Pancreatic Cancer

Pancreatic cancer has been brought to the forefront by the diagnoses of several prominent figures, including the late actor Patrick Swayze, who died of pancreatic cancer in September 2009, Apple cofounder and CEO Steve Jobs, and U.S. Supreme Court justice Ruth Bader Ginsburg.

The American Cancer Society estimated that 37,680 people in the U.S. were diagnosed with pancreatic cancer during 2008. Of those diagnosed, 34,290 will die of the disease, making this type of cancer the fourth leading cause of cancer death overall.

What is the pancreas?

The pancreas is a 6-inch-long spongy, tube-shaped organ located in the back of the abdomen, behind the stomach. It has two major jobs in the body:

• It makes digestive juices (enzymes) that help the intestines break down food.
• It produces hormones -- including insulin -- that regulate the body's use of sugars and starches.

What causes pancreatic cancer?

Aside from advanced age, smoking is the main risk factor for pancreatic cancer; a smoker is three to four times more likely than a nonsmoker to acquire the disease. People frequently exposed to certain petroleum products may also be at increased risk. Excessive alcohol, dietary fat, and protein, as well as low fiber intake, may also promote the disease. Diabetes is also linked to pancreatic cancer, with 10% to 20% of patients diagnosed with pancreatic cancer also having diabetes.

What are the symptoms of pancreatic cancer?

Pancreatic cancer has been called a "silent" disease because early pancreatic cancer usually does not cause symptoms. If the tumor blocks the common bile duct and bile cannot pass into the digestive system, the skin and whites of the eyes may become yellow, and the urine may become darker. This condition is called jaundice. As the cancer grows and spreads, pain often develops in the upper abdomen and sometimes spreads to the back. The pain may become worse after the person eats or lies down. Cancer of the pancreas can also cause nausea, loss of appetite, weight loss, and weakness.

Are there additional tests that may be used to diagnose pancreatic cancer?

Here are other tests that may be performed:

• Angiogram: special X-ray of blood vessels.
• CT scans: X-rays that give detailed pictures of a cross section of the pancreas.
• Transabdominal ultrasound: high-frequency sound waves that form a picture of the pancreas.
• ERCP (endoscopic retrograde cholangiopancreatogram): a special X-ray of the common bile duct.
• Endoscopic ultrasound: a relatively new procedure in which an endoscope containing an ultrasound probe scans the pancreas for cancers.

How is cancer of the pancreas treated?

Cancer of the pancreas is curable only when it is found in its earliest stages, before it has spread. Otherwise, it is very difficult to cure. However, it can be treated, symptoms can be relieved, and the quality of the patient's life can be improved.

Treatment for pancreatic cancer depends on a number of factors. Among these are the type, size, and extent of the tumor as well as the patient's age and general health. Treatment can consist of surgery, radiation therapy, chemotherapy, or possibly biological therapy. We'll take a look at each option and the possible side effects on the following slides.

Surgery may be necessary to treat pancreatic cancer.

Surgery may be done to remove all or part of the pancreas. Sometimes it is also necessary to remove a portion of the stomach, the duodenum, and other nearby tissues. This operation is called a Whipple procedure. In cases where the cancer in the pancreas cannot be removed, the surgeon may be able to create a bypass around the common bile duct or the duodenum if either is blocked.

What are the side effects of pancreatic cancer surgery?

The side effects of surgery depend on the extent of the operation, the person's general health, and other factors. Most patients have pain for the first few days after surgery that can be controlled with medicine. Removal of part or all of the pancreas may make it hard for a patient to digest foods. At first, a patient may have only liquids and may receive extra nourishment intravenously or by a feeding tube. Solid foods are added to the diet gradually. The health-care team can suggest a diet plan and medicines to help relieve diarrhea, pain, cramping, or feelings of fullness. Patients may not have enough pancreatic enzymes or hormones after surgery. Those who do not have enough insulin may develop diabetes. The doctor can give the patient insulin, other hormones, and enzymes.

