What is Pancreatic Cancer?
Pancreatic cancer occurs when normal cells of the pancreas grow out of control within the pancreas. Normal pancreatic cells have well-controlled growth, do not spread or move outside the pancreas and have a defined life span. Cancerous cells of the pancreas have none of these traits and usually occur due to an individual’s genetic make-up and the risk factors in the environment they encounter during their life.
What are the Types of Pancreatic Cancers?
There are several types of pancreatic cancer. They are named for the cell type within the pancreas that started the cancer.
- Adenocarcinoma of the Pancreas
This is the most common of pancreatic cancers and accounts for over 80% of all pancreatic cancer. This type of pancreatic cancer starts from cells lining the main or accessory duct of the pancreas.
- Adenocarcinoma of the Ampulla
This is another common type of cancer and starts from cells lining the approach to the ampulla where the bile duct and the pancreatic duct join the small intestine.
- Intraductal Papillay Mucinous Neoplasm (IPMN)
A growing number of people are being diagnosed with IPMN which start from pancreatic duct cells that produce mucin. These are important because while some IPMNs are already cancerous when diagnosed, most have not yet become malignant. If left untreated, IPMNs may progress to pancreatic cancer. If surgically removed at an early stage, over 95% of patients will be cured.
- Islet Cell Neoplasms of the Pancreas
Islet cells make and release different kinds of hormones (such as gastrin, insulin, and glucagon) into the blood. There are three major types of islet cell neoplasms of the pancreas and several more rare types of these tumors. Islet cell tumors may be functional (the hormones that are released cause symptoms) or nonfunctional (the hormones that are released do not cause symptoms) tumors.
What are risk factors for pancreatic cancer?
While the exact causes are unknown, there are multiple risk factors associated with pancreatic cancer. According to the National Cancer Institute, these risk factors include:
- Age - most pancreatic cancer occurs in people over the age of 60.
- Smoking - heavy cigarette smokers are two or three times more likely than non-smokers to develop pancreatic cancer.
- Diabetes - pancreatic cancer occurs more often in people who have diabetes than in those who do not. New onset diabetes can also be a symptom of pancreatic cancer.
- Gender - slightly more men than women are diagnosed with pancreatic cancer.
- Race - African Americans and Ashkenazi Jews are more likely than Asians, Hispanics, or Caucasians to be diagnosed with pancreatic cancer.
- Chronic pancreatitis - this condition of the pancreas has been linked with a nine-fold increased risk for pancreatic cancer over the general population.
- Family history - the risk for developing pancreatic cancer triples if a person's mother, father, or a sibling had the disease. High risk groups include individuals who are positive for BRCA1, BRCA2 and some other genetic syndromes. Medical geneticists at OHSU can help you determine your familial risk for pancreatic cancer.
What are the signs & symptoms of pancreatic cancer?
Since the pancreas is located deep within the body, symptoms may not occur until the tumor has already spread, or is large enough to interfere with the function of nearby organs. The following are the other most common signs and symptoms of pancreatic cancer. However, each individual may experience symptoms differently. Symptoms may include:
- Pain in the upper abdomen or upper back
- Loss of appetite
- Weight loss
- Jaundice (yellow skin and eyes, and dark urine)
- New onset diabetes in individuals without other risk factors for the condition
How is pancreatic cancer diagnosed?
First the doctor will ask questions about your health and do a physical exam. The exam will focus mostly on the belly (abdominal area). Sometimes pancreatic cancer can spread to the lymph nodes or the liver so the doctor will check these areas for swelling. The skin and the white part of the eyes will be checked for yellow color (jaundice). Imaging tests and/or a biopsy may also be used to help diagnose your pancreatic cancer.
CT scan (Computed Tomography)
This is a special type of x-ray that creates detailed pictures of the inside of the body. CT scans take longer than regular x-rays, but they are faster with the 36 multi-planar detector CT that we use at the OHSU Knight Cancer Institute.
