Keeping on Top of Your Condition
The Pancreas
The pancreas
is a gland
located deep in the abdomen
between the stomach and the spine (backbone). The liver,
intestine,
and other organs surround the pancreas.
The pancreas is about 6 inches long and is shaped like a flat pear. The
widest part of the pancreas is the head, the middle section is the body,
and the thinnest part is the tail.
This picture shows the pancreas and nearby
organs.
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The pancreas makes insulin
and other hormones.
These hormones enter the bloodstream and travel throughout the body. They
help the body use or store the energy that comes from food. For example,
insulin helps control the amount of sugar in the blood.
The pancreas also makes pancreatic
juices. These juices contain enzymes
that help digest food. The pancreas releases the juices into a system of
ducts
leading to the common
bile duct. The common bile duct empties into the duodenum,
the first section of the small intestine.
This picture shows the pancreas, common bile duct, and
small intestine.
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Understanding Cancer
Cancer is a group of many related diseases. All cancers begin in cells,
the body's basic unit of life. Cells make up tissues,
and tissues make up the organs of the body.
Normally, cells grow and divide to form new cells as the body needs
them. When cells grow old and die, new cells take their place.
Sometimes this orderly process breaks down. New cells form when the
body does not need them, or old cells do not die when they should. These
extra cells can form a mass of tissue called a growth or tumor.
Tumors can be benign
or malignant:
-
Benign tumors are not cancer. Usually, doctors can remove
them. In most cases, benign tumors do not come back after they are
removed. Cells from benign tumors do not spread to tissues around them
or to other parts of the body. Most important, benign tumors are rarely
a threat to life.
-
Malignant tumors are cancer. They are generally more serious
and may be life threatening. Cancer cells can invade and damage nearby
tissues and organs. Also, cancer cells can break away from a malignant
tumor and enter the bloodstream or lymphatic
system. That is how cancer cells spread from the original cancer
(primary
tumor) to form new tumors in other organs. The spread of cancer
is called metastasis.
Most pancreatic cancers begin in the ducts that carry pancreatic
juices. Cancer of the pancreas may be called pancreatic
cancer or carcinoma
of the pancreas.
A rare type of pancreatic cancer begins in the cells that make insulin
and other hormones. Cancer that begins in these cells is called islet
cell cancer. This booklet does not deal with this rare disease.
The Cancer Information Service (1-800-4-CANCER) can provide information
about islet cell cancer.
When cancer of the pancreas spreads (metastasizes)
outside the pancreas, cancer cells are often found in nearby lymph
nodes. If the cancer has reached these nodes, it means that cancer
cells may have spread to other lymph nodes or other tissues, such as the
liver or lungs. Sometimes cancer of the pancreas spreads to the peritoneum,
the tissue that lines the abdomen.
When cancer spreads from its original place to another part of the
body, the new tumor has the same kind of abnormal cells and the same name
as the primary tumor. For example, if cancer of the pancreas spreads to
the liver, the cancer cells in the liver are pancreatic cancer cells. The
disease is metastatic pancreatic cancer, not liver cancer. It is treated
as pancreatic cancer, not liver cancer.
Pancreatic Cancer: Who's at Risk?
No one knows the exact causes of pancreatic cancer. Doctors can seldom
explain why one person gets pancreatic cancer and another does not.
However, it is clear that this disease is not contagious. No one can
"catch" cancer from another person.
Research has shown that people with certain risk
factors are more likely than others to develop pancreatic cancer.
A risk factor is anything that increases a person's chance of developing a
disease.
Studies have found the following risk factors:
-
Age -- The likelihood of developing pancreatic cancer
increases with age. Most pancreatic cancers occur in people over the age
of 60.
-
Smoking -- Cigarette smokers are two or three times more
likely than nonsmokers to develop pancreatic cancer.
-
Diabetes
-- Pancreatic cancer occurs more often in people who have diabetes than
in people who do not.
-
Being male -- More men than women are diagnosed with
pancreatic cancer.
