Pancreatic Cancer

Cancer and Neoplasms, Oral and Gastrointestinal

Pancreatic cancer occurs when abnormal cells begin to grow in the pancreas. The pancreas is an organ that lies just behind the stomach. It secretes enzymes that assist with digestion and insulin that keeps your blood sugar in check. The exocrine cells secrete digestive enzymes and the endocrine cells secrete insulin. Pancreatic cancer is most common in exocrine cells. Pancreatic cancer is a rapidly growing cancer that most of the time has a poor prognosis. Around 48,960 people in the United States are diagnosed with pancreatic cancer each year. Out of that number, 40,560 people die from pancreatic cancer. This type of cancer is the fourth leading type of cancer death and the five-year survival rate is around 7%. This means early detection and treatment are key with this type of cancer. This article will help you understand the symptoms when to see a doctor and options for treatment.

Symptoms of pancreatic cancer often do not appear until the late stages of the disease. They include:

Severe pain in the upper abdomen that moves toward the back
Jaundice – yellow skin
Weight loss
Lack of appetite
Nausea and vomiting
Pale and fatty stools
Itching skin
Dark urine
Blood clotting
Depression

It is very important to diagnose and treat pancreatic cancer early. If you have any of these symptoms, see your doctor as soon as possible.

There are two different types of pancreatic cancer: exocrine cancer and endocrine cancer.

Exocrine cancer. The most common type. Exocrine cancer starts in the cells that make up the lining of the ducts to the pancreas. The official name is pancreatic adenocarcinoma.

Endocrine cancer. The rarer type of pancreatic cancer starts in the cells that produce hormones. This affects the islet cells and is more formerly known as islet cell cancer.

The cause of pancreatic cancer is unknown, but there are risk factors that can increase your chances of getting pancreatic cancer. Having a risk factor does n mean you will positively get pancreatic cancer. They are loosely associated with this condition. Risk factors include:

Cigarette smoking. Smoking is thought to be one of the number one risk factors for pancreatic cancer. The heavier the smoker, the risk increases.

Family history and genetics. In about 5 to 10 percent of pancreatic cancer cases, someone in the immediate family had pancreatic cancer.

Dietary influences. People that take in too much fat and processed meats are at higher risk for pancreatic cancer. Also, low intake of selenium and lycopene may increase the risk of pancreatic cancer.

Being overweight. Obesity and lack of exercise may increase the risk of pancreatic cancer.

Diabetes. This disease doesn’t necessarily increase the risk, but researchers have found a link between the two.

Your doctor will take a thorough history of your symptoms, a medical history, family medical history, and your lifestyle factors. After a good physical examination, your doctor may order the following tests:

Imaging. You may need imaging tests to look at your organs including a CT (computerized tomography) scan, MRI (magnetic resonance imaging), and/or ultrasound. These will show abnormalities or masses.

Endoscopic exam. The doctor uses an endoscope to look at your abdominal structures. A lighted tube is passed down your throat into your stomach. They can take pictures of your pancreas and take tissue for biopsy and testing.

ERCP. Another test is the endoscopic retrograde cholangiopancreatography or ERCP where the doctor uses a dye to look at your bile ducts during the endoscopy.

Treatment for pancreatic cancer typically involves surgery, radiation, chemotherapy, targeted therapy, and intense pain control. The treatments are:

Surgery. There are a few different surgical procedures done for pancreatic cancer:

Whipple procedure. Removal of the head of the pancreas, gallbladder, some stomach, small intestine, and the bile duct. The pancreas can still produce insulin and digestive enzymes.

Total pancreatectomy. The entire pancreas is removed, some stomach, some small intestine, bile duct, gallbladder, spleen, and lymph nodes in the abdomen.

Distal pancreatectomy. The pancreas and spleen are taken out.

Biliary bypass. The gallbladder is removed and the bile duct is then connected directly to the small intestine.

Endoscopic stent. A stent is placed in the bile duct to help with drainage.

Radiation. Radiation is directed at the cancerous areas to kill off cancer cells. It can be either external or internal. The external type just sends radiation beams to the part of the body that needs treatment. Internal injects radioactive “seeds” into the body near the area where the cancer is.

