What is parncreatic cancer?
Pancreas cancer is a disease in which cancerous (cancer) cells form in the tissues of the pancreas. The pancreas is a gland about 6 inches long that is shaped like a thin pear lying on its side. The wider end of the pancreas is called the head, the middle section is called the body, and the narrow end is called the tail. The pancreas lies behind the stomach and in front of the spine.
The pancreas has two main jobs in the body
- To produce juices that help digest (break down) food.
- To produce hormones, such as insulin and glucagon, that help control blood sugar levels. Both of these hormones help the body use and store the energy it gets from food.
The digestive juices are produced by exocrine pancreas cells and the hormones are produced by endocrine pancreas cells. About 95% of pancreas cancers begin in exocrine cells.
Smoking and pancreas cancer
The following are possible risk factors for pancreas cancer
Symptoms and signs of pancreas cancer
- Long-standing diabetes.
- Chronic pancreatitis.
- Certain hereditary conditions, such as hereditary pancreatitis, multiple endocrine neoplasia type 1 syndrome, hereditary nonpolyposis colon cancer (HNPCC; Lynch syndrome), von Hippel-Lindau syndrome, ataxia-telangiectasia, and the familial atypical multiple mole melanoma syndrome (FAMMM).
These and other symptoms may be caused by pancreas cancer. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems occur: .
Pancreas cancer is difficult to detect early
Pancreas cancer is difficult to detect and diagnose for the following reasons:
- Jaundice (yellowing of the skin and whites of the eyes).
- Pain in the upper or middle abdomen and back.
- Unexplained weight loss.
- Loss of appetite.
Diagnosis and staging of pancreas cancer
- There aren't any noticeable signs or symptoms in the early stages of pancreas cancer.
- The signs of pancreas cancer, when present, are like the signs of a number of other illnesses.
- The pancreas is hidden behind other organs such as the stomach, small intestine, liver, gallbladder, spleen, and bile ducts.
Pancreas cancer is commonly diagnosed with tests and procedures that produce pictures of the pancreas and the area around it. The process used to find out if cancer cells have spread within and around the pancreas is called staging. Tests and procedures to detect, diagnose, and stage pancreas cancer are commonly done at the same time. In order to plan therapy, it is important to know the stage of the disease and whether or not the pancreas cancer can be removed by surgery. The following tests and procedures may be used:
Treatment of pancreas cancer
- Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
- Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient's health habits and past illnesses and therapys will also be taken.
- Computerized axial tomography scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. A spiral or helical Computerized axial tomography scan makes a series of very detailed pictures of areas inside the body using an x-ray machine that scans the body in a spiral path.
- MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
- PET scan (positron emission tomography scan): A procedure to find cancerous tumor cells in the body. A small amount of radionuclide glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Cancerous tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells.
- Endoscopic ultrasound (EUS): A procedure in which an endoscope (a thin, lighted tube) is inserted into the body. The endoscope is used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. This procedure is also called endosonography.
- Laparoscopy: A surgical procedure to look at the organs inside the abdomen to check for signs of disease. Small incisions (cuts) are made in the wall of the abdomen and a laparoscope (a thin, lighted tube) is inserted into one of the incisions. Other instruments may be inserted through the same or other incisions to perform procedures such as removing organs or taking tissue samples for biopsy.
- Endoscopic retrograde cholangiopancreatography (ERCP): A procedure used to x-ray the ducts (tubes) that carry bile from the liver to the gallbladder and from the gallbladder to the small intestine. Sometimes pancreas cancer causes these ducts to narrow and block or slow the flow of bile, causing jaundice. An endoscope (a thin, lighted tube) is passed through the mouth, esophagus, and stomach into the first part of the small intestine. A catheter (a smaller tube) is then inserted through the endoscope into the pancreatic ducts. A dye is injected through the catheter into the ducts and an x-ray is taken. If the ducts are blocked by a tumor, a fine tube may be inserted into the duct to unblock it. This tube (or stent) may be left in place to keep the duct open. Tissue samples may also be taken.
- Percutaneous transhepatic cholangiography (PTC): A procedure used to x-ray the liver and bile ducts. A thin needle is inserted through the skin below the ribs and into the liver. Dye is injected into the liver or bile ducts and an x-ray is taken. If a blockage is found, a thin, flexible tube called a stent is sometimes left in the liver to drain bile into the small intestine or a collection bag outside the body. This test is done only if ERCP cannot be done.
- Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. There are several ways to do a biopsy for pancreas cancer. A fine needle may be inserted into the pancreas during an x-ray or ultrasound to remove cells. Tissue may also be removed during a laparoscopy (a surgical incision made in the wall of the abdomen).
Treatment of pancreatic cancer depends on the stage of the cancer. Recent advances have made resection of tumors that were previously unrescetable due to blood vessel involvement possible. The Whipple procedure is the most common surgical treatment for cancers involving the head of the pancreas.
Prognosis of pancreas cancer
The prognosis (chance of recovery) and therapy options depend on the following:
||Approx. % of cases
||Disease is confined to the pancreas and is clearly separated from surrounding blood vessels
||Surgery; postoperative chemotherapy and/or radiation may also be offered
||Disease encases or compresses surrounding blood vessels, or has directly extended into adjacent structures
||Chemotherapy (most commonly gemcitabine-based) and/or radiation. In very rare instances, cancers that respond well to initial treatment may subsequently be surgically resected.
||Evidence of extrapancreatic spread to distant organs (liver, lungs, etc.)
||Chemotherapy (most commonly gemcitabine-based); investigational trials
- Whether or not the tumor can be removed by surgery.
- The stage of the cancer (the size of the tumor and whether the cancer has spread outside the pancreas to nearby tissues or lymph nodes or to other places in the body).
- The patient's general health.
- Whether the cancer has just been diagnosed or has recurred (come back).
Pancreas cancer can be controlled only if it is found before it has spread, when it can be removed by surgery. If the cancer has spread, palliative therapy can improve the patient's quality of life by controlling the symptoms and complications of this disease.
Taking part in one of the clinical trials being done to improve therapy should be considered. Information about ongoing clinical trials is available from the NCI Web site.
Staging of pancreas cancer
In stage 0, the cancer is found only in the lining of the pancreas. Stage 0 is also called carcinoma in situ.
In stage I, cancer is found only in the pancreas. Stage I is divided into stage IA and stage IB, based on the size of the tumor.
- Stage IA: The tumor is 2 centimeters or smaller.
- Stage IB: The tumor is larger than 2 centimeters.
In stage II, cancer may have spread to nearby tissue and organs, and may have spread to lymph nodes near the pancreas. Stage II is divided into stage IIA and stage IIB, based on where the cancer has spread.
- Stage IIA: Cancer has spread to nearby tissue and organs but has not spread to nearby lymph nodes.
- Stage IIB: Cancer has spread to nearby lymph nodes and may have spread to nearby tissue and organs.
In stage III, cancer has spread to the major blood vessels near the pancreas and may have spread to nearby lymph nodes.
In stage IV, cancer may be of any size and has spread to distant organs, such as the liver, lung, and peritoneal cavity. It may have also spread to organs and tissues near the pancreas or to lymph nodes.
Recurrent Pancreatic Cancer
Recurrent pancreas cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the pancreas or in other parts of the body.