Pancreatic Cancer

by Peter B. Cotton M.D.

Pancreatic cancer is the fourth most common cause of cancer in the U.S. The usual form (Adenocarcinoma) has often spread before it is diagnosed, and has a very poor prognosis. Only about six percent survive for more than five years.

Symptoms

Pancreatic cancer usually causes upper abdominal pain, weight loss and yellow jaundice (if it affects the head of the pancreas and blocks the bile duct from the liver). However, the tumor has often spread outside the pancreas before such symptoms develop.

Risk Factors

Pancreatic cancer has no specific risk factor. It is slightly more common in men, smokers and patients with chronic pancreatitis, especially if it is classified as hereditary pancreatitis (the form that runs in families) for which screening tests are available.

Diagnosis

Pancreatic cancer causes a mass, which can usually be detected by abdominal scans, such as ultrasound, computed tomography (CT) and magnetic resonance scanning (MRI, MRCP). The most accurate test is endoscopic ultrasound (EUS), which may be needed to find the smallest tumors.

Treatment

Surgery is the only treatment that can remove the tumor, but this is not possible in about 80% of patients because of local and/or distant spread of cancerous cells. The classic operation is "pancreato-duodenectomy" (commonly referred to as a Whipple procedure). This is major surgery with some risk, and a prolonged period of recovery. Unfortunately, only about 20% of patients survive five years after surgery since tumor cells have spread (metastasized) outside the gland.

As with other cancers, attempts are made to improve the survival with pancreatic cancer with assistive treatments such as chemotherapy and radiotherapy. They may be given before surgery (to shrink the tumor to make it easier to remove at operation), after surgery, or instead of it. Currently available options are helpful in only a minority of patients, and many have troublesome side effects.

Jaundice caused by tumors that block the bile duct can be treated by placement of a tube (stent), usually done through the mouth with a procedure called ERCP (endoscopic retrograde cholangiopancreatography). Any pain that is resistant to medications can be managed by injecting the nerves around the pancreas. This is called a celiac plexus block, best performed with EUS.

Other Pancreatic Tumors

There are other less common conditions that may look like pancreatic cancer initially, but have a much better prognosis.

Neuro-endocrine tumors begin in the cells that make hormones in the pancreas, and are also called islet cell tumors. (What is islet cell transplant surgery?) Some cause odd symptoms (i.e. flushing, fainting) because of the excess hormones that they produce. Some are benign, but most grow and can spread, often to the liver. The diagnostic tools are similar to those for pancreatic cancer, and surgery can be curative.

An important condition that can mimic pancreatic cancer is called auto-immune pancreatitis. It responds remarkably well to medical treatment with steroids.

Cancer-Related Terms

One of the bewildering aspects of a cancer diagnosis is the many words that are used to describe the condition. Here are a few that we thought you should know:

• Carcinoma — an early form of cancer that has not spread, or a pre-cancer
• Dysplasia — the earliest form of a pre-cancerous lesion
• Histology — microscopic study of the anatomy of cells
• Malignant — a medical condition that becomes progressively worse
• Metastasis — term used to indicate that a disease has spread to another organ
• Neoplasm — term used for an abnormal mass. (A tumor is a neoplasm.)
• Staging — the extent to which a cancer has developed or spread

Resources

Pancreatic Cancer Action Network