The pancreas is an oblong flattened gland located deep in the abdomen. It is an integral part of the digestive system. It is about 6 inches long and is shaped like a flat pear. The widest part of the pancreas is the head, the middle section is the body, and the thinnest part is the tail.
The pancreas produces insulin and other hormones. These hormones help the body use or store the energy that comes from food. The pancreas also makes pancreatic juices which contain enzymes that help digest food. The pancreas releases the juices into a system of ducts leading to the common bile duct. The common bile duct empties into the duodenum, the first section of the small intestine.
Benign tumors are not cancer and are usually not life threatening. In most cases, benign tumors can be removed and do not come back. Cells from benign tumors do not spread to tissues around them or to other parts of the body. Malignant tumors are cancer. The term malignant is used to describe a tumor that invades the tissue around it and may spread to other parts of the body. Malignant tumors are more serious and may be life threatening.
Most pancreatic cancers begin in the ducts that carry pancreatic juices. Cancer of the pancreas may be called pancreatic cancer or carcinoma of the pancreas.
A rare type of pancreatic cancer that begins in the cells that make insulin and other hormones.
When cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary tumor. For example, if cancer of the pancreas spreads to the liver, the cancer cells in the liver are pancreatic cancer cells. The disease is metastatic pancreatic cancer, not liver cancer. It is treated as pancreatic cancer, not liver cancer.
No one knows the exact causes of pancreatic cancer though research has shown that people with certain risk factors are more likely to develop pancreatic cancer. Risk factors include:
People who think they may be at risk for pancreatic cancer should discuss this concern with their doctor. The doctor may suggest ways to reduce the risk and can plan an appropriate schedule for checkups.
In the early stages, pancreatic cancer is extremely difficult to detect because often there are no symptoms. But, as the cancer grows, symptoms may include:
These symptoms are not sure signs of pancreatic cancer. An infection or other problem could also cause these symptoms. Only a doctor can diagnose the cause of a person’s symptoms. Anyone with these symptoms should see a doctor so that the doctor can treat any problem as early as possible.
Pancreatic cancer can be difficult to detect and diagnose. A variety of techniques can be used to establish a diagnosis. These techniques include lab tests, CT scan, endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP).
Although all of these techniques may reveal a suspicious mass in the pancreas, by far the best diagnostic method remains histopathology.
Lab tests- The doctor may take blood, urine, and stool samples to check for bilirubin and other substances. Bilirubin is a substance that passes from the liver to the gallbladder to the intestine. If the common bile duct is blocked by a tumor, the bilirubin cannot pass through normally. Blockage may cause the level of bilirubin in the blood, stool, or urine to become very high. High bilirubin levels can result from cancer or from noncancerous conditions.
CT scan (computed tomography) – An x-ray machine linked to a computer takes a series of detailed pictures. The x-ray machine is shaped like a donut with a large hole. The patient lies on a bed that passes through the hole. As the bed moves slowly through the hole, the machine takes many x-rays. The computer puts the x-rays together to create pictures of the pancreas and other organs and blood vessels in the abdomen.
Ultrasonography – The ultrasound device uses sound waves to produce a pattern of echoes as they bounce off internal organs. The echoes create a picture of the pancreas and other organs inside the abdomen. The echoes from tumors are different from echoes made by healthy tissues. The ultrasound procedure may use an external or internal device, or both types.
Transabdominal ultrasound – To make images of the pancreas, the doctor places the ultrasound device on the abdomen and slowly moves it around.
EUS (Endoscopic ultrasound) – The doctor passes a thin, lighted tube (endoscope) through the patient’s mouth and stomach, down into the first part of the small intestine. At the tip of the endoscope is an ultrasound device. The doctor slowly withdraws the endoscope from the intestine toward the stomach to make images of the pancreas and surrounding organs and tissues.
ERCP (endoscopic retrograde cholangiopancreatography) – The doctor passes an endoscope through the patient’s mouth and stomach, down into the first part of the small intestine. The doctor slips a smaller tube (catheter) through the endoscope into the bile ducts and pancreatic ducts. After injecting dye through the catheter into the ducts, the doctor takes X-ray pictures. The x-rays can show whether the ducts are narrowed or blocked by a tumor or other condition.