-
Being African American -- African Americans are more likely
than Asians, Hispanics, or whites to get pancreatic cancer.
-
Family history -- The risk for developing pancreatic cancer
triples if a person's mother, father, sister, or brother had the
disease. Also, a family history of colon or ovarian cancer increases the
risk of pancreatic cancer.
-
Chronic pancreatitis
-- Chronic pancreatitis is a painful condition of the pancreas. Some
evidence suggests that chronic pancreatitis may increase the risk of
pancreatic cancer.
Other studies suggest that exposure to certain chemicals in the
workplace or a diet high in fat may increase the chance of getting
pancreatic cancer.
Most people with known risk factors do not get pancreatic cancer. On
the other hand, many who do get the disease have none of these factors.
People who think they may be at risk for pancreatic cancer should discuss
this concern with their doctor. The doctor may suggest ways to reduce the
risk and can plan an appropriate schedule for checkups.
Pancreatic Cancer Symptoms
Pancreatic cancer is sometimes called a "silent disease" because often, early
on, there are not any symptoms of cancer of the pancreas.
But, as the cancer grows, pancreatic cancer symptoms may include:
These symptoms are not sure signs of pancreatic cancer. An infection or
other problem could also cause these symptoms. Only a doctor can diagnose
the cause of a person's symptoms. Anyone with these symptoms should see a
doctor so that the doctor can treat any problem as early as possible.
Diagnosis
If a patient has symptoms that suggest pancreatic cancer, the doctor
asks about the patient's medical history. The doctor may perform a number
of procedures, including one or more of the following:
-
Physical exam -- The doctor examines the skin and eyes for
signs of jaundice. The doctor then feels the abdomen to check for
changes in the area near the pancreas, liver, and gallbladder.
The doctor also checks for ascites,
an abnormal buildup of fluid in the abdomen.
-
Lab tests -- The doctor may take blood, urine, and stool
samples to check for bilirubin
and other substances. Bilirubin is a substance that passes from the
liver to the gallbladder to the intestine. If the common bile duct is
blocked by a tumor, the bilirubin cannot pass through normally. Blockage
may cause the level of bilirubin in the blood, stool, or urine to become
very high. High bilirubin levels can result from cancer or from
noncancerous conditions.
-
CT
scan (Computed tomography) -- An x-ray machine linked to a
computer takes a series of detailed pictures. The x-ray machine is
shaped like a donut with a large hole. The patient lies on a bed that
passes through the hole. As the bed moves slowly through the hole, the
machine takes many x-rays. The computer puts the x-rays together to
create pictures of the pancreas and other organs and blood vessels in
the abdomen.
-
Ultrasonography
-- The ultrasound device uses sound waves that cannot be heard by
humans. The sound waves produce a pattern of echoes as they bounce off
internal organs. The echoes create a picture of the pancreas and other
organs inside the abdomen. The echoes from tumors are different from
echoes made by healthy tissues.
The ultrasound procedure may use an external or internal device, or
both types:
-
Transabdominal
ultrasound: To make images of the pancreas, the doctor
places the ultrasound device on the abdomen and slowly moves it
around.
-
EUS
(Endoscopic ultrasound): The doctor passes a thin, lighted
tube (endoscope)
through the patient's mouth and stomach, down into the first part of
the small intestine. At the tip of the endoscope is an ultrasound
device. The doctor slowly withdraws the endoscope from the intestine
toward the stomach to make images of the pancreas and surrounding
organs and tissues.
-
ERCP (endoscopic
retrograde cholangiopancreatography) -- The doctor passes an
endoscope through the patient's mouth and stomach, down into the first
part of the small intestine. The doctor slips a smaller tube (catheter)
through the endoscope into the bile ducts and pancreatic ducts. After
injecting dye through the catheter 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.
-
PTC (percutaneous
transhepatic cholangiography) -- A dye is injected through a
thin needle inserted through the skin into the liver. Unless there is a
blockage, the dye should move freely through the bile ducts. The dye
makes the bile ducts show up on x-ray pictures. From the pictures, the
doctor can tell whether there is a blockage from a tumor or other
condition.
