The pancreas is a small gland in the upper abdomen, behind the stomach. It helps break down food by releasing digestive enzymes and secretes hormones, particularly insulin, to control blood sugar levels.

Most pancreatic cancers start in the cells that produce digestive enzymes. As these tumors grow, they can invade nearby organs(em dash)the bile duct, intestine or stomach(em dash)as well as nearby blood vessels. Cancer cells can also break away and spread to lymph nodes and other distant organs, such as the liver.

In the United States, more than 40,000 people are diagnosed with pancreatic cancer each year. It is the fourth leading cause of cancer death. Since this cancer does not cause symptoms in its early stages, the diagnosis is usually only made after it spreads beyond the pancreas.

Risk Factors

• Smoking
• Older age
• Ethnicity–African Americans are more likely to develop pancreatic cancer than Causasians, Hispanics or Asians.
• Genetic factors–About 10 percent of patients with pancreatic cancer have some inherited risk for the disease. These genetic syndromes include familial atypical multiple mole melanoma syndrome, familial breast cancer and Peutz-Jeghers syndrome, which is characterized by non-cancerous growths in the gastrointestinal tract. Patients with a family history of pancreatic cancer are also at increased risk of developing the disease.
• Obesity
• Diabetes
• Chronic pancreatitis

Symptoms

Patients do not usually exhibit symptoms in the early stages of pancreatic cancer. Some symptoms that may occur include:

• Weight loss
• Jaundice (yellowing of the eyes and skin), which may be also be accompanied by itching, dark urine and whitish stools
• Severe pain in the upper abdomen and/or back.

Keep in mind that these symptoms can be caused by other health problems that are more common than pancreatic cancer.

Diagnosis and Staging

The USA Health Mitchell Cancer Institute provides comprehensive, compassionate and personalized care for all patients with pancreatic cancer.

Diagnostic tests may include:

• Blood tests (liver function tests, tumor markers)
• Imaging (CT scans, MRIs, endoscopic ultrasound)
• Biopsies

Pancreatic cancer can be assigned one of the following four stages:

• Stage 1–The tumor is smaller than two centimeters and is completely contained within the pancreas.
• Stage 2–The tumor has grown outside of the pancreas but has not invaded a major blood vessel. It may have spread to nearby lymph nodes but not to distant sites.
• Stage 3–The tumor has grown into major blood vessels.
• Stage 4–The cancer has spread to other parts of the body, such as the liver or inner lining of the abdomen.

Treatment

Treatment for pancreatic cancer likely includes a combination of different therapies. Our multidisciplinary approach to pancreatic cancer ensures that surgeons, medical oncologists and radiation oncologists review your individual case before treatment starts. This allows for the selection of the optimal combination and timing of various therapies.

Surgery

When a pancreatic tumor can be removed safely, surgery is the best chance to improve chances of survival.

• The Whipple procedure is the most common type of surgery for pancreatic cancer. It is performed to remove tumors in the right side, or head, of the pancreas. It involves removal of the head of the pancreas, the first part of the small intestine (known as the duodenum), the lower portion of the bile duct, surrounding lymph nodes, gallbladder and sometimes part of the stomach. The remaining pancreas, stomach and bile duct are then reconnected to the small intestine to enable digestion. Although this operation is complex, it is effective for many patients.
• A distal pancreatectomy is the operation to remove a tumor in the left side of the pancreas (body and tail). It may also require removal of the spleen. This operation is often performed laparoscopically.

Chemotherapy

Chemotherapy involves a drug or combination of drugs used to kill cancer cells in the body. With pancreatic cancer, chemotherapy has been shown to improve survival. It can be given to patients in conjunction with radiation, before or after surgery, or to treat patients whose cancer has spread to organs beyond the pancreas.

Radiation Therapy

Radiation therapy is often used in combination with surgery and chemotherapy. By shrinking tumors, it allows for surgery to be performed; it can also be used after removal of the tumor. It can also be used to relieve pain when the tumor cannot be safely removed.

Managing Symptoms

Controlling symptoms of cancer and side effects of therapies is a critical part of your treatment. We strive not only to extend your survival but also to maintain your quality of life.