PTC (percutaneous transhepatic cholangiography) – A dye is injected through a thin needle inserted through the skin into the liver. Unless there is a blockage, the dye should move freely through the bile ducts. The dye makes the bile ducts show up on xray pictures. From the pictures, the doctor can tell whether there is a blockage from a tumor or other condition.
Biopsy – In some cases, the doctor may remove tissue. A pathologist then uses a microscope to look for cancer cells in the tissue. The doctor may obtain tissue in several ways. One way is by inserting a needle into the pancreas to remove cells. This is called fine-needle aspiration. The doctor uses x-ray or ultrasound to guide the needle. Sometimes the doctor obtains a sample of tissue during EUS or ERCP. Another way is to open the abdomen during an operation.
When pancreatic cancer is diagnosed, the doctor needs to know the stage, or extent, of the disease to plan the best treatment. Staging is a careful attempt to find out the size of the tumor in the pancreas, whether the cancer has spread, and if so, to what parts of the body. The results of various diagnostic tests will indicate how far the cancer has progressed and determine the stage. Subsequent decisions about treatment will be based upon the stage assigned.
The shock and stress that people may feel after a diagnosis of cancer can make it hard for them to think of everything they want to ask the doctor. Often it helps to make a list of questions before an appointment. To help remember what the doctor says, patients may take notes or ask whether they may use a tape recorder. Some patients also want to have a family member or friend with them when they talk to the doctor to take part in the discussion, to take notes, or just to listen. Always remember that the doctor is there to answer your questions; don’t be afraid to voice your opinion or question any action or procedure.
If you are meeting with a surgeon or oncologist for the first time, you may want to ask:
At any point in the relationship with your physician, you have the right to ask
Do not forget to ask about the things that are most important to you:
Finally, and most importantly, ask these questions of YOURSELF:
If you are uncomfortable with the results of some of these questions, you may want to reevaluate your choice of physician or get a second opinion.
Palliative therapy aims to improve quality of life by controlling pain and other problems caused by pancreatic cancer.
Yes. While some insurance companies require a second opinion; others may cover a second opinion if the patient requests it. Gathering medical records and arranging to see another doctor may take a little time. But in most cases, a brief delay to get another opinion will not make therapy less helpful.
There are a number of ways to find a doctor for a second opinion:
Generally if the cancer is localized, surgical treatment, via resection or removal of the tumor, can be pursued. This means that the cancer has not spread to any blood vessels, distant lymph nodes or other organs, such as the liver or lung. These characteristics are determined through various diagnostic techniques.
Radiation therapy (also referred to as radiotherapy) uses high-energy rays to kill cancer cells. Radiation therapy may be administered alone, or in combination with surgery, chemotherapy, or both.
Questions to ask the doctor before radiation therapy:
Chemotherapy is the use of drugs to kill cancer cells. Doctors also give chemotherapy to help reduce pain and other problems caused by pancreatic cancer. It may be given alone, with radiation, or in combination with surgery and radiation. Chemotherapy is systemic therapy and is most often delivered intravenously. Once in the bloodstream, the drugs travel throughout the body. Usually chemotherapy is an outpatient treatment. However, depending on which drugs are given and the patient’s general health, the patient may need to stay in the hospital.
Questions to ask before chemotherapy:
Because cancer treatment may damage healthy cells and tissues, unwanted side effects are common. These side effects depend on many factors, including the type and extent of the treatment. Side effects may not be the same for each person, and they may even change from one treatment session to the next. The health care team will explain possible side effects and how they will help the patient manage them.
Surgery: The side effects of surgery depend on the extent of the operation, the person’s general health, and other factors. Most patients have pain for the first few days after surgery. Pain can be controlled with medicine, and patients should discuss pain relief with the doctor or nurse.
Removal of part or all of the pancreas may make it hard for a patient to digest foods. The health care team can suggest a diet plan and medicines to help relieve diarrhea, pain, cramping, or feelings of fullness. During the recovery from surgery, the doctor will carefully monitor the patient’s diet and weight. At first, a patient may have only liquids and may receive extra nourishment intravenously or by feeding tube into the intestine. Solid foods are added to the diet gradually.
Patients may not have enough pancreatic enzymes or hormones after surgery. Those who do not have enough insulin may develop diabetes. The doctor can give the patient insulin, other hormones, and enzymes.
