Pancreatic cancer

What is pancreatic cancer?

Pancreatic cancer is an abnormal, uncontrolled growth of cells in the pancreas, which is a digestive gland located behind the stomach. The pancreas is both an exocrine and endocrine gland, meaning that it releases secretions into ducts (exocrine) as well as directly into the bloodstream (endocrine). More than 95 percent of the cells in the pancreas are exocrine; these glands produce pancreatic juice, which contains enzymes that break down fats, proteins and carbohydrates. The small percentage of cells that are endocrine are organized into small clusters called islets of Langerhans. These cells release the hormones insulin and glucagon that are essential to controlling the amount of sugar in the blood.

Cancer of the exocrine pancreas is more common, accounting for the majority of pancreatic cancer cases. Adenocarcinoma, often beginning the in the pancreatic ducts, is the most prevalent type of pancreatic cancer. As the disease progresses, the tumor may invade surrounding organs such as the stomach and small intestine, or metastasize to more distant sites in the body. Tumors of the endocrine pancreas, or islet cell tumors, are much less common, and most are benign. This section discusses exocrine cancers of the pancreas.

How many people get pancreatic cancer?

The American Cancer Society estimates that 37,170 people in the United States will be diagnosed with pancreatic cancer this year and that about 33,370 will die of the disease.

What causes pancreatic cancer?

Although the exact causes of pancreatic cancer are unknown, several risk factors appear to be linked with the disease, such as:

• Age: The likelihood of developing pancreatic cancer increases with age, with most people over the age of 60 when the cancer is diagnosed.
• Race: African Americans are more likely to develop pancreatic cancer than are whites or Asian Americans.
• Smoking: Cigarette smokers are two to three times more likely than nonsmokers to develop pancreatic cancer, and about three out of every 10 cases of pancreatic cancer are found to be linked to smoking.
• Diet: A diet high in meats and fat increases the risk of pancreatic cancer, whereas eating more fruits and vegetables appears to offer some protection.
• Diabetes: Pancreatic cancer is more common in people with this disease.
• Family history: The risk for developing pancreatic cancer is three times greater if an immediate family member (mother, father, sister, brother) has had the disease.

How is pancreatic cancer diagnosed?

Because there are few early signs and symptoms, pancreatic cancer is difficult to detect early. For this reason, by the time a person has symptoms, the tumor is often already quite large and the cancer may have spread to other organs.

Symptoms of pancreatic cancer include jaundice (a condition in which the eyes and skin look yellow), abdominal pain, unexpected weight loss, loss of appetite, extreme exhaustion, digestive problems and swollen gallbladder. Although these symptoms can be a sign of pancreatic cancer, they are often caused by other conditions.

If there is reason to suspect pancreatic cancer, the doctor will first obtain a complete medical history, conduct a physical exam and perform lab tests such as blood and urine tests. In addition, certain imaging tests such as CT scan, ultrasound or MRI may be done in order to create pictures of the inside of the body. To definitively determine if cancer is present, the doctor will need to obtain a biopsy in order to evaluate a sample of the tumor tissue microscopically. The biopsy technique most often used to diagnose pancreatic cancer is fine needle aspiration biopsy, a procedure in which a thin needle is inserted through the skin and into the pancreas to remove small pieces of tissue.

How is pancreatic cancer staged?

Staging is the process of finding out how far the cancer has spread. It is very important because, to a large extent, treatment and outlook for recovery depend on the stage of the cancer. In general, the lower the number, the less the cancer has spread.

Is pancreatic cancer fatal?

About 19 percent of patients with cancer of the exocrine pancreas survive at least one year after diagnosis. The five-year relative survival rate is approximately 4 percent.

How is pancreatic cancer treated?

The main treatments for pancreatic cancer are surgery, radiation therapy and chemotherapy. Surgical treatment is usually performed only when the cancer is still contained entirely within the pancreas at the time of diagnosis, which occurs in about 10 percent of cases. Even when no spread beyond the pancreas seems apparent, sometimes a small number of cancer cells may have already spread to other parts of the body but have not yet formed detectable tumors.

In cases of advanced disease, radiation therapy and/or chemotherapy may be used, or palliative surgery may be performed to, for example, bypass areas obstructed by tumor growth (such as blockages in the bile duct or small intestine). New approaches for the treatment of pancreatic cancer include immunotherapy and hormone therapy.

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