Pancreatic cancer is the malignancy of the pancreas.

Cause

• Unknown at this time

Risk Factors

• Not proven but suspected:

1. Sex --males>females

2. Age -- rare under 40, but risks increases with age; average age of diagnosis is 70.

3. Race -- blacks and Hawaiians > whites.  Low occurrence in Asians and Hispanics.

4. Diet -- low in vegetables and fruits, high in animal fats and meat products

5. Smoking

6. Diabetes

7. Occupation -- petroleum and other chemicals

8. Likely that there is no association between pancreatitis (swollen, irritated pancreas), coffee, or alcohol.

Symptoms

• Weight loss is the most common (90%) symptom

• Fatigue and weakness

• Loss of appetite

• Nausea and vomiting

• Diarrhea or clay-colored stool

• Abdominal pain (75%)

• Abdominal tenderness when touched

• Indigestion -- feeling bloated and heartburn

• Back pain

• Yellowish discoloration of skin and whites of the eye (jaundice)

• Itchiness of the skin

• May feel a mass or a lump over the pancreas

• May feel an enlarged gallbladder or liver

• There may be fluid build up in the abdomen (Ascites)

• Depression

• Anemia -- low blood levels are present in 60% of patients

Screening and Diagnostics

• The general physician will consult with a gastroenterologist or digestive tract specialist (GI), cancer specialist, or oncologist, radiologist, and surgeons.

• A full medical history of symptoms, risk factors, medical surgeries, illnesses, habits, and family history

• Medical exam may reveal jaundice, weight loss, Ascites, a mass, or enlarged liver.

• The doctor will do a stool test for the presence of blood by using his index finger and inserting it in the rectum to collect small stool sample.

• Blood test -- routine liver and kidney functions and a complete blood cell count (red and white cells)

• Blood chemical such as Bilirubin, Alkaline phosphatase, Amylase, CEA, CA 19-9, pancreatic-oncofetal antigen, and alpha-fetal Proteins are tests that when elevated may help in diagnosing PC.

• X-Rays of abdomen

• Upper GI -- special X-Ray (Barium) will show a outline of the esophagus and the stomach

• Ultrasound uses sound to show the structure of the pancreas

• CAT scan (computers) and MRI (magnetic energy) show a more detailed picture of the pancreas.

• ERCP -- done by GI.  A flexible plastic camera (endoscope) is passed down the throat into the stomach and the doctor injects a dye for X-Rays.  ERCP is useful in seeing the common bile and pancreatic ducts.

• PTC -- is done by inserting a needle through the skin into the liver to inject dye, and X-Rays of the bile ducts are taken to see blockages.

• Angiography -- done if the blood vessels supplying the pancreas need to be visualized.  A dye is injected into the blood and X-Rays taken.

• Biopsy -- a piece of the cancer is taken for proper identification

1. Biopsies can be done at the same time as the ERCP by attaching a brush to the end of the endoscope and scraping some of the cancerous tumor cells off for review.

2. Biopsy can also be done using a needle inserted into the pancreas while a CAT scan or Ultrasound guides the radiologist.

3. Biopsy is also done by surgeons using a laparoscope.

4. Laparotomy refers to opening the abdomen under anesthesia and examining its contents and the tumor.

5. Biopsies are sent to a pathologist who uses a microscope to look for cancer cells.

Treatment

• If the cancer is small and has not metastasized (spread) out of the pancreas, the prognosis of treatment (outcome) is favorable.

• The patient is admitted to a hospital for tests and treatments

• Type of treatment depends on the extent of metastasis and general health of the patient

• Antacids

• Insulin, if glucose levels are high

• Glucose solutions, if blood sugars are low.

• Painkillers such as Tylenol, Codeine, Demerol, and Morphine

• Cholestyramine or other medications for severe itching

• Pancreatic enzymes such as Pancrease

• Medications to treat Depression may be needed.

• Diet is usually as tolerated.

• If losing weight, consider supplementing with high protein shakes and use of Nasal GT or GT feeding (done by putting a tube into the stomach through the nose, or directly through the stomach).

• TPN is giving nutrients via plastic tubing directly into the blood stream.

• Surgery -- removal of a part or the entire pancreas and some of the surrounding structures is often the only choice.

• Radiation -- radioactive rays can be lethal to cancer cells.  Radiation may be given before surgery to shrink the cancer, or afterward to decrease the chance of the cancer cells returning.  Radiation can also be useful in cases where surgery is not an option, to alleviate symptoms such as pain.

• Chemotherapy -- uses cancer-killing chemicals, often given in combination with other treatments

• Immunotherapy -- fights cancer by strengthening body's own defenses.

• Clinical trials -- new treatments tested and researched on cancer patients

• Most treatments have severe side effects that must be considered.

• Support for the family and patient

• If treatments are not effective, hospice and other organizations can provide palliative or comfort care.

Prognosis

     Some patients with pancreatic cancer that is resectable (can be surgically removed) are cured. However, cure rates are significantly less than 50%.

     Chemotherapy and radiation are often given after surgery to attempt to increase the cure rate. For pancreatic cancer that cannot be removed completely with surgery, or cancer that has spread beyond the pancreas, cure is not currently possible and the average survival is usually less than 1 year. Such patients might consider enrollment in a clinical trial (a medical research study to determine the best treatment).

     Pancreatic cancer may result in weight loss, blood clots, liver dysfunction, infections, pain, and depression. Symptoms such as pain can usually be controlled with aggressive pain management.