Radiation Therapy: Radiation therapy may cause patients to become very tired as treatment continues. Rest is important, but doctors usually advise patients to try to stay as active as possible. In addition, when patients receive radiation therapy, the skin in the treated area may sometimes become red, dry, and tender. Radiation therapy to the abdomen may cause nausea, vomiting, diarrhea, or other problems with digestion. The health care team can offer medicine or suggest diet changes to control these problems. For most patients, the side effects of radiation therapy go away when treatment is over.
Chemotherapy: The side effects of chemotherapy depend on the drugs and the doses the patient receives as well as how the drugs are administered. As with other types of treatment, side effects vary from patient to patient. Patients who undergo chemotherapy may also be more likely to get infections, bruise or bleed easily, and may have less energy. Since systemic therapy affects rapidly dividing cells, patients may lose their hair and may have other side effects such as poor appetite, nausea and vomiting, diarrhea, or mouth sores. Usually, these side effects go away gradually during the recovery periods between treatments or after treatment is over. The health care team can suggest ways to relieve side effects.
The management of pain for patients with pancreatic cancer is one of the most important aspects of their care. Pain is a common symptom that can be successfully controlled. The best management of pain is aggressive therapy with constant assessment. The patient with pancreatic cancer who is experiencing pain can maintain his/her quality of life. Pain can be relieved or reduced in several ways:
Medication: The use of opioids (or narcotics, the strongest pain relievers available) is the main way to treat pain from pancreatic cancer. Other types of medicines used to relieve pain that are not opioids are: acetaminophen and nonsteroidal antiinflammatory drugs (NSAIDs). At times, medicines called adjuvant analgesics are also used. These are medicines used for purposes other than the treatment of pain but help in relieving pain in some situations.
Types of Opioids* Recommended for Pain of Pancreatic Cancer:
*Opioids are available only by prescription
Nonopioids Recommended for Pain of Pancreatic Cancer
Radiation: High energy rays can help relieve pain by shrinking the tumor.
Nerve block: The doctor may inject alcohol into the area around certain nerves in the abdomen to block the feeling of pain.
Surgery: The surgeon may cut certain nerves to block pain. The doctor may suggest other ways to relieve or reduce pain. For example, massage, acupuncture, or acupressure may be used along with other approaches to help relieve pain. Also, the patient may learn relaxation techniques such as listening to slow music or breathing slowly and comfortably.
Questions to ask your doctor about pain control:
Living with a serious disease such as pancreatic cancer is not easy. Some people find they need help coping with the emotional and practical aspects of their disease. Support groups can help. In these groups, patients or their family members get together to share what they have learned about coping with their disease and the effects of treatment. People living with pancreatic cancer may worry about the future. They may worry about caring for themselves or their families, keeping their jobs, or continuing daily activities. Concerns about treatments and managing side effects, hospital stays, and medical bills are also common. Doctors, nurses, and other members of the health care team can answer questions about treatment, diet, working, or other matters. Meeting with a social worker, counselor, or member of the clergy can be helpful to those who want to talk about their feelings or discuss their concerns. Often, a social worker can suggest resources for financial aid, transportation, home care, emotional support, or other services.
Doctors in clinics and hospitals are searching for a cure. In their efforts, they often conduct clinical trials. These are research studies in which people take part voluntarily. In these trials, researchers are studying ways to treat pancreatic cancer. Research already has led to advances in treatment methods, and researchers continue to search for more effective approaches to treat this disease.
Patients who join clinical trials have the first chance to benefit from new treatments that have shown promise in earlier research. They also make an important contribution to medical science by helping doctors learn more about the disease.
Although clinical trials may pose some risks, researchers take very careful steps to protect their patients. In trials with people who have pancreatic cancer, doctors are studying new drugs, new combinations of chemotherapy, and combinations of chemotherapy and radiation before and after surgery.
Use these links to find out more about pancreatic cancer:
Although pancreatic cancer is relatively rare, it is also fast moving. About 20 percent of patients with a diagnosis make it through to the next year. There are many factors that affect survival rate, including the type and stage of the cancer and the Palmer pancreatic cancer treatment methods used. At Mat-Su Valley Comprehensive Cancer Center, hope is here. Our doctors will create a plan tailored to your needs, and we will explore all of our options to fight your cancer. For more information about our treatment methods, contact us by calling 907-707-1333.