CT scans are often used to find out if a person has pancreatic cancer. They are also helpful in finding out how much the cancer has spread. This is called staging the cancer. CT scans show the pancreas clearly and often can confirm where the cancer is. CT scans can also show the organs near the pancreas, as well as lymph nodes and distant organs where the cancer might have spread. The CT scan can help the doctor to decide whether surgery is a good treatment option for your pancreatic cancer.
MRI (Magnetic Resonance Imaging)
MRI scans use radio waves and strong magnets instead of x-rays to take pictures. MRI scans are helpful in looking at the brain and spinal cord. MRI scans take longer than CT scans—often up to an hour. Also, you have to lie still inside a narrow tube, which can be upsetting for some people. Some patients prefer the newer, "open" MRI machines. Most doctors prefer CT scans to look at the pancreas, but an MRI may provide more information.
PET scan (Positron Mission Tomography)Unlike with other types of cancers, the usefulness of PET scans to diagnose pancreatic cancer is still uncertain. Studies are underway to answer this question.
Endoscopic ultrasounds use sound waves to create pictures of the inside of the body. The pictures are combined by a computer to give a detailed image. This test can help tell what kind of a tumor is in the pancreas. Endoscopic ultrasound is performed by placing a probe through the mouth or nose into the stomach and pointing it toward the pancreas. This gives a very good picture and is better than CT scans for spotting small tumors. Patients are given sedative medicine to make them sleepy for this type of ultrasound.
ERCP (Endoscopic Retrograde Cholangiopancreatography)
For an ERCP test, patients are given medication to make them sedated. Then a thin, flexible tube is passed down the throat, all the way into the small intestine. The doctor can see through the end of the tube and find where the common bile duct opens into the small intestine. A small amount of harmless dye is then injected through the tube into the ducts. This dye helps outline the ducts on x-rays. The pictures can show narrowed or blocked ducts that might be caused by a cancer of the pancreas. ERCP can be used to place a small tube (stent) into the bile duct to keep it open prior to surgery if a nearby tumor is pressing on it.
During a biopsy a sample of tissue from the tumor is removed and looked at under a microscope to see if there are cancer cells. There are several types of biopsies that might be done. In the past, a biopsy was often done as part of surgery. Now, the FNA (fine needle aspiration) biopsy is most often used. For this test, the doctor puts a thin needle through the skin and into the pancreas to remove small pieces of tissue. Ultrasound might be used to place the needle through the wall of the intestine into the tumor. This test can be done while you are awake. It rarely causes side effects.
Another way to get biopsy samples is by doing 'keyhole surgery' (laparoscopy). For this procedure, you are given drugs to make you sleep. Then the surgeon makes small cuts and puts small, thin, telescope-like instruments into the belly. One of these instruments is connected to a video screen. The surgeon can look at your insides, see how big the tumor is, and see if it has spread. Biopsy samples can also be taken.
Most doctors who treat people with pancreatic cancer try to avoid surgery unless it looks like an operation might be able to remove all of the cancer. Even so, there are times when the doctor starts an operation only to find that the cancer has spread too far to be completely removed. In these cases, the doctor will take a sample of the tumor and perform a bypass palliative operation as needed before stopping the operation.
How is pancreatic cancer treated?
At OHSU Knight Cancer Institute, we work together to develop an individualized treatment plan for each patient. Your treatment plan for your pancreatic cancer may include:
- Radiation Therapy
Can you prevent pancreatic cancer?
Unlike other cancers such as colorectal and breast, pancreas cancer screening is in its infancy. Currently, there are no routine screening tests to detect pancreatic cancer in the general population; however, researchers are searching for new screening tests that can help detect pancreatic cancer in at-risk risk populations. The American Cancer Society recommends that people avoid smoking, stay at a good weight, eat a balanced diet, and get plenty of exercise to reduce the risk of pancreatic cancer.