February 14, 2008

cheryl youngbrown

Pancreatic Cancer

Patient Education and Options

The pancreas (pàng¹krê-es), is a glandular organ of the digestive system that secretes digestive
enzymes and hormones. In humans, the pancreas is a yellowish organ that lies crosswise beneath the
stomach and is connected to the small intestine at the duodenum. It produces trypsin, amylase, and
lipase—enzymes essential to the digestion of proteins, carbohydrates, and fats, respectively. Small
groups of cells in the pancreas, called islets of Langerhans, contain several types of specialized cells:
alpha-2 cells, which produce the hormone glucagon ; beta cells, which produce the hormone insulin;
and alpha-1 cells, which produce somatostatin, all of which regulate blood-sugar levelsi

Pancreatic Cancer
What Is Pancreatic Cancer?

The pancreas is an organ found in the abdomen, behind the stomach and surrounded by
the small intestine, liver, and spleen that produces enzymes and hormones.

Most of the pancreas consists of the exocrine gland. This gland produces enzymes that
aid in the breakdown of proteins and fats in foods. A small portion of the pancreas
consists of endocrine cells. These cells produce insulin, a hormone that helps balance
sugar levels in the blood.

At times these cells begin to grow abnormally and turn into tumors. Both the exocrine
and endocrine cells can form tumors. While some tumors are not cancerous (benign),
most tumors tend to be cancerous. These tumors often disrupt the normal activity of the
cells and can also produce enzymes and hormones that can may spread and harm other
organs and body functions.

While it is a serious disease, pancreatic cancer is rare. The American Cancer Society
estimates that nearly 40,000 people in the United States (less than one-tenth of a percent
of the population) will be diagnosed with a form of pancreatic cancer.

Pancreatic cancers are very difficult to detect and are often found in advanced forms.
Very little is known about the cause of pancreatic cancer, but it tends to be more
prevalent in smokers. The majority of cases are found in people over the age of 60.

Most pancreatic cancers do not produce symptoms until the cancer has spread to other
parts of the body, therefore is not found until the cancer has spread, making treatment
difficult. Most pancreatic cancers (tumors) grow large enough to cause extreme
discomfort.
About Pancreatic Cancer

Very little is known about the exact cause of pancreatic cancer. Many studies have drawn links between the
disease and various types of behaviors and genetic groups. There are many studies currently underway that
are investigating what causes the DNA of a cell to suddenly tell it to become cancerous. The following is a list
of some of the behaviors and genetic groups that are prone to pancreatic cancer more than others:
• Smoking – Adenocarcinomas, the most common form of pancreatic
cancer, is two to three times more common in heavy smokers than
in nonsmokers.

• Age – While pancreactic cancer is sometimes found in young people,

the majority of cases are found in people over 60.

• Gender – Men are more often diagnosed than women.

• Ethnicity – African Americans, Ashkenazi Jews (Jews of European

descent) and Native Hawaiians have been found to have the
highest rates of pancreatic cancer. Asians and Hispanics have
been found to have the least.

• Diet – A diet high in meats and fats has been linked to an increased
risk of pancreatic cancers.

• Diabetes mellitus – Pancreatic cancer has been found to be more

common in people with diabetes.

• Environment – Studies have shown that people with prolonged

exposure to pesticides, dyes, petrochemicals, and other
carcinogens are more likely to contract pancreatic cancers.

• Family history – People who have immediate family (mother, father, or

siblings) that have been diagnosed with pancreatic cancer are
three times more likely to also be diagnosed. A family history of
colon or ovarian cancer also increases the risk of pancreatic
cancer.

Symptoms
Pancreatic cancer is hard to diagnose due to the lack of early warning signs. The
disease has often advanced and spread to other parts of the body by the time it is
found.

One of the most pronounced symptoms is pain in the upper abdomen and back.
At times the cancer may also cause the gallbladder to swell. Because 80 percent
of pancreatic cancers occur in the head of the pancreas, where they can block
 the bile duct, jaundice (a yellowing of the skin, or whites of the eyes, and
darkening of the urine) is often another sign. Weight loss often occurs when the
cancer interferes with the food-processing functions of the pancreas, especially
the digestion of fatty foods. This interference can cause stool to be pale and
greasy. It can also cause vomiting and nausea after eating.

Diagnosis
No screening tests are available for cancers of the pancreas. CA 19-9, a molecule
that is released into the blood cells by some pancreatic tumor cells, can be useful in
tracking the progression of the disease, but is only 80 percent accurate in
diagnosing pancreatic cancer.

Traditionally, patients with pancreatic cancer need exploratory surgery to

determine whether removal of the pancreas is necessary. Often times this
surgery needs six to eight weeks of recovery time, so doctors often opt for less
invasive means. If pancreatic cancer is suspected, certain imaging tests
(pictures of the inside of the body) can be taken in order to make a diagnosis.
The following is a list of imaging tests used to find pancreatic cancer:

• Computed Tomography Scan (CT Scan) Shows cross-sectional

pictures of the body. This test can help a doctor see if there is an
abnormal growth on the pancreas.

