HEALTH - PANCREATIC CANCER (PANCREAS) SYMPTOMS & TREATMENT
What is Pancreatic Cancer?
Pancreatic cancer is a disease in which normal cells in the pancreas malfunction and begin to grow uncontrollably. These cancerous cells can build up and form a mass, called a tumor. As it grows, a pancreatic tumor can affect the functioning of the pancreas, grow outward to involve nearby blood vessels and organs, and eventually metastasize (spread) to other parts of the body.
Cancer that starts in the pancreas is called pancreatic cancer. When pancreatic cancer spreads, it usually travels through the lymphatic system. The lymphatic system includes a network of thin tubes that branch, like blood vessels, into tissues all over the body. Cancer cells are carried through these vessels by lymph, a colorless, watery fluid that carries cells that fight infection. Along the network of lymphatic vessels are groups of small, bean-shaped organs called lymph nodes. Surgeons often remove lymph nodes near the pancreas to learn whether they contain cancer cells.
Cancer cells can also be carried through the bloodstream to the liver, lungs, bone, or other organs. Pancreatic cancer that spreads to other organs is called metastatic pancreatic cancer. Pancreatic cancer often has a poor prognosis, even when diagnosed early. Pancreatic cancer typically spreads rapidly and is seldom detected in its early stages, which is a major reason why it's a leading cause of cancer death. Symptoms may not appear until pancreatic cancer is quite advanced and surgical removal isn't possible.
The pancreas is a spongy, tube-shaped organ about 6 inches long. It is located in the back of the abdomen, behind the stomach. The head of the pancreas is on the right side of the abdomen. It is connected to the duodenum, the upper end of the small intestine. The narrow end of the pancreas, called the tail, extends to the left side of the body.
The pancreas makes pancreatic juices and hormones, including insulin. Pancreatic juices, also called enzymes, help digest food in the small intestine. Insulin controls the amount of sugar in the blood. Both enzymes and hormones are needed to keep the body working right.
As pancreatic juices are made, they flow into the main pancreatic duct. This duct joins the common bile duct, which connects the pancreas to the liver and the gallbladder. The common bile duct, which carries bile (a fluid that helps digest fat), connects to the small intestine near the stomach.
Function of the pancreas
The pancreas is composed of two major components:
- The exocrine component, made up of ducts and acini (small sacs on
the end of the ducts), produces enzymes (specialized proteins) that are
released into the small intestine to help the body digest and break
down food, particularly fats.
- The endocrine component of the pancreas is made up of specialized cells clustered together in islands within the organ, called islets of Langerhans. These cells produce specific hormones, with the most important one being insulin, a substance that helps control the amount of sugar in the blood.
Types of pancreatic cancer
It is important to determine if the cancer started in the exocrine or endocrine component of the pancreas, as the diagnosis and treatment of each type is much different. The types of cells involved in a pancreatic cancer help determine the best treatment. Types of pancreatic cancer include:
- Cancer that forms in the pancreas ducts (adenocarcinoma). Cells that line the ducts of the pancreas help produce digestive juices. The majority of pancreatic cancers are adenocarcinomas. Sometimes these cancers are called exocrine tumors.
- Cancer that forms in the hormone-producing cells. Cancer that forms in the hormone-producing cells of the pancreas is called endocrine cancer. Endocrine cancers of the pancreas are very rare.
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Health: Risk Factors of Pancreatic Cancer (Pancreas - Cancer)
While it can seldom be explained why one person gets pancreatic cancer and another doesn't, it is clear that the disease is not contagious. No one can "catch" cancer from another person. Pancreatic cancer is slightly more common in men than in women. The health risk increases with age.
Although scientists do not know exactly what causes cancer of
the
pancreas, they are learning that some things increase a
person's chance of
getting this disease. Smoking is a major risk factor. Research
shows that
cigarette smokers develop cancer of the pancreas two to three
times more
often than nonsmokers. Quitting smoking reduces the risk of
pancreatic
cancer, lung cancer, and a number of other diseases.
