PANCREATIC CANCER

What is the pancreas?

The pancreas makes pancreatic juices, which help digest food in the small intestines, and hormones, including insulin. It is located behind the stomach in the back of the abdomen. The duct of the pancreatic gland opens into the first portion of the small intestine (called the duodenum) through a nipple like opening called the ampulla.

What causes pancreatic cancer?

It is not known exactly why certain people get pancreatic cancer. Research shows that there are certain risk factors that increase the chance of getting pancreatic cancer. Smoking is a major risk factor. Alcohol consumption, a diet rich in animal fat and chronic pancreatitis may also be risk factors. People with a condition called hereditary pancreatitis are also at increased risk for getting pancreatic cancer.

What are the symptoms of pancreatic cancer?

Early pancreatic cancer usually does not cause symptoms and is therefore known as the "silent" disease. As the tumor gets larger, the patient may have one or more of the following:

  • Jaundice- If the tumor blocks the bile ducts (the major bile duct passes through the pancreas), the patient may develop jaundice, a condition where the skin and eyes may become yellow and the urine may become dark in color.
  • Abdominal pain- As the cancer grows, the patient may have pain in the abdomen which may radiate to the back. Pain may increase with eating or lying down.
  • Nausea
  • Decreased appetite
  • Weight loss

How is cancer of the pancreas diagnosed?

In addition to taking a complete history and performing a physical examination, the doctor may perform certain endoscopic and radiologic tests such as a CT scan or ultrasound. Endoscopic ultrasound may also be performed. This test may help in finding small tumors that may be less than 2-3 cms (one inch). A biopsy of an abnormal area of the pancreas may be performed in certain cases by inserting a needle into the pancreas under ultrasonic guidance.

ERCP (endoscopic retrograde cholangiopancreatogram), a special x-ray study of the pancreatic duct and the common bile duct may also be used to make the diagnosis. For this test, a flexible tube with a light and a camera at the end is passed through the mouth into the stomach and then the small intestines. Sedation is given. A dye is then injected into the pancreatic duct and the bile duct to look for abnormal filling or obstruction of these ducts by the tumor. During this procedure, biopsies can be taken using a brush that is inserted into the bile duct. The biopsy specimens are then examined under a microscope to look for cancer cells.

What is the treatment for cancer of the pancreas?

Cancer of the pancreas is really only curable if it is found in the early stages. Surgery, radiation and chemotherapy are possible treatment options. Surgery may be done to remove all or part of the pancreas and surrounding tissues if needed. Radiation therapy can be used to damage the cancer cells and prevent them from growing. Radiation maybe used in certain trials after surgery to help kill any remaining cancer cells. Chemotherapy will not cure pancreatic cancer but may have some effect on slowing the rate of progression of the tumor or to improve the patient's quality of life. Many new drugs are being investigated for chemotherapy of pancreatic cancer and patients with this disease may have an opportunity to participate in one of the research trials for chemotherapeutic treatment of pancreatic cancer.

Pain control may be a difficult problem in patients with pancreatic cancer. Oral pain medication may be used, or patients may be referred for a nerve block which is performed by injecting alcohol into the bundle of nerves (celiac plexus) near the pancreas to decrease pain signals from the pancreatic cancer to the brain.

GASTROINTESTINAL TRACT IMAGE:

 

Authors

Radha Tamerisa, MD, and Manoop S. Bhutani, MD, FACG, FACP, University of Texas Medical Branch, Galveston, TX