The pancreas is a pear shaped gland stretching lengthwise across the abdomen between the spine and the stomach. The pancreas has two major functions. It releases hormones into the bloodstream, most notably insulin, and also produces enzymes, which break down fats and proteins to help digest food. Ducts carry the enzymes through the pancreas where they are emptied into the small intestine. The most common place for cancer to occur is in the ducts that transport enzymes to the small intestine. Cancer also arises in glandular tissue of the pancreas, in the cells that make hormones.

Risk Factors

  • Most patients are over the age of 50
  • Men are more frequently diagnosed than women
  • Cigarette smokers are two to three times more likely than nonsmokers to develop pancreatic cancer
  • Family history of pancreatic, colon or ovarian cancer, diabetes, and chronic pancreatitis
  • African-Americans are more likely to get pancreatic cancer
  • Exposure to some chemicals
  • Diet high in fats
  • Family history of BRCA+ breast cancer

Symptoms

Early stage pancreatic cancer is particularly difficult to detect and treat because it exhibits very few notable symptoms. Those who suffer from pancreatic cancer may experience the following symptoms:

  • Weight loss
  • Loss of appetite
  • Nausea and vomiting
  • Pain in the upper abdomen and back
  • Jaundice, a condition causing darkened urine or yellow eyes and skin

Detection and Diagnosis

A physical examination usually is the first step towards diagnosis. When a patient exhibits symptoms, the physician will feel the abdomen for changes in the area around the pancreas, liver, and gallbladder and for abnormal fluid swelling in the abdomen, called ascites. Blood, urine and stool samples may be checked for bilirubin, a buildup which can occur from the blockage of the common bile duct by a tumor. Tumor markers, proteins that appear in the blood at the time of cancer, can be helpful for diagnosis and follow-up.

A computerized tomography (CT) scan is a type of X-ray that can take very detailed pictures. The CT scan is used to find tumors in the pancreas, lymph nodes and liver and can also detect a blocked bile duct. 

An ultrasound utilizes inaudible sound waves, which bounce off internal organs and create a picture of the internal body. Two kinds of ultrasound procedures are employed at the possibility of pancreatic cancer: external or internal. Externally an ultrasound device is placed on the abdomen, which is referred to as a transabdominal ultrasound. Internally, in an endoscopic ultrasound (EUS) an endoscope, or a thin tube with an ultrasound device at the end, is inserted into the body via the mouth through to the small intestine. An ultrasound device is at the end of the tube.

In an endoscopic retrograde cholangiopancreatography (ERCP), an endoscope, or thin tube, is passed through the body through the mouth. The physician can see through the tube as it is pushed towards the small intestine, where then a smaller tube, called a catheter, is inserted through the endoscope. The catheter releases harmless dye that outlines the structure of the ducts. An x-ray is taken showing whether the ducts are blocked or narrowed.

In a percutaneous transhepatic cholangiography (PTC), harmless dye is injected to the liver through the skin. An X-ray is taken showing if or where there are blockages in the bile ducts, which can indicate tumorous growth.

In a biopsy, a piece of tissue is extracted from the pancreas and examined under a microscope by a pathologist. 

Positron Emission Tomography (PET) uses a radioactive material called a tracer to highlight areas of concern and help determine if the cancer can be removed surgically.

Treatment Options for Pancreatic Cancer

A Whipple procedure, or pancreaticoduodenectomy, is a surgical procedure performed to treat pancreatic cancer and other disorders of the pancreas, intestine and bile duct such as pancreatitis and bile duct cancer. It is the most common surgery used to remove cancer that is in the head of the pancreas. The goal of the procedure is to remove the tumor and thus prevent it from getting larger or spreading to other organs.

The operation is typically performed by making a large incision down the middle of the abdomen, but it can also be done laparoscopically, using smaller incisions and special instruments including a camera. Once inside, the surgeon removes the head of the pancreas. The body of the pancreas may also be removed, as well as other nearby organs such as part of the small intestine, part of the bile duct, the gallbladder, lymph nodes and part of the stomach. The surgeon then attaches the remaining bile duct and pancreas to the small intestine so bile and digestive enzymes can still flow into the small intestine. To ensure food can pass through the digestive tract, the end pieces of the small intestine are reattached.

A Whipple procedure is a very complex and demanding operation that has a relatively high risk of life-threatening complications. To get the best outcome, the procedure must be performed by highly skilled and experienced surgeons. Despite the risks, the procedure is often lifesaving and is the only known cure for most pancreatic tumors and cancers.

Surgery can also relieve blockages of the bile duct and duodenum without removing tumors. A bypass or stent, a plastic or metal tube, can keep pathways propped open.

Radiation therapy kills cancer cells with intense x-rays aimed only at the cancerous growth. Radiation can be emitted from outside the patient's body or radioactive materials can be placed internally to the targeted area. Side effects from radiation therapy include loss of appetite, fatigue, nausea, vomiting and problems with digestion.

Chemotherapy involves taking drugs which kill cells that are growing rapidly, thus noncancerous cells can be killed as well. Side effects vary by type of drug but in general, hair loss, nausea, vomiting, diarrhea, loss of appetite, sores on the mouth and the lips and a lower resistance to infection are expected.

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