Pancreatic cancer occurs when cells in your pancreas develop genetic mutations. These mutations cause the cells to grow uncontrollably and to continue living after normal cells would die. These accumulating cells can form a tumor.
Factors that may increase your risk of pancreatic cancer are as following:
- Smoking. Smokers are two to three times more likely to develop pancreatic cancer than nonsmokers.
- Obesity and diet. Eating a high-fat diet is a risk factor for pancreatic cancer. Research has shown that obese and even overweight men and women have a higher health risk of dying from pancreatic cancer.
- Family history. A person’s chance of developing this cancer increases three-fold if a first-degree relative (mother, father, sister, or brother) had pancreatic cancer. That risk increases even further if more first-degree relatives are affected. Melanoma that runs in families and certain hereditary forms of colon, breast, and ovarian cancers are also associated with an increased health risk of developing pancreatic cancer.
- Older age. Pancreatic cancer occurs most often in older adults. Most people diagnosed with pancreatic cancer are in their 70s and 80s.
- Race. African Americans are more likely than Asians, Hispanics, or white people to develop pancreatic cancer.
- Gender. More men are diagnosed with pancreatic cancer than women.
- Diabetes. The sudden onset of type 2 diabetes can be an early symptom of pancreatic cancer. Whether diabetes itself is a risk factor for the development of pancreatic cancer has been a topic of great interest for many years with large studies reaching different conclusions. It is now believed that long-term diabetes does increase an individual’s risk of developing pancreatic cancer to a modest degree.
- Chemicals. Exposure to certain chemicals (such as pesticides, benzene, certain dyes, and petrochemicals) may increase the risk of developing pancreatic cancer.
- Hepatitis B infection. Hepatitis viruses are viruses that infect the liver. One recent study has shown that evidence of a previous hepatitis B infection was twice as common in people with pancreatic cancer than in people without the cancer. More research is needed to evaluate the nature of this link and to confirm the results of this study.
- Chronic pancreatitis. Pancreatitis is the inflammation of the pancreas, a painful disease of the pancreas. Some research suggests that having chronic pancreatitis may increase the risk of developing pancreatic cancer.
Health: Symptoms of Pancreatic Cancer (Pancreas - Cancer)
Pancreatic cancer has been called a "silent" disease because it usually does not cause any symptoms in the beginning. If the tumor blocks the common bile duct and bile cannot pass into the digestive system, the skin and whites of the eyes may become yellow, and the urine may become darker. This health condition is called jaundice.
As the cancer grows and spreads, pain often develops in the upper abdomen and sometimes spreads to the back. The pain may become worse after the person eats or lies down. Cancer of the pancreas can also cause nausea, loss of appetite, weight loss, and weakness.
A rare type of pancreatic cancer, called islet cell cancer,
begins in the cells of the pancreas that produce insulin and
other
hormones. Islet cells are also called the islets of Langerhans.
Islet cell
cancer can cause the pancreas to produce too much insulin or
hormones.
When this happens, the patient may feel weak or dizzy and may
have chills,
muscle spasms, or diarrhea.
These symptoms may be caused by cancer or by other, less serious health problems. If an individual is experiencing symptoms, a doctor should be consulted.
People with pancreatic cancer may
experience the following symptoms. Sometimes, people with pancreatic
cancer do not show any of these symptoms. Or, these symptoms may be
caused by a health condition that is not cancer.
There are currently no blood tests that can reliably detect the cancer while it is in its early stage. As the cancer grows, symptoms may include:
- Yellow skin and eyes, darkening of the urine, itching, and
clay-colored stool, which are signs of obstructive jaundice (blockage
of the bile ducts)
- Pain in upper abdomen or upper back
- Painful swelling of an arm or leg due to a blood clot
- Burning feeling in stomach or other gastrointestinal discomforts
- Floating stools with a particularly bad odor, due to malabsorption of fats
- Weakness
- Loss of appetite
- Nausea and vomiting
- Unexplained weight loss
- Depression
Health: Complications of Pancreatic Cancer (Pancreas - Cancer)
As pancreatic cancer progresses, it can cause complications such as:
-
Jaundice. Pancreatic cancer that blocks the liver's bile duct can cause jaundice. Symptoms include yellow skin and eyes, dark-colored urine and very pale stools.
