Pancreatic Cancer

Pancreatic cancer arises when cells in the pancreas, a glandular organ behind the stomach, begin to multiply out of control and form a mass.

Signs & Symptoms:

• Pain in the stomach or back
• Jaundice
• Weight loss
• Bowel problems
• Nausea and vomiting
• Indigestion / Heartburn
• Fever and shivering
• Diabetes
• Other symptoms can include
• Extreme tiredness / fatigue
• Feeling unusually full after food
• Venous thromboembolism (blood clots that form in a vein)
• Unexplained acute pancreatitis (inflammation of the pancreas).

Risk Factors:

• Smoking
• Overweight and obesity
• Workplace exposure to certain chemicals
• Age
• Gender
• Race
• Family history
• Genetic syndromes
• Diabetes
• Chronic pancreatitis
• Cirrhosis of the liver
• Stomach problems
• Diet
• Physical inactivity
• Coffee
• Alcohol

Common Types:

• Exocrine Tumors
• Endocrine Tumors

Diagnosis:

• Medical history and physical exam
• Imaging tests
• Computed tomography (CT) scan
• Magnetic resonance imaging (MRI)
• MR cholangiopancreatography (MRCP)
• MR angiography (MRA)
• Ultrasound
• Magnetic resonance cholangiopancreatography (MRCP)
• Somatostatin receptor scintigraphy (SRS)
• Positron emission tomography (PET) scan
• Angiography
• Blood tests
• Biopsy

Stages:

• Stage 0:
  The tumor is confined to the top layers of pancreatic duct cells and has not invaded deeper tissues. It has not spread outside of the pancreas. These tumors are sometimes referred to as pancreatic carcinoma in situ
• Stage IA:
  The tumor is confined to the pancreas and is 2 cm across or smaller. It has not spread to nearby lymph nodes or distant sites
• Stage IB:
  The tumor is confined to the pancreas and is larger than 2 cm across. It has not spread to nearby lymph nodes or distant sites
• Stage IIA:
  The tumor is growing outside the pancreas but not into major blood vessels or nerves. It has not spread to nearby lymph nodes or distant sites
• Stage IIB:
  The tumor is either confined to the pancreas or growing outside the pancreas but not into major blood vessels or nerves. It has spread to nearby lymph nodes but not to distant sites
• Stage III:
  The tumor is growing outside the pancreas into nearby major blood vessels or nerves. It may or may not have spread to nearby lymph nodes. It has not spread to distant sites
• Stage IV:
  The cancer has spread to distant sites

Prevention:

• Eating a diet rich in fruits and vegetables
• Staying physically active and engaging in daily exercise
• Maintaining a healthy weight
• Avoid smoking
• Avoid alcohol consumption

Management:

• Surgery
  One of the following types of surgery may be used to take out the tumor:
  • Whipple procedure: A surgical procedure in which the head of the pancreas, the gallbladder, part of the stomach, part of the small intestine, and the bile duct are removed. Enough of the pancreas is left to produce digestive juices and insulin.
  • Total pancreatectomy: This operation removes the whole pancreas, part of the stomach, part of the small intestine, the common bile duct, the gallbladder, the spleen, and nearby lymph nodes.
  • Distal pancreatectomy: The body and the tail of the pancreas and usually the spleen are removed.
  • If the cancer has spread and cannot be removed, the following types of palliative surgerymay be done to relieve symptoms and improve quality of life:
  • Surgical biliary bypass: If cancer is blocking the small intestine and bile is building up in the gallbladder, a biliary bypass may be done. During this operation, the doctor will cut the gallbladder or bile duct and sew it to the small intestine to create a new pathway around the blocked area.
  • Endoscopic stent placement: If the tumor is blocking the bile duct, surgery may be done to put in a stent (a thin tube) to drain bile that has built up in the area. The doctor may place the stent through a catheter that drains to the outside of the body or the stent may go around the blocked area and drain the bile into the small intestine.
  • Gastric bypass: If the tumor is blocking the flow of food from the stomach, the stomach may be sewn directly to the small intestine so the patient can continue to eat normally.
• Radiation Therapy
  Radiation Therapy is the use of high-energy x-rays or other particles to destroy cancer cells. Radiation therapy may be given for pancreatic cancer in the following situations:
  • After surgery for patients who have a high risk of their cancer coming back in the area of surgery. This includes patients with a tumor that is large or was removed with close or positive surgical margins, meaning that cancer cells are seen up to or very close to the edge of the tissue removed during surgery.
  • Before surgery to try to shrink a borderline resectable tumor
  • For patients with locally advanced, unresectable disease
  • To relieve severe pain for people with metastatic cancer

  External-beam radiation therapy is the type of radiation therapy used most often for pancreatic cancer, and treatment usually takes five to six weeks with once-daily doses of radiation. Newer types of radiation therapy, such as stereotactic radio-surgery, are being used for pancreatic cancer because they can provide more localized treatment and require a fewer number of treatment sessions.

• Chemotherapy
  Chemotherapy is the use of drugs to destroy cancer cells, usually by stopping the cancer cells’ ability to grow and divide. Adjuvant chemotherapy is given after a pancreatic tumor is removed with surgery to prevent the cancer from coming back. Chemotherapy given before surgery is generally used for patients with borderline resectable disease, when shrinking the tumor may increase the chance of removing it with surgery. First-line chemotherapy is generally the first treatment used for patients with either locally advanced or metastatic pancreatic cancer. Second-line chemotherapy is given when treatment does not work to control cancer growth. Sometimes, first-line treatment does not work at all, which is called primary resistance. Or, treatment may work well for a while and then stop being effective later, which is sometimes called secondary or acquired resistance. In these situations, patients may benefit from additional treatment with different drugs if the patient’s overall health is good. Palliative chemotherapy is any chemotherapy regimen discussed above which helps relieve the symptoms of pancreatic cancer, such as lessening pain, improving a patient’s energy and appetite, and stopping or slowing weight loss.
• Targeted therapy
  Targeted therapy is a treatment that targets the cancer’s specific genes, proteins or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells while limiting damage to healthy cells.

Supportive care for people with pancreatic cancer includes:

• Relieving bile duct or small intestine blockage
• Improving digestion and appetite
• Controlling diabetes
• Relieving pain and other side effects