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Pancreatic cancer happens when cells that aren't normal grow and start to form tumors in the pancreas, a small organ located deep in the belly, behind your stomach.
The pancreas makes juices that help your body digest food. It also makes insulin and other hormones that help control your blood sugar.
There are two main types of pancreatic tumors: exocrine and endocrine. The type of tumor depends on which type of cells are involved. Exocrine (say "EX-oh-krin") cells make digestive juices. Endocrine (say "EN-doh-krin") cells make insulin. Most people with pancreatic cancer have exocrine tumors, which grow faster than endocrine tumors.
Treatments are more successful when cancer is found early. But in most cases, pancreatic cancer has already spread by the time it is found. Still, treatment may help you feel better, and it helps some people live longer.
Experts don't know what causes pancreatic cancer. But they do know that changes in the body's DNA play a role in many cancers.
Pancreatic cancer rarely causes symptoms until it has spread. Then, symptoms may include pain in the upper belly or the back, weight loss, extreme tiredness, and jaundice.
There are not yet any tests that work well for finding pancreatic cancer in its early stages.
If your doctor suspects pancreatic cancer, you may have one or more imaging tests—tests that produce pictures of the pancreas and surrounding areas—such as a CT scan or MRI.
The only sure way to diagnose pancreatic cancer is with a biopsy. This means taking a tissue sample from the pancreas and checking it under a microscope.
Your risk of getting pancreatic cancer is higher if you:
Surgery, chemotherapy, and radiation are the main treatments for pancreatic cancer. Although treatment doesn't usually cure the cancer, it may help you feel better and live longer.
This cancer is rarely found before it has grown. But when it is found early, treatment can help the person live longer. Statistics show that for every 100 people whose cancer is found early, about 23 will live at least 5 more years.1
Finding out that you have cancer can change your life. You may feel like your world has turned upside down and you've lost control. Talking with family, friends, and a counselor can really help. Ask your doctor about support groups. Or call the American Cancer Society (1-800-227-2345) or visit its website at www.cancer.org.
Learning about pancreatic cancer:
Health Tools help you make wise health decisions or take action to improve your health.
Pancreatic cancer usually doesn't cause symptoms at first. It's silent and painless. Symptoms usually don't begin until the cancer has spread. They may include:
Of course, there are other conditions that cause these symptoms, so they don't necessarily mean you have cancer. But it's important to talk to your doctor if you have any of these problems.
To look for or diagnose pancreatic cancer, your doctor will use one or more imaging tests—tests that produce pictures of the pancreas and the area around it. Such tests include:
Imaging tests can show evidence of pancreatic cancer. But your doctor may also order a biopsy. This means getting a sample of tissue from the pancreas to see if it contains cancer cells. There are two main kinds:
An important part of treating most types of cancer is staging and grading. This means looking at tissue samples under a microscope to see whether the cancer cells have spread beyond the pancreas and what kind of cells they are.
For pancreatic cancer, the tissue samples may be collected during a separate biopsy or during an endoscopic ultrasound. Sometimes the biopsy is done at the time of surgery to remove the cancer.
Knowing the stage and grade helps doctors know whether surgery will work to remove the cancer or what kind of treatment will help you feel better.
Even if treatment doesn't usually cure the cancer, it may help you live longer and feel better. The most common treatments include surgery, radiation, and chemotherapy. Often a combination of these treatments is used.
Surgery will be done to remove the tumor if possible. But most of the time the cancer has already spread so far that not all of it can be removed.
If surgery can remove all of the cancer, it can help you live longer. But even with successful surgery, the cancer often comes back.
If you are told that your cancer has spread too much for surgery, you may want to get a second opinion from a pancreatic cancer surgeon.
Surgery for pancreatic cancer includes:
You'll be in the hospital for 1 to 2 weeks after the surgery. You will probably be able to return to work or your normal routine in about 1 month. It will probably take about 3 months until your strength is back to normal. You will probably need more treatment for the cancer, such as chemotherapy or radiation.
Depending on how much of your pancreas is removed, you may need to take enzyme supplements (to replace the enzymes the pancreas makes) and anti-ulcer pills from now on. If your entire pancreas is removed, you will need to replace the insulin produced by your pancreas. You may have to check your blood sugar levels and give yourself insulin shots.
Chemotherapy, sometimes called chemo, uses medicine to destroy cancer cells. The drugs used in this treatment can also affect healthy cells and cause side effects. The most common chemo drugs used for pancreatic cancer are:
Common side effects of these drugs include:
Radiation treatment may be used for certain types of pancreatic tumors.
External radiation is the kind of radiation most often used. It may be used along with chemotherapy. It may also be used before or after surgery.