Your doctor may recommend that a plastic or metal tube (stent) be placed inside the bile duct to hold it open. In some cases a bypass may be needed to create a new way for bile to flow from the liver to the intestines.
-
Pain. A growing tumor may press on nerves in your abdomen, causing pain that can become severe. Pain medications can help you feel more comfortable. Radiation therapy may help stop tumor growth temporarily to give you some relief.
In severe cases, your doctor may recommend a procedure to inject alcohol into the nerves that control pain in your abdomen (celiac plexus block). This procedure stops the nerves from sending pain signals to your brain.
-
Bowel obstruction. Pancreatic cancer that grows into or presses on the small intestine (duodenum) can block the flow of digested food from your stomach into your intestines.
Your doctor may recommend a tube (stent) be placed in your small intestine to hold it open. Or bypass surgery may be necessary to attach your stomach to a lower point in your intestines that isn't blocked by cancer.
-
Weight loss. A number of factors may cause weight loss in people with pancreatic cancer. Nausea and vomiting caused by cancer treatments or a tumor pressing on your stomach may make it difficult to eat. Or your body may have difficulty properly processing nutrients from food because your pancreas isn't making enough digestive juices.
Your doctor will work to correct the factors contributing to your weight loss. Pancreatic enzyme supplements may be recommended to aid in digestion. Try to maintain your weight by adding extra calories where you can and making mealtime as pleasant and relaxed as possible.
- Death. Pancreatic cancer leads to death for most people diagnosed with the disease. Even people diagnosed when their cancer is at an early stage face a high health risk of recurrence and death.
Health: Diagnosis of Pancreatic Cancer (Pancreas - Cancer)
To diagnose pancreatic cancer, the doctor does a complete physical exam and asks about the patient's personal and family medical history. In addition to checking general signs of health (temperature, pulse, blood pressure, and so on), the doctor usually orders blood, urine, and stool tests. The doctor may also ask for a "barium swallow," or "upper GI series." For this test, the patient drinks a barium solution before x-rays of the upper digestive system are taken. The barium shows an outline of the pancreas on the x-rays.
Other tests may be ordered, such as:
- An angiogram, a special x-ray of blood vessels.
- CT scans, x-rays that give detailed pictures of a cross- section of the pancreas. These pictures are created by a computer.
- Magnetic resonance imaging (MRI). MRI uses a powerful magnetic field and radio waves to create images of your pancreas.
- Ultrasound. Ultrasound uses high-frequency sound waves to create moving images of your internal organs, including your pancreas. The ultrasound sensor (transducer) is placed on your upper abdomen to obtain images.
- Transabdominal ultrasound to view the pancreas. In this procedure, an instrument that sends out high-frequency sound waves, which cannot be heard, is passed over the abdomen. The sound waves echo off the pancreas. The echoes form a picture on a screen that looks like a television.
- ERCP (endoscopic retrograde cholangiopancreatogram), is a special x-ray of the common bile duct. For this test, a long, flexible tube (endoscope) is passed down the patient's throat through the stomach and into the small intestine. A dye is injected into the common bile duct, and x-rays are taken. The doctor can also look through the endoscope and take tissue samples.
- Endoscopic ultrasound is a relatively new procedure that can be used to diagnose pancreatic cancer. For the procedure, an endoscope is passed in the same way as for ERCP; however, on the end of the endoscope is an ultrasound probe which scans the pancreas for cancers. Because the ultrasound probe is closer to the pancreas than with transabdominal ultrasound, it is possible to identify small cancers within the pancreas. The cancers also can be biopsied through the endoscope.
A biopsy is the only sure way for the doctor to know whether cancer is present. In a biopsy, the doctor removes some tissue from the pancreas. It is examined under a microscope by a pathologist, who checks for cancer cells.