• Laparoscopy A specialized telescope with an attached camera is sent

into the abdomen to view the pancreas and surrounding organs.
This procedure can allow a doctor to directly view a tumor and
help determine the next step.

• Magnetic Resonance Imaging (MRI) For patients whose major blood

vessels are compressed, or invaded by cancer, this special type of
MRI allows the physician to get a picture of the pancreatic ducts.

• Endoscopic Retrograde Cholangiopancreatography (ERCP) A

flexible tube is sent down the throat, through the stomach, and
into the small intestine. ERCP can also be used to look at the
pancreas; the doctor can inject dye into the tube, allowing the area
to be seen more clearly on an X-ray. During an ERCP, the doctor
may also put a fine needle or brush into the pancreas in order to
take out cells for a biopsy. A needle inserted through the tube can
also be used to alleviate jaundice.

• Percuteanous Transhepatic Cholangiography (PTC) A thin needle

is inserted into the liver through the right side; dye is injected into
the bile ducts (in the liver) so that any blockages can be seen on
an X-ray. To relieve jaundice, a fine tube is sometimes left on the
right side of the liver so it can drain properly.

Types of Pancreatic Cancer

While both portions of the pancreas can form cancer, the majority of cases are found in the
exocrine cells. It is important to know in which portion of the pancreas the tumor has
formed. There are different treatment strategies and prognoses for each type. Treatment
strategies are more often determined by the stage, or how developed the cancer is than by
where the cancer is found.
Most pancreatic cancers begin in the ducts that carry pancreatic juices to the common
bile duct, which empties into the duodenum, the first section of the small intestine.
These cancers are called nonendocrine cancers and account for 98 percent of all
pancreatic cancers. The most common of these types of cancer is adenocarcinoma.
Nearly 95 percent of all pancreatic cancers are adenocarcinomas.

Tumors found in the endocrine cells are known as islet cell tumors. These tumors are
very rare (accounting for only 2 percent of all cases) and are often benign.

There are approximately 20 types of pancreatic tumors. The nonendocrine pancreatic

cancers include the following:

Acinar cell carcinomas, which may produce excess amounts of the digestive enzymes
normally produced by the pancreas;

• Adenosquamous carcinomas, which are similar to adenocarcinomas

because they form in glands;

• Giant cell tumors, which have unusually large “giant” cells;

• Mucinous cystadenocarcinomas, which have spaces within a spongy

tumor filled with a thick fluid called mucin;

• Pancreaticoblastoma, which is usually seen in children when it occurs;

• Papillary epithelial neoplasms, which occurs mostly in young women

in their teens and twenties.

Endocrine cancers include:

• Gastrinoma, which makes large amounts of a hormone called gastrin;

• Insulinoma, which makes too much of the hormone insulin and causes
the body to store sugar instead of burning sugar for energy.
 Treatment
Pancreatic cancer is difficult to diagnose and is often found to be in advanced
stages. In most cases the cancer has spread from the pancreas into the surrounding
organs. Due to these facts, pancreatic cancer is difficult to treat. It is rare for a
person diagnosed to achieve a full recovery.

Most treatment plans are aimed at managing the disease, attempting pain
control pain, and prolonging life. Most patients undergo surgery (removal of
the cancerous tissue), radiation therapy (using high energy rays to kill cancer
cells), and/or chemotherapy (using drugs to kill cancer cells). There are some
clinical studies underway that use stem cells and other biological treatments to
help boost the immune system and protect the body from chemo and radiation
therapy side effects.

Surgery
Two types of surgery can be used in treating pancreatic cancer. If the cancer is found to
be contained in the pancreas and has not spread to other organs, the pancreas is often
totally removed. This surgery is known as the Whipple procedure. The head if the
pancreas and parts of the stomach, gallbladder, and small intestine are removed. Some
nearby lymph nodes and the common bile duct are also sometimes removed. The patient
is often then treated with chemo or radiation therapy to ensure that the body is free of
cancer.

Only 10 percent of diagnosed pancreatic cancer is considered to be contained within the

pancreas.

When the cancer has spread the next step is to perform what is called palliative surgery.
This surgery is often used to relieve symptoms and pain. The most common goal of this
surgery is to unblock the bile duct. This often reduces pain and allows the patient to
avoid other associated problems. This surgery is often used in conjunction with
chemotherapy and radiation therapy. These approaches rarely result in a full cure and
most often are aimed at prolonging life and comfort.

Radiation Therapy
Radiation therapy, usually combined with chemotherapy, is often used to treat
patients after surgery to help destroy cancer cells in the tissue from where
the tumor was removed and to prevent recurrence of pancreatic cancer. Radiation
therapy is also used to help slow the spread of cancer cells to other parts of the body.
Radiation therapy is also often used to treat patients whose pancreatic cancer is too
widespread to be removed surgically. The most common type of radiation therapy is
called external beam radiation therapy. Patients may also receive a new treatment,
called intraoperative radiation therapy. In this procedure, the surgeon removes the
tumor, and the patient receives a high-dose of radiation therapy while still in the
operating room.
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