What is Pancreatic Cancer?
The pancreas is a gland deep in the abdomen, behind the stomach, that is part of the digestive and endocrine systems. It is situated near the liver, gallbladder (where bile is stored) and the beginning of the small intestine (duodenum). The pancreas makes juices that help with digestion (enzymes) as well as important hormones such as insulin that control the level of sugar in the bloodstream. Pancreatic Cancer is a condition in which cells grow abnormally and form a mass or tumor. Over time the mass continues to grow without heeding the body’s usual checkpoints. Not all masses are cancerous, benign conditions such as chronic pancreatitis and autoimmune pancreatitis can simulate cancer of the pancreas. Sometimes, although rare, instead of forming a solid mass, PC can begin as a collection of fluid known as a cyst (most cysts however are not cancerous, they are benign).
Unfortunately by the time most patients develop symptoms the cancer has become difficult to treat. Since the pancreas is near the drainage tubes for bile and digestive enzymes, a mass in the pancreas can block the flow of these substances into the small intestine. This can cause the skin and eyes to turn yellow (jaundice) and the stool to turn pale. It can also cause nausea, vomiting and itchy skin. It can invade the nerves that run through the lower spine and cause back pain. If the digestive enzymes are not able to flow freely or if the pancreas cannot make enough insulin, patients can develop diarrhea or diabetes (high levels of sugar in the blood).
Who is at risk?
While this is a relatively rare form of cancer, some people are more likely to develop it than others. Unfortunately most so called ‘risk factors’ cannot be changed, one main exception is smoking (smokers are up to three times more likely to develop Pancreatic Cancer than non-smokers). Other risk factors include age greater than 60, male gender, race (African Americans at higher risk), exposure to certain chemicals, or family history, having a close relative such as parent or sibling with Pancreatic Cancer. There is some evidence that middle aged patients with newly diagnosed diabetes or with a long history of chronic pancreatitis are also at some increased risk.
The symptoms can be confused with those of benign diseases such as arthritis (back pain), gallstones (jaundice) or chronic pancreatitis (pain, diarrhea, weight loss).
A variety of tests are used to detect and understand the extent or stage of the disease. It is important to detect Pancreatic Cancer at its earliest and most treatable stage. Precise staging helps determine what treatment course is best and what alternatives (such as participation in a clinical trial) might be appropriate. After a physical examination and some basic blood tests (may include a special test known as CA 19-9), most patients get scanned with a CT (computerized tomography) or “CAT” scan of the abdomen. CT scans and MRI (magnetic resonance imaging) provide a birds-eye view of the pancreas and neighboring organs.
A very important test, usually performed after a CT or MRI scan, is an endoscopic ultrasound (EUS). EUS allows specially trained gastroenterologists to obtain highly detailed pictures of the pancreas and to get a biopsy (fine needle aspiration). This technique, which is performed under deep sedation, takes about one hour and patients can go home the same day it is performed in most cases. It uses a thin, flexible camera (combined with a tiny ultrasound device) that is passed gently through the mouth and into the stomach and small bowel. If pain cannot be managed by standard pain medicines, EUS can be used to inject an anesthetic directly into the nerves that may be responsible for the pain (celiac neurolysis).
Another test that may be required is known as ERCP (endoscopic retrograde cholangiopancreatography). During this test a small optical scope is used to inject a dye into the ducts that drain bile and the pancreatic juices. It also allows doctors to insert a small tube (stent) if needed to relieve a blockage. Both EUS and ERCP are performed by gastroenterologists that have had additional training in the technique.
Although there are many options, ranging from special medicines (chemotherapy) and radiation to surgical removal, cancer of the pancreas remains very difficult to treat. In most cases it is only those patients with very early stage disease who can be cured by surgery. Regardless of stage, there are many types of treatment that can help patients live longer and improve their quality of life. As mentioned earlier, the type or types or treatment available depend on the stage of the disease and the overall health of the patient.
Surgery is the most invasive, and most definitive, treatment for PC. The type of surgery considered depends on the size, location and stage of the cancer.
Chemotherapy uses special medicines that target the cancer cells. One or a combination of such medicines is usually delivered by vein (intravenously) under the direction of a medical oncologist. Chemotherapy can sometimes kill normal cells as well and cause a variety of side effects. Oncologists are specially trained to help decide which drugs may be best and can help patients manage any side effects.
Radiation therapy (radiotherapy) uses high-energy X-rays to kill cancer cells. Radiation is directed by radiation oncologists and can be given alone or in combination with chemotherapy and surgery.