Radiation can have side effects. The most common ones include:
Radiation can also be used to help control pain by shrinking the tumor so that it doesn't press on nerves or other organs.
Your doctor may talk to you about being in a clinical trial. For some people with pancreatic cancer, taking part in a clinical trial may be the best treatment choice.
Among the treatments being looked at by clinical trials for pancreatic cancer is biologic therapy, a treatment that uses your immune system to fight cancer.
When pancreatic cancer gets worse or comes back, the goal of treatment in many cases is to help you feel better and live longer. This is called palliative care.
Pain is one of the main concerns of people with pancreatic cancer. But cancer pain can almost always be controlled. You and your doctor have several options to help your pain.
Sometimes the tumor presses on and blocks the bile duct where it passes through the pancreas. This can cause digestion problems. There are two ways to fix the blockage and help you feel better.
Because the pancreas is next to the stomach, the tumor can sometimes block the flow of food from the stomach to the first part of the small intestine. In that case, your doctor may do a gastric bypass, sewing the stomach directly to a lower part of the small intestine to get around the blocked area.
Additional information about pancreatic cancer is provided by the National Cancer Institute at www.cancer.gov/cancertopics/types/pancreatic.
If your disease is at an advanced stage, you may choose not to have treatment because the time, costs, and side effects of treatment may be greater than the benefits. Making the decision about when to stop medical treatment aimed at prolonging life and shift the focus to end-of-life care can be difficult.
For more information, see the topics:
People sometimes use complementary therapies along with medical treatment to help relieve symptoms and side effects of cancer treatments. Some of the complementary therapies that may be helpful include:
These mind-body treatments may help you feel better. They can make it easier to cope with treatment. They also may reduce chronic low back pain, joint pain, headaches, and pain from treatments.
Before you try a complementary therapy, talk to your doctor about the possible value and potential side effects. Let your doctor know if you are already using any such therapies. They aren't meant to take the place of standard medical treatment.
The side effects of treatment can be serious. Healthy habits such as eating a balanced diet and getting enough sleep and exercise may help control your symptoms. Your doctor may also give you medicines to help you with certain side effects, such as
medicines to control and prevent nausea and vomiting.
Other symptoms that can be treated at home include:
Pancreatic cancer and its treatments can cause you to lose your appetite. And the cancer can make it harder for your body to get what it needs from food. This can make you lose weight and grow weak. So it's important to pay attention to what you eat.
A dietitian can help you plan meals that will give you the most energy. You may also need to take supplements.
Having cancer and being treated for it can be very stressful. There are steps you can take to reduce your stress. Some people find that it helps to talk about their feelings with family and friends. Others find that spending time alone is what they need.
If your emotional reaction to cancer gets in the way of your ability to make decisions about your health, it's important to talk with your doctor. Your cancer treatment center may offer psychological or financial services. And a local chapter of the American Cancer Society can help you find a support group.
Having cancer can change your life in many ways. For support in managing these changes, see the topic
Getting Support When You Have Cancer.
The American Cancer Society (ACS) conducts educational
programs and offers many services to people with cancer and to their families.
Staff at the toll-free number have information about services and activities
in local areas and can provide referrals to local ACS divisions.
The National Cancer Institute (NCI) is a U.S. government
agency that provides up-to-date information about the prevention, detection,
and treatment of cancer. NCI also offers supportive care to people who have cancer
and to their families. NCI information is also available to doctors, nurses,
and other health professionals. NCI provides the latest information about
clinical trials. The Cancer Information Service, a service of NCI, has trained
staff members available to answer questions and send free publications.
Spanish-speaking staff members are also available.
American Cancer Society (2011). Cancer Facts and Figures 2011. Atlanta: American Cancer Society. Available online: http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-029771.pdf.
Other Works Consulted
American Cancer Society (2011). Treating pancreatic cancer. Detailed Guide: Pancreatic Cancer. Available online: http://www.cancer.org/Cancer/PancreaticCancer/DetailedGuide/index.
National Cancer Institute (2010). Pancreatic Cancer Treatment PDQ—Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/pancreatic/HealthProfessional.
National Cancer Institute (2010). Pancreatic Cancer Treatment PDQ—Patient Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/pancreatic/Patient.
Royal RE, et al. (2008). Pancreatic cancer. In VT DeVita Jr et al., eds., DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology, 8th ed., vol. 1, pp. 1086–1124. Philadelphia: Lippincott Williams and Wilkins.
October 22, 2012
E. Gregory Thompson, MD - Internal Medicine & Joseph O'Donnell, MD - Hematology, Oncology
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