One way to remove tissue is with a long needle that is passed through the skin into the pancreas. This is called a needle biopsy. Doctors use x-rays or ultrasound to guide the placement of the needle. Another type of biopsy is a brush biopsy. This is done during the ERCP. The doctor inserts a very small brush through the endoscope into the bile duct to rub off cells to examine under a microscope.
Sometimes an operation called a laparotomy may be needed. During this operation, the doctor can look at organs in the abdomen and can remove tissue. The laparotomy helps the doctor determine the stage, or extent, of the disease. Knowing the stage helps the doctor plan treatment.Tissue samples that are obtained with one kind of biopsy may
not
give a clear diagnosis, and the biopsy may need to be repeated
using a
different method.
Once a diagnosis of pancreatic cancer is confirmed, your doctor will work to determine the extent, or stage, of the cancer. Your cancer's stage helps determine what treatments are available to you. In order to determine the stage of your pancreatic cancer, your doctor may recommend:
- Laparoscopy. Laparoscopy uses a lighted tube with a video camera to explore your pancreas and surrounding tissue. The surgeon passes the laparoscope through an incision in your abdomen. The camera on the end of the scope transmits video to a screen in the operating room. This allows your doctor to look for signs cancer has spread within your abdomen.
- Chest X-ray. A chest X-ray helps your doctor look for signs that cancer has spread to your lungs.
- CT scan. CT scans allow your doctor to see your pancreas and assess whether the cancer has spread to nearby tissues, lymph nodes or other organs.
- MRI. MRI images may show if the cancer has spread beyond the pancreas.
- Positron emission tomography (PET) scan. PET scans use a radioactive tracer injected into a vein in order to help your doctor look for areas where cancer has spread beyond the pancreas. PET scans aren't typically used for pancreatic cancer, but they may offer another way to examine unusual areas found with a CT scan or MRI.
- Bone scan. Bone scans use radioactive tracers to look for evidence that cancer cells have spread to your bones.
- Blood test. Your doctor may test your blood for specific proteins (tumor markers) shed by pancreatic cancer cells. One tumor marker test used in pancreatic cancer is called CA19-9. Some research indicates that the more elevated your level of CA19-9 is, the more advanced the cancer. But the test isn't always reliable, and it isn't clear how best to use the CA19-9 test results. Some doctors measure your levels before, during and after treatment. Others use it to gauge your prognosis.
Health: Stages of Pancreatic Cancer (Pancreas - Cancer)
Doctors use several systems to stage
pancreatic cancer. The method used to stage other cancers, the TNM
classification, is not routinely applied to pancreatic cancer; however,
for completeness, it is discussed below. A more common classification
is one that places pancreas cancer into three categories: Resectable. This type of pancreatic cancer can be surgically
removed. A tumor may lie within the pancreas or extend beyond it, but
there is no involvement of the critical arteries or veins in the area.
There is no evidence of any spread to areas outside of the pancreas.
Approximately 10% to 15% of patients are diagnosed at this stage. Locally advanced. This type is still confined to the area
around the pancreas, but cannot be surgically removed because there is
involvement of the critical arteries or veins, or the tumor directly
extends to involve surrounding organs. There is no evidence of spread
to any distant areas of the body. Approximately 35% to 40% of patients
are diagnosed at this stage. Metastatic. The tumor has spread beyond the area of the
pancreas and involves other organs, such as the liver or distant areas
of the abdomen. Approximately 45% to 55% of patients are diagnosed at
this stage. By classifying each cancer into one of these three categories, the health care team can then plan the best treatment strategy.
Another description of the stages uses numerals:
Stage 0: Refers to cancer in situ, in which the cancer has not yet invaded outside the duct (or tube) in which it originated.
Stage IA: The tumor is 2 cm or smaller in the pancreas. It has not spread to lymph nodes or other parts of the body.
Stage IB: A tumor larger than 2 cm is in the pancreas. It has not spread to lymph nodes or other parts of the body.
Stage IIA: A tumor extends beyond the pancreas, but the tumor has not spread to nearby arteries/veins. It has not spread to any lymph nodes or other parts of the body.