Chemotherapy. Chemotherapy for pancreatic cancer is most often combined with radiation for the most effectiveness. Chemotherapy is given either by mouth or intravenously. It can also be directly placed into the abdominal cavity. For more severe stages, more than one chemotherapy drug will be given.

Targeted therapy. These drugs go directly to the abnormal cells and leave healthy cells alone. They can block the actual part of cancer cells that causes them to reproduce and grow.

Pain control. Pancreatic cancer is very painful. When tumors grow and place pressure on the nerves near the pancreas, pain medication ceases to relieve the pain. Doctors can do direct injections into these nerves known as a nerve block. They can also sever the nerves to the pancreas to stop the pain.

There are forms of alternative medicine that can help with symptoms of pancreatic cancer. To date, researchers have not found any effects on the actual cancer cells. Also, make sure you clear any alternative medicine with your doctor. Alternative medicine options that may be helpful are:

Acupuncture
Ayurvedic medicine – Diet, herbs, meditation, breathing. Form of medicine from India
Homeopathy
Naturopathy
Herbal therapies
Chinese medicine
Yoga

Lifestyle changes and prevention of pancreatic cancer should include:

Quit smoking. Smoking can increase the growth of cancer cells. If you are diagnosed with pancreatic cancer, quit right away.

Eat healthily. Pancreatic cancer causes weight loss. Much of this is due to pain. See a nutritionist to develop a diet plan that is easy to eat, yet nutritious for your body.

Reduce stress. Lower your stress levels and try to stay positive. Find ways to relieve any anxiety and depression over your diagnosis. Try talking to someone about how you feel and try to do things that make you feel better.

If caught and treated early in the disease, prostate cancer has one of the highest survival rates among cancers to affects males.

Table I. 5-year survival rates of pancreatic cancer according to stage.

Stage of Cancer	5 Year Survival Rate
Stage I	100%
Stage II	Close to 100%
Stage III	98%
Stage IV	29%

If you receive a confirmed diagnosis of pancreatic cancer, the doctor will stage your disease. This will help with planning treatments and give you a prognosis. This is how pancreatic cancer is staged:

Blood Testing. The CA19 blood test can detect and identify the levels of the proteins that are produced from pancreatic cancer.

CT, MRI, and PET (positron emission tomography)scans. Used to determinehow far cancer has spread in the body.

Laparoscopy. A minor surgery where the doctor can explore the abdomen to check for cancer spread by looking for tumors. If a tumor is found, a biopsy will be taken.

According to the stages of pancreatic cancer:

Stage I. At this stage, cancer is still inside just the pancreas.

Stage II. Cancer is in the pancreas, but now spreading to close by organs and lymph nodes.

Stage III. Cancer is outside the pancreas, in major blood vessels, and in lymph nodes.

Stage IV. Cancer is far beyond the pancreas and into other organs (i.e., lungs, liver, and abdominal lining).

There are new clinical trials for pancreatic cancer treatment that may help increase the survival rate for this aggressive cancer. One of these is biological therapy. This will use your immune cells to go out and attack damaged cancer cells. Your immune cells are taken into the lab and made into specific attack cells for pancreatic cancer.

Cancer.net. (2014, November). Pancreatic Cancer: Statistics. Retrieved from Cancer.net: https://www.cancer.net/cancer-types/pancreatic-cancer/statistics

Di Marco, M., et. al. (2016, January 15). State of the art biological therapies in pancreatic cancer. World Journal of Gastrointestinal Oncology, 8(1), 55-66. Retrieved from PMC: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4714146/

Mayo Clinic.(2014, November 22). Pancreatic Cancer: Definition. Retrieved from Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/pancreatic-cancer/basics/definition/con-20028153

National Cancer Institute. (2015, July 02). Pancreatic Cancer Treatment. Retrieved from National Cancer Institute: https://www.cancer.gov/types/pancreatic/patient/pancreatic-treatment-pdq#section/_162

Pancreatic Cancer Action Network. (2015, August 8). Complementary and Alternative Medicine. Retrieved from PanCan: https://www.pancan.org/section-facing-pancreatic-cancer/learn-about-pan-cancer/treatment/complementary-and-alternative-therapies/

WebMD. (2015, April 26). Pancreatic Cancer. Retrieved from WebMD: https://www.webmd.com/cancer/pancreatic-cancer/digestive-diseases-pancreatic-cancer

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