Pancreatic Cancer

Pancreatic cancer is the fourth leading cause of cancer death; approximately 34,000 people will have died from the disease in 2008. It strikes men and women equally. Like so many other cancers, the earlier it's caught, the greater the chances of survival. However, there is no way to screen for it. By the time symptoms appear, it's usually too late for a cure.

The Pancreatic and Biliary Disease Program in conjunction with the Samuel Oschin Comprehensive Cancer Institute diagnoses and treats pancreatic cancer.

Diagnosis

In the exocrine part of the pancreas (which produces the digestive fluids that help break down fats, proteins and carbohydrates)and ducts (where the fluids are released into tiny tubes) are where more than 95% of all pancreatic cancers, or adenocarcinomas, begin. The other 5% grow in the endocrine section, where hormones like insulin are made. It's important to identify which type of tumor it is, since they behave, develop and respond to treatment differently.

Pancreatic cancer's symptoms are like those of many other pancreatic conditions. Early on, there may be no symptoms at all. As the tumor develops, the patient may have abdominal pain, nausea, loss of appetite, weight loss and jaundice. Other symptoms include itching, brown urine and light clay-colored stools. But these symptoms can point to other conditions as well. That's why it's important to be seen by an expert, who may use any of the following tests:  

  • Lab tests: basic blood work; a test called CA19-9.
  • Ultrasound: though not a definitive test for tumors, it is a good way to find gallstones or cysts in the pancreas.
  • Computed tomography (CT): these three-dimensional X-rays are the most accurate test for cancer. A CT scan is also used to guide a biopsy needle exactly to the tumor to take a tissue sample for lab analysis.
  • Magnetic resonance imaging (MRI): this uses magnetic fields and radio waves to create detailed images of soft tissue. A special type, magnetic resonance cholangiopancreatography (MRCP), can find blockages in the pancreatic and bile ducts.
  • Endoscopic retrograde cholangiopancreatography (ERCP): The doctor uses an endoscope (a flexible tube with an optical device) to reach the duodenum and injects a dye to outline the bile and pancreatic ducts. He or she may take a fluid sampling, remove a gallstone or unclog a blockage. This is considered the 'gold standard' for pancreatic and biliary diagnosis, but there is a 2 to 5% risk of causing pancreatitis.

Causes

The cause of pancreatic cancer is unknown. Smoking seems to be the main preventable risk factor. Patients with chronic pancreatitis are at higher risk of getting pancreatic cancer. It is quite common among patients with a hereditary form of pancreatitis. A hereditary form of pancreatic cancer has also been identified, though it is quite rare. Diabetes has not been shown to be a risk factor.

Screening and Prevention

There is no way to screen for pancreatic cancer, but since smoking is the only known risk factor, quitting is the best and only way to prevent contracting this deadly disease.

Treatment

Once cancer has been confirmed, the doctor will estimate how advanced the cancer is using a process called staging. The cancer's stage guides how the tumor is treated. Here are the four stages of pancreatic cancer:

Resectable: The cancer has involved only the pancreas, a rarity in pancreatic cancer. The doctor may remove the head of the pancreas, part of the small intestine and some surrounding tissue (Whipple procedure). Or the entire pancreas and surrounding organs may come out (total pancreatectomy). Or the body and tail of the pancreas are removed (distal pancreatectomy). Radiation and chemotherapy may also follow surgery. The patient may be invited to take part in a clinical trial to test new treatments and advance medical science.

Locally advanced cancer: The cancer has spread to nearby organs, blood vessels, the intestine or all of these. Removing the tumor isn't usually an option. Treatment typically involves radiation therapy (with or without chemotherapy), surgery or other procedures to reduce symptoms. Depending on the medical center, the patient may be invited to join clinical trials (which use combinations of surgery, radiation and chemotherapy).

Metastatic cancer: The cancer has spread to distant parts of the body (liver, abdomen or lungs). Treatment may involve combinations of chemotherapy, pain relief, and surgery to reduce symptoms, clinical trials (e.g., experimental therapy to fight the cancer).

Recurrent: After successful treatment, the cancer may reappear in the pancreas or another part of the body. Treatment options include any of those used in the metastatic stage, as well as radiation therapy to reduce symptoms.

Since the survival rate is so poor, much pancreatic cancer treatment focuses on relieving pain and discomfort. Endoscopic therapy is an often used, noninvasive way to relieve jaundice and the pain and nausea caused by tumor blockages in the duodenum. Some studies have found stents to work well to relieve the pain and upset stomach that can go with blockages, which also lead to jaundice. Relieving jaundice symptoms improves patients' appetites and emotional well being. Doctors can also relieve biliary blocks by inserting stents in the main pancreatic duct using an endoscope or traditional surgery. One possible advantage of endoscopic stent treatment is a shorter hospital stay and lower morbidity and mortality.

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