Stage IIB: A tumor of any size has not spread to nearby arteries/veins. It has spread to lymph nodes but not to other parts of the body.
Stage III: A tumor has spread to nearby arteries, veins, and/or lymph nodes but has not spread to other parts of the body.
Stage IV: Any tumor that has spread to other parts of the body.
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Health: Conventional Treatment for Pancreatic Cancer (Pancreas - Cancer)
Treatment for pancreatic cancer depends on the stage and location of the cancer as well as on your age, overall health and personal preferences. The first goal of pancreatic cancer treatment is to eliminate the cancer, when possible. When that isn't an option, the focus may be on preventing the pancreatic cancer from growing or causing more harm. When pancreatic cancer is advanced and treatments aren't likely to offer a benefit, your doctor may suggest ways to relieve symptoms and make you as comfortable as possible.
Cancer of the pancreas is curable only when it is found in its earliest stages, before it has spread. Otherwise, it is very difficult to cure. However, it can be treated, symptoms can be relieved, and the quality of the patient's life can be improved.
Pancreatic cancer is treated with surgery, radiation therapy, or chemotherapy. Researchers are also studying biological therapy to see whether it can be helpful in treating this disease. Sometimes several methods are used, and the patient is referred to doctors who specialize in different kinds of cancer treatment.
Most people with bladder cancer undergo surgery to remove the cancerous cells. The types of surgical procedures available to you may be based on factors such as the stage of your bladder cancer, your overall health and your preferences.
Surgery for early-stage bladder cancer
If your cancer is very small and hasn't invaded the wall of your bladder, your doctor may recommend:
-
Surgery to remove the tumor. Transurethral resection of bladder tumor (TURBT) is often used to remove bladder cancers that are confined to the inner layers of the bladder. During TURBT, your doctor passes a small wire loop through your urethra and into your bladder. The loop is used to burn away cancer cells with an electric current (fulguration). In some cases, a high-energy laser may be used instead of electric current.
TURBT may cause painful or bloody urination for a few days following the procedure.
-
Surgery to remove the tumor and a small portion of the bladder. During segmental cystectomy, sometimes called partial cystectomy, the surgeon removes only the portion of the bladder that contains cancer cells. Segmental cystectomy may be an option if your cancer is limited to one area of the bladder that can easily be removed without harming bladder function. To remove the tumor, the surgeon makes an incision in your abdomen. General anesthesia is used, and you usually stay in the hospital for a week to 10 days.
Surgery carries a risk of bleeding and infection. You may experience more frequent urination after segmental cystectomy, since the operation reduces the size of your bladder. Over time this may improve, though in some people it's permanent.
Surgery for invasive bladder cancer
If your cancer has invaded the deeper layers of the bladder wall, you may consider:
-
Surgery to remove the entire bladder. A radical cystectomy is an operation to remove the entire bladder, as well as surrounding lymph nodes. In men, radical cystectomy typically includes removal of the prostate and seminal vesicles. In women, radical cystectomy involves removal of the uterus, ovaries and part of the vagina.
Cystectomy carries a risk of infection, bleeding, blood clots and bowel obstruction. In men, removal of the prostate and seminal vesicles will cause infertility. But in most cases your surgeon will take care to spare the nerves necessary for an erection. In women, removal of the ovaries causes infertility and premature menopause in women who haven't experienced menopause prior to this surgery.
-
Surgery to create a new way for urine to leave your body. Immediately after your radical cystectomy, your surgeon works to create a new way for your body to expel urine. Several options exist. Which option is best for you depends on your cancer, your health and your preferences. Your surgeon may create a tube (urinary conduit) using a piece of your intestine. The tube runs from your kidneys to the outside of your body, where your urine drains into a pouch (urostomy bag) you wear on your abdomen.
In another procedure, your surgeon may use a section of intestine to create a small reservoir for urine inside your body (cutaneous continent urinary diversion). You can drain urine from the reservoir through a hole in your abdomen using a catheter a few times each day.