-
Biopsy
-- In some cases, the doctor may remove tissue. A pathologist
then uses a microscope to look for cancer cells in the tissue. The
doctor may obtain tissue in several ways. One way is by inserting a
needle into the pancreas to remove cells. This is called fine-needle
aspiration. The doctor uses x-ray or ultrasound to guide the
needle. Sometimes the doctor obtains a sample of tissue during EUS or
ERCP. Another way is to open the abdomen during an
operation.
A person who needs a biopsy may want to ask the doctor the
following questions:
-
What kind of biopsy will I have?
-
How long will it take? Will I be awake? Will it hurt?
-
Are there any risks?
-
How soon will I know the results?
-
If I do have cancer, who will talk to me about treatment?
When? |
Staging
When pancreatic cancer is diagnosed, the doctor needs to know the stage,
or extent, of the disease to plan the best treatment for pancreatic cancer. Staging
is a careful attempt to find out the size of the tumor in the pancreas,
whether the cancer has spread, and if so, to what parts of the body.
The doctor may determine the stage of pancreatic cancer at the time of
diagnosis, or the patient may need to have more tests. Such tests may
include blood tests, a CT scan, ultrasonography, laparoscopy,
or angiography.
The test results will help the doctor decide which treatment is
appropriate.
Pancreatic Cancer Treatment
Many people with pancreatic cancer want to take an active part in
making decisions about their medical care. They want to learn all they can
about their disease and their choices for pancreatic cancer treatment. However, the shock and
stress that people may feel after a diagnosis of cancer can make it hard
for them to think of everything they want to ask the doctor. Often it
helps to make a list of questions before an appointment. To help remember
what the doctor says, patients may take notes or ask whether they may use
a tape recorder. Some patients also want to have a family member or friend
with them when they talk to the doctor-to take part in the discussion, to
take notes, or just to listen.
Cancer of the pancreas is very hard to control with current treatments.
For that reason, many doctors encourage patients with this disease to
consider taking part in a clinical
trial. Clinical trials are an important option for people with all
stages of pancreatic cancer. The section on "The
Promise of Cancer Research" has more information about clinical
trials.
At this time, pancreatic cancer can be cured only when it is found at
an early stage, before it has spread. However, other treatments may be
able to control the disease and help patients live longer and feel better.
When a cure or control of the disease is not possible, some patients and
their doctors choose palliative therapy. Palliative
therapy aims to improve quality
of life by controlling pain and other problems caused by this
disease.
The doctor may refer patients to an oncologist,
a doctor who specializes in treating cancer, or patients may ask for a
referral. Specialists who treat pancreatic cancer include surgeons,
medical
oncologists, and radiation
oncologists. Treatment generally begins within a few weeks after
the diagnosis. There will be time for patients to talk with the doctor
about treatment choices, get a second opinion, and learn more about the
disease.
Getting a Second Opinion
Before starting treatment, a patient may want a second opinion about
the diagnosis and the treatment plan. Some insurance companies require a
second opinion; others may cover a second opinion if the patient requests
it. Gathering medical records and arranging to see another doctor may take
a little time. In most cases, a brief delay to get another opinion will
not make therapy less helpful.
There are a number of ways to find a doctor for a second opinion:
-
The doctor may refer patients to one or more specialists. At cancer
centers, several specialists often work together as a team.
-
The Cancer Information Service (1-800-4-CANCER) can tell callers
about treatment facilities, including cancer centers and other programs
supported by the National Cancer Institute, and can send printed
information about finding a doctor.
-
A local medical society, a nearby hospital, or a medical school can
usually provide the name of specialists.
-
The Official ABMS Directory of Board Certified Medical
Specialists lists doctors' names along with their specialty and
their educational background. This resource is available in most public
libraries. The American Board of Medical Specialties (ABMS) also offers
information by telephone and on the Internet. The public may use these
services to check whether a doctor is board certified. The telephone
number is 1-866-ASK-ABMS (1-866-275-2267). The Internet address is http://www.abms.org/newsearch.asp.
