Pancreatic Cancer

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Pancreatic Cancer


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Overview

The pancreas is a gland behind your stomach and in front of your spine. It produces juices that help break down food and hormones that help control blood sugar levels. Cancer of the pancreas is the fourth-leading cause of cancer death in the U.S.



Symptoms

Early cancer of the pancreas often doesn’t cause symptoms. When the cancer grows larger, you may notice one or more of these common symptoms:

-- Dark urine, pale stools, and yellow skin and eyes from jaundice

-- Pain in the upper part of your belly



Symptoms

-- Pain in the middle part of your back that doesn’t go away when you shift your position

-- Nausea and vomiting

-- Stools that float in the toilet

Also, advanced cancer may cause these general symptoms:



Symptoms

-- Weakness or feeling very tired

-- Loss of appetite or feelings of fullness

-- Weight loss for no known reason



Symptoms

These symptoms may be caused by pancreatic cancer or by other health problems. People with these symptoms should tell their doctor so that problems can be diagnosed and treated as early as possible.



Diagnosis

If you have symptoms that suggest cancer of the pancreas, your doctor will try to find out what’s causing the problems.

You may have blood or other lab tests. Also, you may have one or more of the following tests:



Diagnosis**Physical exam**

: Your doctor feels your abdomen to check for changes in areas near the pancreas, liver, gallbladder, and spleen. Your doctor also checks for an abnormal buildup of fluid in the abdomen. Also, your skin and eyes may be checked for signs of jaundice.



Diagnosis**CT scan**

: An x-ray machine linked to a computer takes a series of detailed pictures of your pancreas, nearby organs, and blood vessels in your abdomen. You may receive an injection of contrast material so your pancreas shows up clearly in the pictures. Also, you may be asked to drink water so your stomach and duodenum show up better. On the CT scan, your doctor may see a tumor in the pancreas or elsewhere in the abdomen.



Diagnosis**Ultrasound**

: Your doctor places the ultrasound device on your abdomen and slowly moves it around. The ultrasound device uses sound waves that can’t be heard by humans. The sound waves make a pattern of echoes as they bounce off internal organs. The echoes create a picture of your pancreas and other organs in the abdomen. The picture may show a tumor or blocked ducts.



Diagnosis**EUS**

: Your doctor passes a thin, lighted tube (endoscope) down your throat, through your stomach, and into the first part of the small intestine. An ultrasound probe at the end of the tube sends out sound waves that you can’t hear. The waves bounce off tissues in your pancreas and other organs. As your doctor slowly withdraws the probe from the intestine toward the stomach, the computer creates a picture of the pancreas from the echoes. The picture can show a tumor in the pancreas. It can also sho



Diagnosis**EUS**

Some doctors use the following tests also:

-- **ERCP**



Diagnosis**EUS**

: The doctor passes an endoscope through your mouth and stomach, down into the first part of your small intestine. Your doctor slips a smaller tube through the endoscope into the bile ducts and pancreatic ducts. (See picture of ducts.) After injecting dye through the smaller tube 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.



Diagnosis**EUS**

-- **MRI**

: A large machine with a strong magnet linked to a computer is used to make detailed pictures of areas inside your body.

-- **PET scan**



Diagnosis**EUS**

: You’ll receive an injection of a small amount of radioactive sugar. The radioactive sugar gives off signals that the PET scanner picks up. The PET scanner makes a picture of the places in your body where the sugar is being taken up. Cancer cells show up brighter in the picture because they take up sugar faster than normal cells do. A PET scan may show a tumor in the pancreas. It can also show cancer that has spread to other parts of the body.



Diagnosis**EUS**

-- **Needle biopsy**

: The doctor uses a thin needle to remove a small sample of tissue from the pancreas. EUS or CT may be used to guide the needle. A pathologist uses a microscope to look for cancer cells in the tissue.

You may want to ask the doctor these questions before having a biopsy:



Diagnosis**EUS**

-- Do you recommend that I have a biopsy? If so, why?

-- How long will it take? Will I be awake? Will it hurt?

-- Is there a risk that a needle biopsy procedure will cause the cancer to spread? What are the chances of infection or bleeding after the biopsy?



