The pancreas is an organ in the abdominal cavity that produces digestive enzymes, insulin, and other hormones. The digestive juices flow through ducts to the intestines. Most pancreatic cancers develop in these ducts.
About 1 in 64 people will develop pancreatic cancer during their lifetime. Pancreatic cancer accounts for 7% of all cancer deaths in the US. The risk of pancreatic cancer is slightly higher in men.
Pancreatic cancer is also known as a silent disease because it is difficult to detect and symptoms usually do not appear until cancer has grown for a long time.
Cancer is caused by the uncontrolled growth of abnormal cells. When these cells grow and form a mass, it is called a tumor. When some pancreatic cells break down and enter the bloodstream or lymphatic system, they can spread cancer. The spread of cancer is called metastatic spread; the places where cancer has spread are called metastatic sites.
The cause of cancer cell formation in the pancreas is not known, but studies have shown that certain risk factors play a role in the development of pancreatic cancer.
Studies have shown that the following factors increase the risk of pancreatic cancer:
- Age – The risk of pancreatic cancer increases with age. Most occur in people over the age of 55.
- Family history – someone with a mother, father, sister, or brother with pancreatic cancer has about 3 times the risk of getting the disease.
- Diabetes – pancreatic cancer is more common in people with diabetes.
- Obesity – being overweight or obese is associated with a 2-fold increase in the risk of pancreatic cancer.
- Chronic pancreatitis and pancreatic cysts – people with chronic pancreatitis may have an increased risk of developing pancreatic cancer.
- Smoking – people who smoke cigarettes are 2 to 3 times more likely to develop pancreatic cancer than people who do not smoke.
Of these risk factors, smoking is the most important, accounting for about one-third of all pancreatic cancer cases.
Symptoms and Complications
Often, the early stages of pancreatic cancer are not accompanied by symptoms. As cancer grows, the following symptoms may occur:
- Dark urine
- Nausea, vomiting
- pain in the upper abdomen or back
- Symptoms of high blood glucose (e.g., unusual thirst, frequent urination, blurred vision)
- Unexpected weight loss
- Weakness or fatigue
- Excess fat in the stool
- Lack of appetite
- Swelling of the legs due to a blood clot in the veins
- Yellowing of the skin and whites of the eyes, dark urine (symptoms of jaundice).
If your doctor suspects pancreatic cancer, he or she will review your medical history and perform a physical examination. Your doctor may also order the following tests:
- Blood tests to determine if your liver is functioning normally.
- A magnetic resonance imaging (MRI) or CT scan of your abdomen to detect masses or obstructions.
- Endoscopic retrograde cholangiopancreatography (ERCP), in which an instrument with a light is inserted through the throat into the stomach and then into the intestines. A dye is then injected to make the pancreas and bile ducts more visible, and tissue samples are taken for biopsies that will look for the presence of certain cancer cells.
- Ultrasound endoscopy, in which an endoscope is inserted through the mouth to follow the digestive tract into the intestine to accurately determine the local extent of cancer by ultrasound; this technique can also be used to perform a biopsy.
- An ultrasound of the abdomen (sound waves traveling through the abdomen) to find masses that may be blocking the pancreas or bile ducts.
Once pancreatic cancer is diagnosed, the doctor will determine the extent of cancer. This process is called staging. Staging may require several other tests that will help your doctor determine the most appropriate treatment.
Treatment and Prevention
Although pancreatic cancer cannot be prevented, you can reduce your risk of developing this disease by not smoking. Reducing your risk of type 2 diabetes by maintaining a healthy weight and eating healthy foods and exercising will also lower your risk of developing pancreatic cancer.
Pancreatic cancer can only be cured if it is caught in the early stages before it has spread to other parts of the body.
In about 80% to 90% of affected people, pancreatic cancer is in an advanced stage when it is diagnosed. Treatment cannot cure advanced cancer, but it can improve and prolong the quality of life.
Pancreatic cancer can be treated with surgery, chemotherapy, and radiation therapy. Your treatment plan will depend on your overall health, the stage of cancer, and whether it can be surgically removed.
Surgical removal is usually the first choice of treatment. The different types of surgery to remove pancreatic cancer are described below:
- Whipple Procedure – this procedure is done when the tumor is in the head of the pancreas (most of it). The head of the pancreas and part of the small intestine, the bile duct, and the stomach are removed.
- Distal pancreatectomy – the body or tail of the pancreas is removed if the tumor is in either of these areas. The spleen is also removed.
- Total pancreatectomy – the entire pancreas, part of the small intestine, part of the stomach, bile duct, gallbladder, spleen, and surrounding lymph nodes are removed.
If pancreatic cancer cannot be completely removed, some surgical procedures are performed to relieve symptoms. A metal tube or stent may be placed in the bile duct to prevent or reduce obstruction. Some bypass procedures may be helpful if the bile duct or stomach is blocked.
After surgery, your doctor may recommend chemotherapy (treatment with drugs that kill cancer cells) or radiation therapy (high-energy radiation that kills cancer cells). These treatments are also used in cases where surgery is not possible due to the location of cancer.
When a cure or control is not possible, treatment focuses on improving quality of life by controlling pain and other problems and symptoms caused by the disease.
Our Doctors Opinion
There have been advances in the early detection of pancreatic cancer. Researchers have discovered a marker that can detect pancreatic cancer. While this marker is absent in benign pancreatic tumors, it is present in 90% of cancers. It is a glycoprotein called mucin.
Enormous progress has been made in the treatment of pancreatic cancer.
- Advances in anesthesia have made it possible to operate on people over the age of 70, which was not possible before because it is a complicated operation.
- Surgeons are able to remove more cancer cells, even if they have spread to nearby organs.
- Thanks to advances in medical imaging (MRI), we know much better how to assess the boundaries of the tumor, so the surgeon can better narrow down the extent of the tumor and operate accordingly.
There are now many people with pancreatic cancer who have lived more than 20 years after having their pancreas removed. And even then, these people were operated on 20 years ago without benefiting from recent advances.