In select cases, your surgeon may create a bladder-like reservoir out of a piece of your intestine (neobladder). This reservoir sits inside your body and is attached to your urethra, which allows you to urinate normally. You may need to use a catheter to drain all the urine from your new bladder.
Biological therapy (immunotherapy)
Biological therapy, sometimes called immunotherapy, works by signaling your body's immune system to help fight cancer cells. Biological therapy for bladder cancer is typically administered through your urethra and directly into the bladder (intravesical therapy).
Biological therapy drugs commonly used to treat bladder cancer include:
- An immune-stimulating bacterium. Bacille Calmette-Guerin (BCG) is a bacterium used in tuberculosis vaccines. BCG can cause bladder irritation and blood in your urine. Some people feel as if they have the flu after treatment with BCG.
- A synthetic version of immune system cell. An interferon is a type of cell your body uses to fight infections. A synthetic version of interferon, called interferon alfa, may be used to treat bladder cancer. Interferon alfa is sometimes used in combination with BCG. Interferon alfa can cause flu-like symptoms.
Biological therapy can be administered after TURBT to reduce the risk that cancer will recur. Biological therapy can also be given before surgery to shrink a tumor to a more manageable size.
Chemotherapy uses drugs to kill cancer cells. Chemotherapy treatment for bladder cancer usually involves two or more chemotherapy drugs used in combination. Drugs can be given through a vein in your arm (intravenously), or they can be administered directly to your bladder by passing through your urethra (intravesical therapy).
Chemotherapy may be used to kill cancer cells that might remain after an operation. It may also be used before surgery. In this case, chemotherapy may shrink a tumor enough to allow the surgeon to perform a less invasive surgery. Chemotherapy is sometimes combined with radiation therapy.
Radiation therapy uses high-energy beams aimed at your cancer to destroy the cancer cells. Radiation therapy can come from a machine outside your body (external beam radiation) or it can come from a device placed inside your bladder (brachytherapy).
Radiation therapy may be used before surgery to shrink a tumor so that
it can more easily be removed with surgery. Radiation therapy can also
be used after surgery to kill cancer cells that might remain. Radiation
therapy is sometimes combined with chemotherapy.
Health: Prevention of Pancreatic Cancer (Pancreas - Cancer)
There's no guaranteed way to prevent bladder cancer, yet there are steps to help reduce your risk:
- Don't smoke. Not smoking means that cancer-causing chemicals in smoke can't collect in your bladder. If you don't smoke, don't start. If you smoke, talk to your doctor about a plan to help you quit. Support groups, medications and other methods may help you quit.
- Take caution with chemicals. If you work with chemicals, follow all safety instructions to avoid exposure.
- Have your well tested for arsenic. If you have your own well, consider having it tested for high levels of arsenic in the water.
- Drink plenty of fluids. Drinking liquids, especially water, dilutes toxic substances that may be concentrated in your urine and flushes them out of your bladder more quickly.
- Eat your fruits and vegetables. Choose a diet rich in a variety of colorful fruits and vegetables. The antioxidants in fruits and vegetables may help reduce your health risk of cancer.
- Maintain a healthy weight. Being overweight increases your risk of pancreatic cancer. If you need to lose weight, aim for a slow, steady weight loss — 1 or 2 pounds (0.5 or 1 kilogram) a week. Combine daily exercise with a plant-focused diet with smaller portions to help you lose weight.
- Exercise regularly. Aim for 30 minutes of exercise on most days. If you're not used to exercising, start out slowly and work up to your goal.
Disclaimer: This information is not presented by a medical practitioner. Therefore any content of this site is strictly intended for educational and informational purpose only. Any access to this site is strictly on a voluntary basis and at the sole discretion of the user. No content of this site is intended as a substitute for medical advice, diagnosis or treatment, nor constitute the practice of any medical profession or health care provider. The information provided on this site is here to educate visitors on health issues that may affect their lives. Otherwise, always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition. And never disregard professional medical advice or delay in seeking it because of something you have read.
Sources: NIH News In Health/National Institutes of Health/National Library of Medicine/Dept of Health and Human Services_______________________________________________________________________________________________________
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