X-Plain Pancreatic Cancer Reference Summary Introduction Pancreatic cancer is the 4th leading cause of cancer deaths in the U.S. About 37,000 new cases of pancreatic cancer are diagnosed each year in the United States. Cancer of the pancreas is a disease that affects the pancreas and sometimes surrounding organs in the abdomen. It is occasionally curable, if found early. This reference summary will help you understand what pancreatic cancer is and how you can reduce your chances of getting it. The Pancreas The pancreas is located in the abdomen, behind the bowels and in front of the spine. The pancreas has 2 main functions: To secrete special digestive juices that help digest the food we eat. To secrete special substances, called hormones, into the blood. Insulin is the name of the most important hormone; it helps control the level of sugar in the blood. Pancreas Digestive juices from the pancreas are secreted into the first part of the small intestines, called the duodenum, through the pancreatic duct. The pancreatic duct is joined by the common bile duct on its way to the duodenum. Liver Gall Bladder Dudodenum Cystic Duct Stomach Common Bile Duct Pancreas 1
The common bile duct carries liver juices, which are called bile, from the liver and gall bladder to the duodenum. Cancer & Its Causes The body is made up of very small cells. Normal cells in the body grow and die in a controlled way. Sometimes cells keep dividing and growing without normal controls, causing an abnormal growth called a tumor. If the tumor does not invade nearby tissues and body parts, it is called a benign tumor, or non-cancerous growth. Benign tumors are almost never life threatening. If the tumor invades and destroys nearby cells, it is called a malignant tumor, or cancer. Cancer can sometimes be life threatening. Cancerous cells sometimes spread to different parts of the body through blood vessels and lymph channels. Lymph is a clear fluid produced by the body that drains waste from cells. It travels through special vessels and bean-shaped structures called lymph nodes. Cancer treatments are used to kill or control abnormally growing cancerous cells. Cancers in the body are given names, depending on where the cancer started. Cancer that begins in the pancreas will always be called pancreatic cancer, even if it has spread to other places in the body. Although doctors can locate where a cancer started, the cause of cancer in an individual patient cannot usually be identified. Cells contain hereditary, or genetic, materials called chromosomes. Chromosomes control the growth of cells. Cancer always arises from changes that occur in the chromosomes. When the chromosomes in a cell become abnormal, the cell can lose the ability to control its growth. Sudden changes in genetic material can happen for a variety of reasons. These changes are sometimes inherited. Changes in chromosomes may also occur as a result of exposure to infections, drugs, tobacco, chemicals, or other factors. 2
Pancreatic Cancer Pancreatic cancer is more common in men than women. People who smoke and eat high fat diets are at a higher risk of developing pancreatic cancer. People who develop sugar diabetes in their 50 s and do not have a family history of diabetes must be checked for pancreatic cancer. Most pancreatic cancer begins in the ducts that carry digestive juices. A rare type of pancreatic cancer can begin in the cells that produce insulin and other hormones. These cells are called islet cells and the cancer is called islet cell cancer. As pancreatic cancer grows, the cancer cells invade other tissues surrounding the pancreas, such as the stomach and small intestine. This is called metastasis. When pancreatic cancer metastasizes, or invades other areas of the body, it tends to go to the lymph nodes of the abdomen and to the liver. Sometimes it also goes to the lungs and bones. Signs & Symptoms Unfortunately, pancreatic cancer tends to have very few early symptoms. As it grows, it can cause major abdominal and back pain. If a tumor is located close to the common bile duct, the duct can become blocked. When the bile duct is blocked, bile can get backed up. Bile is a yellow substance that is secreted by the liver. If bile gets backed up, the skin will turn a yellow color; this is called jaundice. The urine also becomes darker since there is more bile product in it. The stools become chalky white, because they do not contain any yellow bile. When bile gets backed up, the body may feel itchy all over. Diagnosis If there is a possibility that a patient has pancreatic cancer, an abdominal CAT scan is usually done. This allows the doctor to check the pancreas and the rest of the abdomen. 3