Preparing for Treatment
The doctor can describe treatment choices and discuss the results
expected with each pancreatic cancer treatment option. The doctor and patient can work
together to develop a treatment plan that fits the patient's needs.
Treatment depends on where in the pancreas the tumor started and
whether the disease has spread. When planning treatment, the doctor also
considers other factors, including the patient's age and general
health.
These are some questions a person may want to ask the doctor
before treatment begins:
-
What is the diagnosis?
-
Where in the pancreas did the cancer start?
-
Is there any evidence the cancer has spread? What is the stage
of the disease?
-
Do I need any more tests to check whether the disease has
spread?
-
What are my treatment choices? Which do you recommend for me?
Why?
-
What are the expected benefits of each kind of treatment?
-
What are the risks and possible side
effects of each treatment?
-
What is the treatment likely to cost? Is this treatment covered
by my insurance plan?
-
How will treatment affect my normal activities?
-
Would a clinical trial (research study) be appropriate for
me? |
People do not need to ask all of their questions or understand all of
the answers at one time. They will have other chances to ask the doctor to
explain things that are not clear and to ask for more information.
Methods of Pancreatic Cancer Treatment
People with pancreatic cancer may have several treatment options.
Depending on the type and stage, pancreatic cancer may be treated with
surgery,
radiation
therapy, or chemotherapy.
Some patients have a combination of therapies.
Surgery may be used alone or in combination with radiation
therapy and chemotherapy.
The surgeon may remove all or part of the pancreas. The extent of
surgery depends on the location and size of the tumor, the stage of the
disease, and the patient's general health.
-
Whipple
procedure: If the tumor is in the head (the widest part) of
the pancreas, the surgeon removes the head of the pancreas and part of
the small intestine, bile duct, and stomach. The surgeon may also remove
other nearby tissues.
-
Distal
pancreatectomy: The surgeon removes the body and tail of the
pancreas if the tumor is in either of these parts. The surgeon also
removes the spleen.
-
Total
pancreatectomy: The surgeon removes the entire pancreas,
part of the small intestine, a portion of the stomach, the common bile
duct, the gallbladder, the spleen, and nearby lymph nodes.
Sometimes the cancer cannot be completely removed. But if the tumor is
blocking the common bile duct or duodenum, the surgeon can create a bypass.
A bypass allows fluids to flow through the digestive tract. It can help
relieve jaundice and pain resulting from a blockage.
The doctor sometimes can relieve blockage without doing bypass surgery.
The doctor uses an endoscope to place a stent
in the blocked area. A stent is a tiny plastic or metal mesh tube that
helps keep the duct or duodenum open.
After surgery, some patients are fed liquids intravenously
(by IV) and through feeding tubes placed into the abdomen. Patients slowly
return to eating solid foods by mouth. A few weeks after surgery, the
feeding tubes are removed.
These are some questions a person may want to ask the doctor
before having surgery:
-
What kind of operation will I have?
-
How will I feel after the operation?
-
How will you treat my pain?
-
What other treatment will I need?
-
How long will I be in the hospital?
-
Will I need a feeding tube after surgery? Will I need a special
diet?
-
What are the long-term effects?
-
When can I get back to my normal activities?
-
How often will I need checkups? |
Radiation therapy (also called radiotherapy) uses high-energy
rays to kill cancer cells. A large machine directs radiation at the
abdomen. Radiation therapy may be given alone, or with surgery,
chemotherapy, or both.
Radiation therapy is local
therapy. It affects cancer cells only in the treated area. For
radiation therapy, patients go to the hospital or clinic, often 5 days a
week for several weeks.
Doctors may use radiation to destroy cancer cells that remain in the
area after surgery. They also use radiation to relieve pain and other
problems caused by the cancer.
These are some questions a person may want to ask the doctor
before having radiation therapy:
-
Why do I need this treatment?
-
When will the treatments begin? When will they end?
-
How will I feel during therapy? Are there side effects?
