Pancreatic Cancer

Pancreatic cancer begins in the tissues of the pancreas, an organ in the abdomen that lies horizontally behind the lower part of the stomach. This cancer typically spreads rapidly to nearby organs and is seldom detected in its early stages. An estimated 55,000 people will be diagnosed with pancreatic cancer in the United States this year.

Signs and symptoms of pancreatic cancer usually don’t occur until the disease is advanced, but some of these signs include: pain in the upper abdomen that radiates to the back; loss of appetite or unintended weight loss; dark urine or light-colored stool; depression; new-onset diabetes; blood clots; yellowing of your skin and the whites of your eyes (jaundice).

Risk factors for this disease include chronic inflammation of the pancreas (pancreatitis), diabetes, smoking, obesity and an increase in age. In fact, the combination of smoking, poor diet and long-standing diabetes poses the greatest risk of developing the disease. People with a family history of genetic syndromes, such as a BRCA2 gene mutation, Lynch syndrome and familial atypical mole-malignant melanoma (FAMMM) syndrome are also at an increased risk.

Physical exams, blood tests, scans such as MRI, CT and PET scans, ultrasounds and biopsies are often used to diagnosis pancreatic cancer. A procedure called ERCP may be performed to see if the ducts (tubes) that carry bile from the liver to the gallbladder and then on to the small intestine are blocked. Pancreatic cancer can often cause the ducts to narrow. If an ERCP cannot be performed, another procedure called PTC may take its place in which the liver and bile ducts are checked for blockages.

Staging for pancreatic cancer is described by a numerical system of 0 to 4.

Stage 0– cancer is confined to top layers of pancreatic duct cells only and has not invaded deeper tissues.

Stage I– cancer is confined to the pancreas and is no larger than 2 centimeters, or cancer is between 2-4 centimeters and still confined to the pancreas.

Stage II– cancer is confined to the pancreas and is larger than 4 centimeters, or cancer is between 2-4 centimeters and it has spread only to surrounding lymph nodes.

Stage III– cancer is any size in the pancreas and has spread to lymph nodes but not to distant sites, or cancer is growing outside of the pancreas into nearby blood vessels and the cancer may or may not have spread to nearby lymph nodes and has not spread to distant sites.

Stage IV– cancer may be any size and may or may not have spread to lymph nodes and has to spread to distant sites such as the liver, lungs or bones.

Treatment for pancreatic cancer depends on the stage and location of the cancer. The first goal of pancreatic cancer treatment is to eliminate the cancer, but when that isn’t an option, the focus may be to prevent the cancer from growing or causing more harm. Treatment plans typically include surgery, radiation, chemotherapy, targeted therapy or a combination of these.

Surgery is an option for patients with an early stage of pancreatic cancer, when part or all of the pancreas can be removed. The most common type of surgery for this disease is called a Whipple procedure, in which a tumor in the head of the pancreas is removed and the remaining parts of the pancreas are reconnected to the stomach and intestines. Other surgery may involve removing the entire pancreas, and possibly other nearby tissues and organs such as the gallbladder, duodenum, bile ducts, spleen, lymph nodes and parts of the stomach. Because pancreatic surgeries are major operations, longer hospital stays and treatment for pain management can also be expected.