A CAT scan helps to determine if there is a tumor in the pancreas. It also helps the doctor to find out if the tumor has spread to other parts of the abdomen. Pancreatic cancer will usually metastasize to the liver or lymph nodes first. A biopsy may need to be done to determine if a tumor seen on a CAT scan is cancerous or not. To do a biopsy, a small piece of the tumor must be taken out and a pathologist looks at it under a microscope. Abnormal CAT Scan A biopsy is usually done using a small needle under CAT scan guidance. A biopsy can also be done using a scope that is passed through the mouth, to the stomach, and up the pancreatic duct to reach the tumor. Sometimes other biopsy methods can be used, such as open surgery. The doctor may recommend other radiologic tests to determine whether the cancer can be removed. Treatment Cancer of the pancreas can be cured only when the disease is found early. However, since this disease is silent, most patients find out that they have cancer after it has spread and has become hard to control. Even when treatment options cannot cure pancreatic cancer, treatment can control the pain and complications. Which treatment the doctor chooses depends on: The type and size of cancer The stage of the cancer and how far it has spread The patient s age and health Other factors The doctor may use only 1 or a combination of the following treatment plans: Surgery Chemotherapy Radiation therapy Biological therapy 4
The main way to treat pancreatic cancer is surgery. There are 2 main reasons for surgery. 1. To get tissue samples that show whether the growth is cancerous; this is a biopsy. 2. To take the whole tumor out, if possible. Sometimes during surgery it is hard to tell whether or not a tumor is cancerous. In a case like this, the surgeon would just remove the tumor, even though it may not be cancerous. If the cancer has already spread to other parts of the body, an operation to take the whole tumor out might not help. In a case like this, the surgeon might decide to do another operation to reroute the bile duct; this would decrease the chance of jaundice later on. If the doctor decides that it is impossible to remove the cancer surgically and the patient has jaundice, the doctor may recommend putting a catheter in the common bile duct to relieve the obstruction. A catheter would allow the bile to either flow into the duodenum or into a special bag on the outside of the body. The catheter can be inserted into the common bile duct with a scope through the mouth or into the skin under radiological guidance. Catheter Common Bile Duct Radiation therapy can also be used to treat pancreatic cancer. Radiation therapy uses high-energy rays to kill cancer cells and stop them from growing and spreading. The radiation that treats pancreatic cancer comes from a machine that aims the rays at a specific area of the body. Pancreatic cancer patients usually receive radiation therapy as an outpatient in a hospital or clinic. It must be given 5 days a week for several weeks. Outpatient means that the patient goes home after each treatment. Chemotherapy is the use of powerful drugs that kill cancer cells. When cancer can be removed, doctors sometimes give chemotherapy after surgery; this helps control the growth of any 5
cancer cells that might still be in the body. Chemotherapy can also be given if a patient cannot have surgery. Chemotherapy drugs are either given by injection or in the form of tablets by mouth. Usually chemotherapy is an outpatient treatment. New treatments are being developed, like treatment that enhances the body s ability to fight disease and cancer. These treatments are called biological treatments. Pain Management Pancreatic cancer can be very painful. However, recent medical advances have made it possible to control pain and make it bearable. There are many ways to control pain. Narcotic medication, such as morphine, can be given by mouth. These and similar medications can also be given through an IV or through a patch, similar to nicotine patches used by smokers who are trying to quit smoking. Morphine Pump If none of these methods help, morphine can be given around the nerves in the spine using specialized pumps. There are also ways to numb or destroy the nerves that create pain in the area of the pancreas. Summary Pancreatic cancer is a very serious disease. Without treatment, few patients live longer than one year after the cancer is found. Thanks to medical advances, with prompt treatment many pancreatic cancer patients can live several more years. This depends on the type of cancer, in addition to the patient s health condition and age. Some surgical treatment can cure cancer of the pancreas, if discovered early. For patients with advanced stages of pancreatic cancer, treatment options are available to reduce pain, complications, and the spread of the cancer. 6