Cancer of the pancreas is abnormal cell growth in the tissue of the pancreas. The pancreas is about 6 inches long, and is located next to the small intestine, behind the stomach. This organ serves two main functions in the body. It produces juices and enzymes to help with digesting and absorbing food. It also produces several hormones, such as insulin, that regulate the way your body stores and processes food.

About 95 percent of all pancreatic cancers begin in the part of the pancreas that produces digestive fluids (the exocrine pancreas). The remaining 5 percent begin in the part that produces hormones (the endocrine pancreas). These different types of tumors are vastly different. It is extremely important that doctors confirm the type of cancer in the pancreas because of differences in treatment. Since the overwhelming majority of pancreatic cancers are tumors in the exocrine pancreas (adenocarcinomas), this article will focus on this type of cancer.

Unless pancreatic cancer is detected in its very early stages, it has usually spread beyond the pancreas before a diagnosis is established. Pancreatic cancer tends to occur in older people, and the incidence of the disease is rising as people live longer. Health professionals estimate that 33,730 people in the United States will be diagnosed with pancreatic cancer in 2006 and 32,300 will die of the disease. Pancreatic cancer is expected to be the fourth leading cause of cancer death in men and the fifth leading causes of cancer death in women in 2006.

It's not clear what causes pancreatic cancer. However, cigarette smoking significantly raises the risk of developing pancreatic cancer. There is evidence that the risk of pancreatic cancer increases the more a person smokes and the longer he or she smokes. Smokers who quit have a lower risk of developing pancreatic cancer than those who continue smoking.

In most patients with pancreatic cancer, no cause can be found.

Someone with pancreatic cancer in the early stages of the disease may not have any symptoms. When symptoms occur, they can resemble many other ailments of the stomach, intestines, liver and gallbladder. The most common presenting features are pain, weight loss and yellowing of the skin if jaundice occurs. As the body breaks down old and exhausted red blood cells; the liver processes the pigment in the red blood cells and discharges it through the bile and eventually into the gastrointestinal portion of the small bowel. The anatomic area where this discharge takes place is in close proximity to the main portion of the pancreas. Thus, if there is blockage caused by pancreatic enlargement, the pigment containing bile will back up and leech into the skin and other tissues such as the eye.

In addition to jaundice, symptoms may include itching, brown urine and very light-colored bowel movements.

There is no effective method of screening for cancers in the pancreas. Because the pancreas is hidden from view among many other organs, detecting cancer there is difficult. Unfortunately, when first diagnosed, the cancer has reached an advanced stage due to the lack of symptoms during the early stages of the growth of the cancer.

If you have symptoms of pancreatic cancer, your doctor will ask you about your medical history, examine you and order diagnostic tests to look for other possible causes. These diagnostic tests include:

• Routine laboratory tests – Basic blood work can evaluate how your liver is functioning, and can help to narrow the possible causes of your symptoms.



• Ultrasound – In this test, images created by an echo of ultrasound waves are viewed on a video screen. Although ultrasound is not the best way to diagnose a tumor of the pancreas, it may help to discover other possible causes of your symptoms, such as gallbladder disease or cysts in the pancreas.



• Computed tomography (CT) scan – This generally is considered to be a more accurate imaging test for detecting pancreatic cancer. A CT scan uses X-rays to create an image of the inside of the abdomen.



• Magnetic resonance imaging (MRI) scan – Another more accurate test, an MRI scan, uses magnetic fields and radio waves to produce images. A special type of MRI, a magnetic resonance cholangiopancreatography, may be done to look more closely for blockages of the pancreatic bile ducts.



• Positron emission tomography (PET) scanning – PET scanning can also be used either alone or in conjunction with CT scanning to evaluate the activity of the cancer both in the pancreatic region in the abdomen, but also help assess whether there has been spread to other organs in the abdomen and beyond.



• Endoscopic retrograde cholangiopancreatography – In this test, the doctor inserts a tube into your mouth, down into the stomach and then into the first part of the small intestine where the bile duct empties. A small instrument may be inserted through the tube so that a dye can be injected and X-rays can be taken to look for any blockages of the bile duct or the ducts in the pancreas. If a blockage or mass is detected, the doctor can take tissue samples to test for cancer. While this test is often very useful, it must be done by an extremely skilled physician, since complications may occur either during or following the procedure.



• CT-guided biopsy – A CT scan is used to guide the biopsy needle to the right spot for obtaining samples of suspicious tissue. Rarely, surgery may be needed to make the diagnosis.