Diagnosis**EUS**

-- Are there any other risks?

-- How soon will I know the results? How do I get a copy of the pathology report?

-- If I do have cancer, who will talk with me about treatment? When?



Treatment

Treatment options for people with cancer of the pancreas are surgery, chemotherapy, targeted therapy, and radiation therapy. You’ll probably receive more than one type of treatment.

The treatment that’s right for you depends mainly on the following:



Treatment

-- The location of the tumor in your pancreas

-- Whether the disease has spread

-- Your age and general health



Treatment

At this time, cancer of the pancreas can be cured only when it’s found at an early stage (before it has spread) and only if surgery can completely remove the tumor. For people who can’t have surgery, other treatments may be able to help them live longer and feel better.



Treatment

You may want to talk with your doctor about taking part in a clinical trial. Clinical trials are research studies testing new treatments. They are an important option for people with all stages of cancer of the pancreas. See the Taking Part in Cancer Research section.



Treatment

You may have a team of specialists to help plan your treatment. Your doctor may refer you to a specialist, or you may ask for a referral. Specialists who treat cancer of the pancreas include surgeons, medical oncologists, radiation oncologists, and gastroenterologists. Your health care team may also include an oncology nurse.



Treatment

For help relieving or reducing pain, you may work with a specially trained doctor, a nurse, a palliative care team, or another pain control specialist. See the Supportive Care section.

For help reducing eating problems and maintaining your weight, you may work with a registered dietitian. See the Nutrition section.



Treatment

Your health care team can describe your treatment choices, the expected results of each, and the possible side effects. Because cancer treatments often damage healthy cells and tissues, side effects are common. These side effects depend on many factors, including the type and extent of treatment. Side effects may not be the same for each person, and they may even change from one treatment session to the next. Before treatment starts, ask your health care team about possible side effects and how



Treatment

You may want to ask your doctor these questions before you begin treatment:

-- What is the stage of the disease? Has the cancer spread?

-- Do I need any more tests to find out whether I can have surgery?



Treatment

-- What is the goal of treatment? What are my treatment choices? Which do you suggest for me? Why?

-- What are the expected benefits of each kind of treatment?

-- What can I do to prepare for treatment?

-- Will I need to stay in the hospital? If so, for how long?



Treatment

-- What are the risks and possible side effects of each treatment? How can side effects be managed?

-- How will you treat my pain?

-- What is the treatment likely to cost? Will my insurance cover it?



Treatment

-- How will treatment affect my normal activities? Am I likely to have eating problems or other problems?

-- Would a research study (clinical trial) be a good choice for me?

-- Can you recommend other doctors who could give me a second opinion about my treatment options?



Treatment

-- How often should I have checkups?

**Surgery**

Surgery may be an option for people with an early stage of pancreatic cancer. The surgeon usually removes only the part of the pancreas that has cancer. But, in some cases, the whole pancreas may be removed.



Treatment

The type of surgery depends on the location of the tumor in the pancreas. Surgery to remove a tumor in the head of the pancreas is called a Whipple procedure. The Whipple procedure is the most common type of surgery for pancreatic cancer. You and your surgeon may talk about the types of surgery and which may be right for you.



Treatment

In addition to part or all of your pancreas, the surgeon usually removes the following nearby tissues:

-- Duodenum

-- Gallbladder

-- Common bile duct

-- Part of your stomach



Treatment

Also, the surgeon may remove your spleen and nearby lymph nodes.

Surgery for pancreatic cancer is a major operation. You will need to stay in the hospital for one to two weeks afterward. Your health care team will watch for signs of bleeding, infection, or other problems.



Treatment

It takes time to heal after surgery, and the time needed to recover is different for each person. You may have pain or discomfort for the first few days. Medicine can help control your pain. Before surgery, you should discuss the plan for pain relief with your health care team. After surgery, they can adjust the plan if you need more pain control. See the Supportive Care section.



Treatment

It’s common to feel weak or tired for a while. You may need to rest at home for one to three months after leaving the hospital.



