Pancreatic Cancer

Pancreatic cancer begins in the tissues of your pancreas. The pancreas is an organ in your abdomen that lies behind the lower part of your stomach. It secretes enzymes that aid digestion and hormones that help regulate the metabolism of sugars.

Pancreatic cancer often has a poor prognosis, even when diagnosed early. Pancreatic cancer typically spreads rapidly and is seldom detected in its early stages. Signs and symptoms may not appear until pancreatic cancer is quite advanced and complete surgical removal is not possible. For these reasons, it is a leading cause of cancer death.

Pancreatic cancer accounts for approximately 3% of cancers and 7% of cancer deaths in the US. The average lifetime risk for developing pancreatic cancer is 1 in 67 (1.5%). You are more likely to develop pancreatic cancer if you smoke, have diabetes, or have inflammatory conditions of the pancreas.

Pancreatic cancer is difficult to treat. Possible treatments include surgery, radiation, chemotherapy, and targeted therapy.

Signs and symptoms of pancreatic cancer often do not appear until the disease is advanced. When signs and symptoms do appear, they may include:

• upper abdominal pain that may radiate to your back
• yellowing of your skin and the whites of your eyes (jaundice)
• dark urine
• light-colored or greasy stools
• nausea and vomiting
• loss of appetite
• weight loss
• depression
• blood clots

The cause of pancreatic cancer is not entirely clear. Cancer occurs when some cells in the pancreas begin growing abnormally. These cells divide more rapidly than healthy cells do and continue to accumulate, forming a lump or mass.

Hormonal, lifestyle, and environmental factors may increase the risk of getting pancreatic cancer, but it is not clear why some people who have no risk factors develop cancer and others with risk factors never do. Pancreatic cancer is likely caused by a complex interaction of genetic makeup and environment.

Factors that are associated with an increased risk of pancreatic cancer include:

• smoking. Tobacco use nearly doubles the risk of developing pancreatic cancer.
• overweight and obesity. Being overweight increases the risk of developing pancreatic cancer.
• exposure to chemicals. Heavy exposure to certain chemicals, dyes, and pesticides increase the risk of developing pancreatic cancer.
• age. The risk of developing pancreatic cancer increases with age. Most patients who are diagnosed with pancreatic cancer are at least 45 years old and the average age at diagnosis is 71 years.
• gender. Men are more likely to develop pancreatic cancer than women.
• race. African-Americans are more likely to develop pancreatic cancer than Caucasians.
• family history. Pancreatic cancer tends to run in families.
• inherited gene mutations. As many as 10% of pancreatic cancers are caused by inherited gene mutations.
• diabetes. People with a long history of type 2 diabetes have an increased risk of developing pancreatic cancer.
• pancreatitis. Chronic inflammatory conditions of the pancreas are linked to an increased risk of pancreatic cancer.
• liver cirrhosis. Cirrhosis of the liver increases the risk of pancreatic cancer.

If pancreatic cancer is suspected, your doctor will likely conduct imaging tests, such as ultrasound, magnetic resonance imaging, or computed tomography, to help diagnose the cancer.

Surgery to remove a tissue sample (biopsy) from the pancreas can also assist in the diagnosis.

If cancer is confirmed, additional imaging tests and blood tests will be conducted to define the extent — or stage — of your cancer. The cancer's stage helps determine the prognosis and treatment options.

Stages of pancreatic cancer include:

• Stage I. The cancer is confined to the pancreas.
• Stage II. The cancer has spread to nearby tissues or lymph nodes.
• Stage III. The cancer has spread to the major blood vessels near the pancreas.
• Stage IV. The cancer has spread to distant organs such as the liver, lungs, and the lining of the abdomen.

If you have or have had pancreatic cancer, you can take steps to manage the stress that accompanies the diagnosis.

• Learn about pancreatic cancer so you can make informed decisions about your care.
• Have a schedule of follow-up tests and go to each appointment.
• Take care of yourself so that you are ready to fight cancer. This includes eating a healthy that includes plenty of fruits, vegetables and whole grains, exercising for at least 30 minutes most days of the week, and getting enough sleep so that you wake feeling rested.
• Accept help and support from family and friends.
• Talk with other cancer survivors or attend support groups.
• Consider specialized emotional, social, and spiritual care for terminally ill people and their families.

Treatment for pancreatic cancer depends on the stage and location of the cancer, as well as your overall health.

The goal of pancreatic cancer treatment is to eliminate the cancer. If this is not possible, the goal may be to prevent the cancer from growing or causing more harm.

Surgery. Treatment of pancreatic cancer may involve surgery to remove part of the pancreas and surrounding organs.

Radiation. Radiation therapy uses high-powered energy beams to kill cancer cells. Radiation can come from a machine outside your body that aims the beams at your cancer (external beam radiation) or radiation can be placed inside your body near the cancer (brachytherapy).

Chemotherapy. Chemotherapy drugs can be injected into a vein taken by mouth. Chemotherapy drugs can be given before or after surgery. Drugs that are commonly used in treating pancreatic cancer include:

• 5-fluorouracil (5-FU)
• Albumin bound paclitaxel (nab-paclitaxel, Abraxane)
• Capecitabine (Xeloda)
• Cisplatin (Platinol-AQ)
• Docetaxel (Taxotere)
• Gemcitabine (Gemzar)
• Irinotecan (CPT-11, Camptosar)
• Irinotecan liposome (Onivyde)
• Oxaliplatin (Eloxatin)
• Paclitaxel (Taxol)

Targeted therapy. Targeted therapy for cancer targets the changes in cells that cause cancer. Erlotinib (Tarceva) is a targeted therapy that is often combined with chemotherapy to treat advanced pancreatic cancer.