The best hope for a cure exists when cancer is detected early, before it has spread. Unfortunately, by the time symptoms occur and diagnosis is made, cancer usually has spread outside the pancreas. How much symptoms can be controlled depends on how much the cancer has spread, your age and general health, and how well your body responds to treatment. Even when a cure isn't possible, treatment can sometimes improve the length of survival and the quality of life by controlling symptoms and complications of the cancer. Several new chemotherapeutic agents have been introduced to help manage pancreatic cancer.

There is no way to prevent pancreatic cancer. There also is no method of screening for pancreatic cancer so that it can be caught and treated early. Because cigarette smoking is the most significant risk factor associated with pancreatic cancer, it's crucial to quit smoking or avoid starting. Eating a diet including fruits, vegetables and fiber is also recommended to avoid cancers in general.

After your physician diagnoses pancreatic cancer, he or she will conduct more tests to determine how advanced the cancer has become, a process known as staging. The treatment depends on the cancer's stage.

Surgery may be done to remove part or all of the pancreas, and any surrounding tissue that has become cancerous. Your doctor also may use chemotherapy (treatment with tumor-killing drugs) and radiation therapy to kill tumor cells and control symptoms of the disease. In some cases, your doctor may offer you new treatments that are promising but are not yet approved as standard procedure. These treatments are called clinical trials.

Even if the chance for cure is small, treatment may help to prevent or control the development of symptoms.

Pancreatic cancer is classified and treated according to the following stages:

Resectable cancer: The cancer has not spread outside the pancreas. It is rare for patients to be diagnosed with pancreatic cancer at this early stage. Treatment of cancers in this stage typically involves surgery, but may include any of the following:

• Surgery to remove the head of the pancreas, part of the small intestine and some surrounding tissue (Whipple procedure)
• Removal of the entire pancreas and the organs around it (total pancreatectomy)
• Removal of the body and tail of the pancreas (distal pancreatectomy)
• Surgery followed by radiation therapy and chemotherapy
• Clinical trials – Radiation therapy and possibly chemotherapy given before, during or after surgery

Locally advanced cancer: The cancer has spread to neighboring organs, such as the duodenum (the first part of the small intestine), surrounding blood vessels and the intestine. Because of this spread, it generally is not possible to remove the pancreas surgically. Treatment of patients with this stage of pancreatic cancer may include:

• External radiation therapy with or without chemotherapy
• Surgery or other procedures to reduce symptoms
• Clinical trials – Radiation therapy and chemotherapy given before surgery; radiation therapy plus drugs to make cancer cells more responsive to radiation (radiosensitizers); chemotherapy and radiation therapy given during surgery with or without internal radiation therapy
• Stenting ? If the cancer has blocked the bile duct near the liver, a specialist may place a stent (wire mesh tube) to open up the duct. This will relieve the symptoms of bile duct obstruction, including jaundice. The procedure does not require an incision; it is done using an endoscope.

Metastatic cancer: The cancer has spread to distant areas, such as the liver, pelvic organs, abdominal cavity and lungs. Treatment for patients with cancers in this stage may include any of the following:

• Chemotherapy
• Treatments for pain and other symptoms
• Surgery or other treatments to reduce symptoms
• Clinical trials – chemotherapy or biological therapy (sometimes called immunotherapy), which uses the body's immune system, either directly or indirectly, to fight cancer and the side effects caused by cancer treatments
• Stenting – If the cancer has blocked the bile duct near the liver, a specialist may place a wire mesh tube called a stent to open up the duct. This will relieve the symptoms of bile duct obstruction, including jaundice. The procedure does not require an incision. It is done using an endoscope, a tube that is inserted into your mouth, down into the stomach and then into the first part of the small intestine where the bile duct empties.

Recurrent cancer: The cancer has reappeared (recurred) after it has been treated, either in the pancreas or another part of the body. In addition to any of the treatments listed above for metastatic pancreatic cancer, treatment may include external radiation therapy to reduce symptoms.

See your doctor as soon as you notice any of the symptoms of pancreatic cancer. You doctor may refer you to a gastroenterologist (a digestive specialist) or an oncologist (a cancer specialist).

Pancreatic cancer is a serious illness, and its death rate is high. Your chances of recovery depend on your age, the extent of the cancer at the time of diagnosis, general health and the effectiveness of your treatment.

Approximately 19 percent of patients with pancreatic cancer survive at least 1 year after diagnosis, but only 1 percent to 2 percent of people with pancreatic cancer survive 5 years after diagnosis.

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