-
What can I do to take care of myself during therapy? Are there
certain foods that I should eat or avoid?
-
How will we know if the radiation is working?
-
Will I be able to continue my normal activities during
treatment? |
Chemotherapy is the use of drugs to kill cancer cells. Doctors
also give chemotherapy to help reduce pain and other problems caused by
pancreatic cancer. It may be given alone, with radiation, or with surgery
and radiation.
Chemotherapy is systemic
therapy. The doctor usually gives the drugs by injection. Once in
the bloodstream, the drugs travel throughout the body.
Usually chemotherapy is an outpatient
treatment given at the hospital, clinic, doctor's office, or home.
However, depending on which drugs are given and the patient's general
health, the patient may need to stay in the hospital.
Patients may want to ask these questions about chemotherapy:
-
Why do I need this treatment?
-
What will it do?
-
What drugs will I be taking? How will they be given? Will I
need to stay in the hospital?
-
Will the treatment cause side effects? What can I do about
them?
-
How long will I be on this
treatment? |
Side Effects of Treatment
Because cancer treatment may damage healthy cells and tissues, unwanted
side effects are common. These side effects depend on many factors,
including the type and extent of the treatment. Side effects may not be
the same for each person, and they may even change from one treatment
session to the next. The health care team will explain possible side
effects and how they will help the patient manage them.
Surgery
Surgery for pancreatic cancer is a major operation. Patients need to
stay in the hospital for several days afterward. Patients may feel weak or
tired. Most need to rest at home for about a month. The length of time it
takes to regain strength varies.
The side effects of surgery depend on the extent of the operation, the
person's general health, and other factors. Most patients have pain for
the first few days after surgery. Pain can be controlled with medicine,
and patients should discuss pain relief with the doctor or nurse. The
section on "Pain
Control" has more information.
Removal of part or all of the pancreas may make it hard for a patient
to digest foods. The health care team can suggest a diet plan and
medicines to help relieve diarrhea, pain, cramping, or feelings of
fullness. During the recovery from surgery, the doctor will carefully
monitor the patient's diet and weight. At first, a patient may have only
liquids and may receive extra nourishment intravenously or by feeding tube
into the intestine. Solid foods are added to the diet gradually.
Patients may not have enough pancreatic enzymes or hormones after
surgery. Those who do not have enough insulin may develop diabetes. The
doctor can give the patient insulin, other hormones, and enzymes. The
section "Nutrition
for Cancer Patients" has more information.
Radiation Therapy
Radiation therapy may cause patients to become very tired as treatment
continues. Resting is important, but doctors usually advise patients to
try to stay as active as they can. In addition, when patients receive
radiation therapy, the skin in the treated area may sometimes become red,
dry, and tender.
Radiation therapy to the abdomen may cause nausea, vomiting, diarrhea,
or other problems with digestion. The health care team can offer medicine
or suggest diet changes to control these problems. For most patients, the
side effects of radiation therapy go away when treatment is over.
Chemotherapy
The side effects of chemotherapy depend mainly on the drugs and the
doses the patient receives as well as how the drugs are given. In
addition, as with other types of treatment, side effects vary from patient
to patient.
Systemic chemotherapy affects rapidly dividing cells throughout the
body, including blood cells. Blood cells fight infection, help the blood
to clot, and carry oxygen to all parts of the body. When anticancer drugs
damage healthy blood cells, patients are more likely to get infections,
may bruise or bleed easily, and may have less energy. Cells in hair roots
and cells that line the digestive tract also divide rapidly. As a result,
patients may lose their hair and may have other side effects such as poor
appetite, nausea and vomiting, diarrhea, or mouth sores. Usually, these
side effects go away gradually during the recovery periods between
treatments or after treatment is over. The health care team can suggest
ways to relieve side effects.
Pain Control
Pain is a common problem for people with pancreatic cancer. The tumor
can cause pain by pressing against nerves and other organs.
The patient's doctor or a specialist in pain control can relieve or
reduce pain in several ways:
-
Pain medicine -- Medicines often can relieve pain. (These
medicines may make people drowsy and constipated, but resting and taking
laxatives can help.)
