Pancreatic Carcinoma

What is Pancreatic Carcinoma?

Pancreatic cancer occurs when there is uncontrolled growth of abnormal cells in the pancreas or ducts. These abnormal cells reproduce rapidly, unlike healthy cells. They form tumors that can clog the pancreas or the pancreatic ducts.

The purpose of the pancreas is to make pancreatic juices that aid in digestion and to produce hormones such as insulin. The pancreas releases these juices into a system of ducts. The major pancreatic duct is called the bile duct. The bile duct comes from the liver and gallbladder. The bile duct carries bile, which is a fluid that is used to help digest fats. The bile duct forms a short tube, which empties into the duodenum, the first section of the small intestine.

Most pancreatic cancers start in the pancreatic ducts, an area called the exocrine pancreas. About 95% of all pancreatic cancers are found in this area.

However, there is a rare form that begins in the pancreas itself. These cells are called islets of Langerhans (named after the scientist who discovered them). Cancers that begin in these cells are called islet cell cancers. Islet cells can be insulinoma, gastrinoma, VIPoma, glucagonoma, or somatoststinoma. These make up only about 5% of pancreatic cancers.

Pancreatic cancer can spread locally and/or metastasize throughout the body, spreading to the bones, brain, liver, or other organs. These are still considered part of the original cancer, and it is called metastic pancreatic cancer. Half of all pancreatic cancer patients have metastic disease when they are diagnosed.

Cancers can grow in the pancreas for many years before they are detected, due to its location. The pancreas is located behind other organs and is surrounded by the stomach, small intestine, bile ducts, gallbladder, liver, and spleen.

People with adult onset diabetes appear to be at greater risk of developing pancreatic cancer. Pancreatic cancer has also been linked to high calorie diets.

What are the Symptoms of Pancreatic Cancer?

The physical symptoms include:

• Nausea
• Loss of appetite
• Weakness
• Unintentional weight loss
• Jaundice
• Pain in the upper abdomen or lower back
• Itching
• Dizziness and drowsiness
• Depression
• New onset diabetes

These symptoms may be vague, and often do not appear in the early stages of pancreatic cancer. The cancer is usually detected after a growing tumor causes jaundice and itching, or pain in the abdomen and lower back.

Unfortunately, all of the symptoms that can be caused by cancer may also be caused by other less serious problems. Only a healthcare provider will be able to tell what the symptoms mean.

Who is at Risk?

Research has shown that people with certain risk factors are more likely than others to develop pancreatic cancer. However, healthcare providers can seldom explain why one person gets pancreatic cancer and another does not. No one knows the exact causes of pancreatic cancer.

Some of the risk factors that have been found through studies are:

• Age Ð the likelihood of developing pancreatic cancer increases with age. Most pancreatic cancers occur in people over the age of 60.
• Smoking Ð cigarette smokers are two or three times more likely than nonsmokers to develop pancreatic cancer are.
• Diabetes Ð pancreatic cancer occurs more often in people who have diabetes than in people who do not.
• Being male Ð more men that women are diagnosed with pancreatic cancer
• Being African American Ð African Americans are more likely than Asians, Hispanics, or Whites to get pancreatic cancer.
• Family history Ð the risk for developing pancreatic cancer triples if a person's mother, father, sister or brother had the disease. In addition, a family history of colon or ovarian cancer increases the risk of pancreatic cancer.
• Chronic pancreatitis Ð chronic pancreatitis is a painful condition of the pancreas. Some evidence suggests that chronic pancreatitis may increase the risk of pancreatic cancer.

Also, other studies have suggested that exposure to certain chemicals in the workplace or a diet high in fat may increase the chance of getting pancreatic cancer.

Many who do get the disease have none of the factors, and most people with these known risks do not get pancreatic cancer. People who think they may be at risk should discuss this concern with their healthcare provider.

How is Pancreatic Cancer Diagnosed?

The healthcare provider can detect pancreatic cancer through a number of different tests. The type of information the healthcare provider is looking for determines the tests.

The healthcare provider will typically want to get pictures of the pancreas and the areas around it. A common step would be to take a series of X-rays of the area. Along with upper GI series, CAT scans, and MRIs, X-rays reveal information about the size, shape and location of a tumor. However, they do not tell whether a tumor is cancerous.

• An upper GI series is a series of X-rays of the upper digestive system. These X-rays are taken after the patient has drunk a barium solution that makes it possible to view the digestive organs on the X-rays.
• CAT (computer-assisted tomography) scans are produced when the X-ray machine is linked to a computer. The X-ray machine is shaped like a large doughnut with a hole. The patient lies on a bed, which passes through this hole. As the patient's body goes through it, the machine takes X-rays of the different parts of the body. The computer then puts the different X-ray pictures together to produce detailed, three-dimensional pictures.
• MRI (magnetic resonance imaging) uses a powerful magnet linked to a computer. The machine has space for the patient to lie in a tunnel inside the magnet. The machine measures the body' response to the magnetic field. This information is used to create detailed, three-dimensional pictures of areas inside the body. Because CAT scans and MRIs can show the pancreas, lymph nodes, or other parts of the body with much greater precision than X-rays, they can also pinpoint whether the cancer has spread to other organs or parts of the body.
• Ultrasonography is the use of very high frequency waves that cannot be heard by the human ear. The ultrasound instrument sends sound waves into the patient's abdomen that bounce off the internal organs and produce echoes, which create a picture called a sonogram.
• ERCP (endoscopic retrograde cholangiopancreatography), an X-ray procedure in which the doctor passes a long flexible tube (an endescope) down the throat, through the stomach and into the small intestine. Dyes are then injected through the tube and into the ducts. X-rays are then taken of the bile duct and the pancreatic ducts.
• PTC (percuaneous transheptic cholangiography). This procedure consists of a thin needle that is put into the liver through the skin on the right side of the abdomen. Dye is then injected into the bile ducts in the liver so that X-rays will show the blockages in the ducts.
• Angiography is a procedure where dye is injected into the blood vessels and X-rays are then taken of the blood vessels.

If a patient has already been diagnosed with pancreatic cancer, the healthcare provider may want that patient to undergo a separate CAT scan, MRI, or other nuclear medicine scan using low-level radioactivity to see whether the cancer has spread.

However, these methods alone cannot diagnose cancer with 100% certainty. A biopsy is usually ordered when a tumor is suspected of being cancerous. By using biopsies, the healthcare provider can learn the type of pancreatic cancer that is involved.

What are the Treatments for Pancreatic Cancer?

Three kinds of treatment for cancer of the pancreas are most often used:

• Surgery, aimed at removing the cancer or relieving symptoms caused by the cancer:
• Radiation therapy, or the use of high-dose X-rays or other high-energy rays to kill cancer cells
• Chemotherapy, the use of drugs to kill the cancer cells.

Surgery may be used alone or in a combination with other treatments. The extent of surgery depends upon the location and size of the tumor, the stage of the disease, and the patient's general health.

• Whipple procedure: if the tumor is on the head of the pancreas, the surgeon removes the head, part of the small intestine, bile duct, and stomach. The surgeon may also remove nearby tissue.
• Distal pancreatectomy: The surgeon removes the body and tail of the pancreas is the tumor is in either of these parts. The surgeon also removes the spleen.
• Total pancreatectomy: The surgeon removes the entire pancreas, the common bile duct, part of the small intestine, a portion of the stomach, the gall bladder, the spleen, and nearby lymph nodes.

This report is to be used for the gathering of information only, and is in no way a substitute for obtaining a diagnosis from a qualified healthcare provider.