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Pancreatic cancer

Pancreatic cancer; Cancer - pancreas

 

Pancreatic cancer is cancer that starts in the pancreas.

Causes

 

The pancreas is a large organ behind the stomach. It makes and releases enzymes into the intestines that help the body digest and absorb food, especially fats. The pancreas also makes and releases insulin and glucagon. These are hormones that help the body control blood sugar levels.

There are different types of pancreatic cancers. The type depends on the cell the cancer develops in. Examples include:

  • Adenocarcinoma, the most common type of pancreatic cancer
  • Other more rare types include glucagonoma , insulinoma , islet cell tumor , VIPoma

The exact cause of pancreatic cancer is unknown. It is more common in persons who:

  • Are obese
  • Have a diet high in fat and low in fruits and vegetables
  • Have diabetes
  • Have long-term exposure to certain chemicals
  • Have long-term inflammation of the pancreas ( chronic pancreatitis )
  • Smoke

Pancreatic cancer is slightly more common in women than in men. The risk increases with age. Family history of the disease also slightly increases the chance of developing this cancer.

 

Symptoms

 

A tumor (cancer) in the pancreas may grow without any symptoms at first. This means the cancer is often advanced when it is first found.

Symptoms of pancreatic cancer include:

  • Diarrhea
  • Dark urine and clay-colored stools
  • Fatigue and weakness
  • Sudden increase in blood sugar level (diabetes)
  • Jaundice (a yellow color in the skin, mucous membranes, or white part of the eyes) and itching of the skin
  • Loss of appetite and weight loss
  • Nausea and vomiting
  • Pain or discomfort in the upper part of the belly or abdomen

 

Exams and Tests

 

The doctor will perform a physical exam and ask about your symptoms. During the exam, the doctor may feel a lump (mass) in your abdomen.

Blood tests that may be ordered include:

  • Complete blood count ( CBC )
  • Liver function tests
  • Serum bilirubin

Imaging tests that may be ordered include:

  • CT scan of the abdomen
  • Endoscopic retrograde cholangiopancreatography ( ERCP )
  • Endoscopic ultrasound
  • MRI of the abdomen

Diagnosis of pancreatic cancer (and what type) is made by a pancreatic biopsy .

If tests confirm you have pancreatic cancer, more tests will be done to see how far the cancer has spread within and outside the pancreas. This is called staging. Staging helps guide treatment and gives you an idea of what to expect.

 

Treatment

 

Treatment for adenocarcinoma depends on the stage of the tumor.

Surgery may be done if the tumor has not spread or has spread very little. Along with surgery, chemotherapy or radiation therapy or both may be used before or after surgery. A small number of people can be cured with this treatment approach.

When the tumor has not spread out of the pancreas but cannot be surgically removed, chemotherapy and radiation therapy together may be recommended.

When the tumor has spread (metastasized) to other organs such as the liver, chemotherapy alone is usually used.

With advanced cancer, the goal of treatment is to manage pain and other symptoms. For example, if the tube that carries bile is blocked by the pancreatic tumor, a procedure to place a tiny metal tube (stent) may be done to open the blockage. This can help relieve loss of appetite, jaundice, and itching of the skin.

 

Support Groups

 

You can ease the stress of illness by joining a cancer support group . Sharing with others who have common experiences and problems can help you not feel alone.

 

Outlook (Prognosis)

 

Some people with pancreatic cancer that can be surgically removed are cured. But in most people, the tumor has spread and cannot be completely removed at the time of diagnosis.

Chemotherapy and radiation are often given after surgery to increase the cure rate (this is called adjuvant therapy). For pancreatic cancer that cannot be removed completely with surgery or cancer that has spread beyond the pancreas, a cure is not possible. In this case, chemotherapy is given to improve and extend one's life.

 

When to Contact a Medical Professional

 

Call for an appointment with your health care provider if you have:

  • Abdominal pain that does not go away
  • Back pain
  • Loss of appetite
  • Unexplained fatigue or weight loss
  • Other symptoms of this disorder

 

Prevention

 

Preventive measures include:

  • If you smoke, now is the time to quit.
  • Keep a diet high in fruits, vegetables, and whole grains.
  • Exercise regularly to stay at a healthy weight.

 

 

Open References

References

Mauro LA, Herman JM, Jaffee EM, Laheru DA. Carcinoma of the pancreas. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff's Clinical Oncology . 5th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2014:chap 81.

National Cancer Institute. PDQ Pancreatic cancer treatment. Bethesda, MD. www.cancer.gov. Date last modified July 10, 2015. http://www.cancer.gov/types/pancreatic/hp/pancreatic-treatment-pdq. Accessed October 7, 2015.

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Pancreatic adenocarcinoma. Version 2.2015. http://www.nccn.org/professionals/physician_gls/pdf/pancreatic.pdf. Accessed October 7, 2015.

Shires GT, Wilfong LS. Pancreatic cancer, cystic pancreatic neoplasms, and other nonendocrine pancreatic tumors. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management . 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 60.

 
  • Digestive system

    Digestive system - illustration

    The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.

    Digestive system

    illustration

  • Endocrine glands

    Endocrine glands - illustration

    Endocrine glands release hormones (chemical messengers) into the bloodstream to be transported to various organs and tissues throughout the body. For instance, the pancreas secretes insulin, which allows the body to regulate levels of sugar in the blood. The thyroid gets instructions from the pituitary to secrete hormones which determine the pace of chemical activity in the body (the more hormone in the bloodstream, the faster the chemical activity; the less hormone, the slower the activity).

    Endocrine glands

    illustration

  • Pancreatic cancer, CT scan

    Pancreatic cancer, CT scan - illustration

    A CT scan of the upper abdomen showing a tumor (pancreas carcinoma) in the head of the pancreas, seen here in the middle of the picture.

    Pancreatic cancer, CT scan

    illustration

  • Pancreas

    Pancreas - illustration

    The pancreas is an elongated, tapered gland that is located behind the stomach and secretes digestive enzymes and the hormones insulin and glucagon.

    Pancreas

    illustration

  • Biliary obstruction - series

    Biliary obstruction - series

    Presentation

    •  
    • Digestive system

      Digestive system - illustration

      The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.

      Digestive system

      illustration

    • Endocrine glands

      Endocrine glands - illustration

      Endocrine glands release hormones (chemical messengers) into the bloodstream to be transported to various organs and tissues throughout the body. For instance, the pancreas secretes insulin, which allows the body to regulate levels of sugar in the blood. The thyroid gets instructions from the pituitary to secrete hormones which determine the pace of chemical activity in the body (the more hormone in the bloodstream, the faster the chemical activity; the less hormone, the slower the activity).

      Endocrine glands

      illustration

    • Pancreatic cancer, CT scan

      Pancreatic cancer, CT scan - illustration

      A CT scan of the upper abdomen showing a tumor (pancreas carcinoma) in the head of the pancreas, seen here in the middle of the picture.

      Pancreatic cancer, CT scan

      illustration

    • Pancreas

      Pancreas - illustration

      The pancreas is an elongated, tapered gland that is located behind the stomach and secretes digestive enzymes and the hormones insulin and glucagon.

      Pancreas

      illustration

    •   Biliary obstruction - series

      Biliary obstruction - series

      Presentation

      •  

    A Closer Look

     

      Talking to your MD

       

        Self Care

         

          Tests for Pancreatic cancer

           
             

            Review Date: 8/1/2015

            Reviewed By: Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital, Boston, MA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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