Treatment

After surgery, it may be hard to digest food. For four to six weeks after Whipple surgery, you may feel bloated or full, and you may have nausea and vomiting. A dietitian can help you change your diet to reduce your discomfort. Problems with eating usually go away within three months. See the Nutrition section.

You may want to ask your doctor these questions before having surgery:



Treatment

-- What type of surgery do you recommend for me? Why?

-- Will tissues other than the tumor in the pancreas be removed

-- Why?

-- How many times have you performed this surgery? How many pancreatic cancer patients do you treat each year?



Treatment

-- How will I feel after surgery?

-- Am I likely to have eating problems? Will I need a special diet

-- Who can help me if I have a problem?

-- If I have pain, how will you control it?



Treatment

-- How long will I be in the hospital?

-- Will I have any long-term effects because of the surgery?



Treatment**Chemotherapy**

Chemotherapy uses drugs to kill cancer cells. Most people with pancreatic cancer get chemotherapy. For early pancreatic cancer, chemotherapy is usually given after surgery, but in some cases, it’s given before surgery. For advanced cancer, chemotherapy is used alone, with targeted therapy, or with radiation therapy.




Chemotherapy for pancreatic cancer is usually given by vein (intravenous). The drugs enter the bloodstream and travel throughout your body.

Chemotherapy may be given in an outpatient part of the hospital, at the doctor’s office, or at home. Rarely, you may need to stay in the hospital.




The side effects depend mainly on which drugs are given and how much. Chemotherapy kills fast-growing cancer cells, but the drugs can also harm normal cells that divide rapidly:




Blood cells: When drugs lower the levels of healthy blood cells, you’re more likely to get infections, bruise or bleed easily, and feel very weak and tired. Your health care team will check for low levels of blood cells. If your levels are low, your health care team may stop the chemotherapy for a while or reduce the dose of the drug. There are also medicines that can help your body make new blood cells.




Cells in hair roots: Chemotherapy may cause hair loss. If you lose your hair, it will grow back after treatment, but the color and texture may be changed.

Cells that line the digestive tract: Chemotherapy can cause a poor appetite, nausea and vomiting, diarrhea, or mouth and lip sores. Your health care team can give you medicines and suggest other ways to help with these problems. They usually go away when treatment ends.




Some drugs used for pancreatic cancer also may cause tingling or numbness in your hands and feet. Your health care team can suggest ways to control many of these side effects.

You may wish to read the NCI booklet Chemotherapy and You.



Treatment**Targeted Therapy**

People with cancer of the pancreas who can’t have surgery may receive a type of drug called targeted therapy along with chemotherapy.

Targeted therapy slows the growth of pancreatic cancer. It also helps prevent cancer cells from spreading. The drug is taken by mouth.




Side effects may include diarrhea, nausea, vomiting, a rash, and shortness of breath. You may want to read the NCI fact sheet Targeted Cancer Therapies.

You may want to ask your doctor these questions about chemotherapy or targeted therapy:

-- Why do I need this treatment?




-- Which drug or drugs will I have?

-- How do the drugs work?

-- When will treatment start? When will it end?

-- Will I have any long-term side effects?



Treatment**Radiation Therapy**

Radiation therapy uses high-energy rays to kill cancer cells. It can be given along with other treatments, including chemotherapy.




The radiation comes from a large machine. The machine aims beams of radiation at the cancer in the abdomen. You’ll go to a hospital or clinic 5 days a week for several weeks to receive radiation therapy. Each session takes about 30 minutes.




Although radiation therapy is painless, it may cause other side effects. The side effects include nausea, vomiting, or diarrhea. You may also feel very tired. Your health care team can suggest ways to treat or control these side effects.

You may find it helpful to read the NCI booklet Radiation Therapy and You.




You may want to ask your doctor these questions about radiation

-- Why do I need this treatment?

-- When will the treatments begin? When will they end?

-- How will I feel during treatment?




-- How will we know if the radiation treatment is working?

-- Will I have any long-term side effects?



Risks

Some risk factors for developing pancreatic cancer include:

-- Smoking

-- Long-term diabetes

-- Chronic pancreatitis



Risks

-- Certain hereditary disorders


Documents

Pancreatic Cancer