers, and workplace exposure to certain pesticides, dyes, and chemicals used in metal refining. Unavoidable risk factors include advanced age, family history, and inherited genetic mutations.
Symptoms of pancreatic cancer are difficult to detect because the pancreas is deep inside the abdomen, where tumors cannot be seen or felt during a routine examination. Symptoms are more likely to occur after pancreatic cancer has spread to nearby organs or tissues. Jaundice, belly or back pain, digestive problems, a swollen gallbladder, uneven texture of fatty tissue under the skin, and unexplained weight loss may be signs of pancreatic cancer that should be evaluated by a physician.
No routine screening tests are available that look for pancreatic cancer in people who have no symptoms and no history of the disease. The tumor markers CA 19-9 and carcinoembryonic antigen (CEA) are linked to pancreatic cancer, but their presence or absence in the blood cannot confirm or deny the disease, only suggest its likelihood. Patients with a strong genetic risk or family history, however, may consider undergoing an endoscopic ultrasound to search for tumors at an early stage.
Imaging tests, including computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET) scans, or combined PET/CT scans can help determine if and where cancer has spread, helping doctors make informed decisions about possible treatment approaches. Endoscopic or abdominal ultrasound may help distinguish issues between the liver and the pancreas. Cholangiopancreatography uses contrast dye, imaging techniques, and sometimes hollow needles or scopes to see if pancreatic and bile ducts are blocked or damaged; if ducts are blocked by pressing tumors, stents may be placed in them to improve function.
Typically, a biopsy is performed to confirm the presence of pancreatic cancer cells. In some cases, if imaging studies and other diagnostic tests are extremely predictive of pancreatic cancer that may be surgically removed, surgeons may elect to proceed with surgery and confirm diagnosis with a sample of the tissue that is removed.
Very few pancreatic cancers are localized to the pancreas when they are found. If studies suggest all the cancer can be removed surgically, doctors may perform removal of parts of the pancreas or the more complex Whipple procedure, which removes parts of the pancreas, small intestine, bile duct, the entire gallbladder, nearby lymph nodes, and sometimes parts of the stomach. If cancer is too widespread to be treated surgically, surgeons may suggest operations to relieve problems with digestion and discomfort by clearing blockage of the bile duct.
Ablation procedures – destroying tumors with extreme heat or cold – may also relieve discomfort from pancreatic cancer that has spread. Radiofrequency ablation procedures insert a needle with an electrical current directly into a kidney tumor to heat and destroy cancer cells. During cryosurgery, a physician uses CT or ultrasound for guidance to insert a metal probe through a small incision to freeze cancer cells.
Embolization may delay the progression of tumors and alleviate discomfort from pancreatic cancer that has spread by injecting substances that block blood flow to cancer cells. The technique may be combined with chemotherapy or radiation therapy.
Radiation therapy may be administered alone to treat pancreatic cancer, used before or after surgery, or employed to relieve associated symptoms. External beam radiation may cause skin irritation, fatigue, and diarrhea. Internal radiation therapy using implanted radioactive seeds may also cause bleeding, infection, or risk of injury to healthy tissue.
Chemotherapy may be used alone or in combination with surgery and/or radiation. It may be given on a specific schedule orally or through the bloodstream. Drugs may shrink tumors or prevent them from growing and causing side effects, such as abdominal pain from bile duct blockage Side effects during treatment may include fatigue, nausea, vomiting, risk of infection, hair loss, loss of appetite, and diarrhea. Chemotherapy may be combined with targeted therapy to treat different aspects of advanced pancreatic cancer.
Long-acting opiates taken on a regular schedule and some surgical procedures can help control pain associated with pancreatic cancer. Follow-up imaging studies after treatment are key to monitoring signs and symptoms of cancer recurrence or progression.
The Pancreatic Cancer Action Network has a patient and liaison services program that provides free information about treatment options, support resources, specialist physicians, managing side effects, and more. Visit www.pancan.org or call an associate directly from 7 am to 5 pm PST Monday – Friday at 1-877-272-6226.