-
Radiation -- High-energy rays can help relieve pain by
shrinking the tumor.
-
Nerve block -- The doctor may inject alcohol into the area
around certain nerves in the abdomen to block the feeling of pain.
-
Surgery -- The surgeon may cut certain nerves to block
pain.
The doctor may suggest other ways to relieve or reduce pain. For
example, massage, acupuncture,
or acupressure
may be used along with other approaches to help relieve pain. Also, the
patient may learn relaxation techniques such as listening to slow music or
breathing slowly and comfortably.
Nutrition
People with pancreatic cancer may not feel like eating, especially if
they are uncomfortable or tired. Also, the side effects of treatment such
as poor appetite, nausea, or vomiting can make eating difficult. Foods may
taste different. Nevertheless, patients should try to get enough calories
and protein to control weight loss, maintain strength, and promote
healing. Also, eating well often helps people with cancer feel better and
have more energy.
Careful planning and checkups are important. Cancer of the pancreas and
its treatment may make it hard for patients to digest food and maintain
the proper blood sugar level. The doctor will check the patient for weight
loss, weakness, and lack of energy. Patients may need to take medicines to
replace the enzymes and hormones made by the pancreas. The doctor will
watch the patient closely and adjust the doses of these medicines.
The doctor, dietitian, or other health care provider can advise
patients about ways to maintain a healthy diet.
Followup Care
Followup care after treatment for pancreatic cancer is an important
part of the overall treatment plan. Patients should not hesitate to
discuss followup with their doctor. Regular checkups ensure that any
changes in health are noticed. Any problem that develops can be found and
treated. Checkups may include a physical exam, laboratory tests, and imaging
procedures.
Support for People with Pancreatic Cancer
Living with a serious disease such as pancreatic cancer is not easy.
Some people find they need help coping with the emotional and practical
aspects of their disease. Support groups can help. In these groups,
patients or their family members get together to share what they have
learned about coping with their disease and the effects of treatment.
Patients may want to talk with a member of their health care team about
finding a support group.
People living with pancreatic cancer may worry about the future. They
may worry about caring for themselves or their families, keeping their
jobs, or continuing daily activities. Concerns about treatments and
managing side effects, hospital stays, and medical bills are also common.
Doctors, nurses, and other members of the health care team can answer
questions about treatment, diet, working, or other matters. Meeting with a
social worker, counselor, or member of the clergy can be helpful to those
who want to talk about their feelings or discuss their concerns. Often, a
social worker can suggest resources for financial aid, transportation,
home care, emotional support, or other services.
The Promise of Cancer Research
Laboratory scientists are studying the pancreas to learn more about it.
They are studying the possible causes of pancreatic cancer and are
researching new ways to detect tumors. They also are looking for new
therapies that may kill cancer cells.
Doctors in clinics and hospitals are conducting many types of clinical
trials. These are research studies in which people take part voluntarily.
In these trials, researchers are studying ways to treat pancreatic cancer.
Research already has led to advances in treatment methods, and researchers
continue to search for more effective approaches to treat this
disease.
Patients who join clinical trials have the first chance to benefit from
new treatments that have shown promise in earlier research. They also make
an important contribution to medical science by helping doctors learn more
about the disease. Although clinical trials may pose some risks,
researchers take very careful steps to protect their patients.
In trials with people who have pancreatic cancer, doctors are studying
new drugs, new combinations of chemotherapy, and combinations of
chemotherapy and radiation before and after surgery.
Biological
therapy is also under investigation. Scientists are studying
several cancer vaccines
to help the immune system fight cancer. Other studies use monoclonal
antibodies to slow or stop the growth of cancer.
Patients who are interested in joining a clinical study should talk
with their doctor.
Keeping on Top of Your Condition
Keeping in tune with your disease or condition not only makes treatment less intimidating but also increases its chance of success, and has been shown to lower a patients risk of complications. As well, as an informed patient, you are better able to discuss your condition and treatment options with your physician.
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