Research & Publications > Pancreatic Cancer - Fact Sheet

Pancreatic Cancer - Fact Sheet

The pancreas is a spongy, tube-shaped organ about six inches long, that extends from the right to the left side of the abdomen. Located behind the stomach and connected to the small intestine, the pancreas makes juices that digest food in the small intestine, as well as hormones such as insulin. Insulin controls the amount of sugar in the blood.

When some cells in the pancreas lose the ability to control their growth, too much tissue is made and tumors form. If those tumors are cancerous, they are called pancreatic cancers. These cancers can invade and destroy nearby healthy tissues and organs. Individual cancer cells can also break away from the tumor and spread to other parts of the body, where they form new tumors.

A rare type of pancreatic cancer, called islet cell cancer, begins in the pancreas cells that produce insulin and other hormones.

What are the causes of pancreatic cancer?
While scientists don't know exactly what causes cancer of the pancreas, they're learning that some things put people at greater risk for 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 do nonsmokers.

What are the symptoms of pancreatic cancer?
Pancreatic cancer has been called a “silent” disease because, in its early stages, it doesn't usually cause symptoms. If the tumor is blocking the common bile duct so that bile, which helps digest fats, can't pass into the digestive system, the skin and whites of the eyes may become yellow and the urine may become darker – a condition called jaundice.

As the cancer grows and spreads, pain often develops in the upper abdomen and sometimes spreads to the back. The pain may worsen after eating or lying down. Cancer of the pancreas may also cause nausea, loss of appetite, weight loss and weakness.

Islet cell cancer can cause the pancreas to produce too much insulin or too many other hormones, causing weakness or dizziness, chills, muscle spasms or diarrhea.

These symptoms may be caused by cancer or by other, less serious problems. Only a physician can determine the cause of the symptoms.

How is pancreatic cancer diagnosed?
After performing a complete physical examination and taking a personal and family medical history, physicians usually order blood, urine and stool tests. They may also order imaging studies of the abdomen.

• One study for detecting pancreatic cancer is a CT scan. CT, or computerized tomography, scans are X-rays that use computers to create cross-section images of the pancreas.

• Ultrasound is also effective in detecting pancreatic cancer. Ultrasound examination of the pancreas consists of passing an instrument along the abdomen to send high-frequency sound waves to the pancreas. This creates echoes that form a picture of the pancreas, which can be viewed on a screen resembling a television monitor.

• Angiography, another imaging procedure used for this diagnosis, is a special X-ray of the blood vessels during which dye is injected into a blood vessel through a catheter.

• Endoscopic retrograde cholangiopancreatogram (ERCP) is a special examination of the common bile duct, the tube through which bile passes from the liver and gall bladder to the small intestine; and of the pancreatic duct, the tube through which pancreatic juices pass to the small intestine.

  • Both of these tubes go through the pancreas and can be blocked with cancer. The physician can also look through the endoscope and take tissue samples, as well as X-rays.

• A biopsy is an examination, under the microscope, of tissue the physician removes from the pancreas. If tissue samples obtained with one type of biopsy don't give a clear diagnosis, another type of biopsy may be necessary.

  • One form of biopsy is the needle biopsy in which tissue is removed by a needle passed through the skin into the pancreas under CT or ultrasound guidance.

  • Another type of biopsy is the brush biopsy. This is done during the ERCP by passing a very small brush through the endoscope into the bile duct or pancreatic duct, rubbing off cells that are then examined under a microscope.

• A laparotomy is an operation performed using a laparoscope, which is a tiny instrument that allows surgeons to look at organs within the abdomen. At the same time, they can remove tissue for examination. The laparotomy helps physicians determine the stage, or extent, of the disease. They need this knowledge to plan a treatment.

How is pancreatic cancer treated?
Treatment for pancreatic cancer depends on a number of factors, including the type, size and extent to which the tumor has spread, as well as the patient's age and general health. Physicians take these factors into consider-ation so they can design a treatment plan that fits a patient's individual needs.

Do I need a second opinion?
Treatment decisions for pancreatic cancer are complex. Before starting treatment, patients might want another physician to review the diagnosis and treatment plan. There are a number of ways to obtain a second opinion:

• Patients can call Jefferson Health System's free physician referral service at 1-800-JEFF-NOW.

• The patient's physician may be able to suggest a doctor who has a special interest in cancer of the pancreas.

• Patients can obtain the names of doctors from their local medical society, a nearby hospital or a medical school.

Treatment methods
Cancer of the pancreas is curable only when found in its earliest stages, before it has spread. Otherwise, it is very difficult to cure. It can, however, be treated so that symptoms can be relieved and the quality of the patient's life improved. Pancreatic cancer is treated with surgery, radiation therapy or chemotherapy.

Sometimes, several methods are combined, and the patient is referred to physicians who specialize in the different kinds of treatment.

• Surgery may remove all or part of the pancreas. Sometimes, it's also necessary to remove a portion of the stomach, the upper part of the small intestine and other nearby tissues. When the cancer in the pancreas can't be removed, the surgeon may be able to create a bypass around the common bile duct or the upper part of the small intestine, if either is blocked.

• Radiation therapy, or radiotherapy, uses high-powered rays to kill cancer cells or stop them from growing. Radiation is usually given five days a week for five or six weeks. This schedule helps to protect normal tissue by spreading out the total dose of radiation. Patients aren't hospitalized for radiation therapy.

  • Some patients can be treated by placing radioactive seeds within an inoperable tumor or in that portion of a tumor that can't be removed.

  • In addition, radiation can help relieve pain or digestive problems when there's a blockage of the common bile duct or the upper part of the small intestine.

• Chemotherapy uses medications to kill cancer cells. Physicians may use one medication or a combination, administered by mouth or by injection, to circulate throughout the body. Chemotherapy is usually given in cycles – treatment alternates with a “rest” period.

Are new treatments under development?
The National Cancer Institute is supporting many studies of new treatments for pancreatic cancer. Scientists are exploring new medications and medication combin-ations, new forms of radiation therapy, biological therapy and combinations of these treatments.

Researchers are also looking at new ways to give radiation. For example, they are studying giving radiation therapy two or more times a day, or during surgery to kill cancer cells that may remain in the area after removal of a tumor.

This procedure, known as intraoperative radiation, is currently available in only a few hospitals, including Jefferson.

Biological therapy is an investigational treatment that uses natural and laboratory-produced substances to stimulate or restore the body's immune system so it can fight disease more effectively. This treatment is being studied in patients with advanced or recurring pancreatic cancer. Investigators are developing new genetic markers and genetic-based therapy approaches that may ultimately help in the diagnosis and treatment of pancreatic cancer.

For more information or for a physician referral, call the Jefferson Cancer Network at 1-800-JEFF-NOW (1-800-533-3669). The Jefferson Cancer Network staff can also make an appointment for you. For health information and Healthy Neighbors education programs, call 1-888-WELL-123.

Speech- or hearing-impaired callers can access JEFF NOW® by calling 1-800-654-5984. Much of this information comes from the National Cancer Institute.