Radiation therapy may be used to treat pancreatic cancer.

Radiation therapy (also called radiotherapy) uses high-powered radiation to damage cancer cells and stop them from growing. Radiation is usually given five days a week for five to six weeks. This schedule helps to protect normal tissue by spreading out the total dose of radiation. The patient doesn't need to stay in the hospital for radiation therapy.

Radiation is also being studied as a way to kill cancer cells that remain in the area after surgery. In addition, radiation therapy can help relieve pain or digestive problems when the common bile duct or duodenum is blocked.

What are the side effects of pancreatic cancer radiation therapy?

Radiation therapy may cause patients to become very tired as treatment continues. Resting is important, but doctors usually advise patients to try to stay as active as they can be. In addition, when patients receive radiation therapy, the skin in the treated area may sometimes become red, dry, and tender.

Radiation therapy to the abdomen may cause nausea, vomiting, diarrhea, or other problems with digestion. The health-care team can offer medicine or suggest dietary changes to control these problems. For most patients, the side effects of radiation therapy go away when treatment is over.

Chemotherapy may be used to treat pancreatic cancer

Chemotherapy uses drugs to kill cancer cells. When cancer occurs, cells in the body that are not normal keep dividing and forming more cells without control. Chemotherapy destroys cancer cells by stopping them from growing or multiplying. However, healthy cells can also be harmed, causing side effects. These cells usually repair themselves after chemotherapy.

Treatment may consist of just one drug or a combination of drugs. It may be given by mouth or by injection into a muscle or vein. The drugs enter the bloodstream and travel through the body. Chemotherapy is usually given in cycles; a treatment period is followed by a recovery period, then another treatment period, and so on.

What are the side effects of pancreatic cancer chemotherapy?

Systemic chemotherapy affects rapidly dividing cells throughout the body, including blood cells. When anticancer drugs damage healthy blood cells, patients are more likely to get infections, may bruise or bleed easily, and may have less energy. Cells in hair roots and cells that line the digestive tract also divide rapidly. As a result, patients may lose their hair and may have other side effects such as poor appetite, nausea and vomiting, diarrhea, or mouth sores. Usually, these side effects go away gradually during the recovery periods between treatments or after treatment is over.

Biological therapy may be used to treat pancreatic cancer

Biological therapy is treatment designed to stimulate or restore the ability of the body's immune system (natural internal defense) to fight infection and disease. Biological therapy is also called biotherapy or immunotherapy. This form of treatment uses portions of the body's natural immune system to treat a disease. Biological therapy is also used to protect the body from some of the side effects of certain treatments.

Biological therapy often involves the use of substances called biological response modifiers (BRMs). The body normally produces these substances in small amounts in response to infection and disease. Using modern laboratory techniques, scientists can produce BRMs in large amounts for use in the treatment of the cancer.

What are the side effects of pancreatic cancer biological therapy?

The side effects of biological therapy depend on the type of treatment. Side effects include flu-like symptoms such as chills, fever, muscle aches, weakness, loss of appetite, nausea, vomiting, and diarrhea. Some patients develop a rash, and some bleed or bruise easily. Depending on how severe these problems are, for some patients, hospitalization during treatment may be required. Side effects are usually short-term and gradually subside after treatment ends.

What happens after treatment for pancreatic cancer?

Follow-up care after treatment for pancreatic cancer is an important part of the overall treatment plan. Patients should not hesitate to discuss follow-up with their doctor. Regular checkups ensure that any changes in health are noticed. Any problem that develops can be found and treated. Checkups may include a physical exam, laboratory tests, and imaging procedures.

What support can pancreatic cancer patients seek?

Being diagnosed with cancer is a physically and emotionally trying experience. Patients worry about the future, caring for themselves or their families, keeping their jobs, or continuing daily activities. Concerns about treatments and managing side effects, hospital stays, and medical bills are also common.

Support groups can be helpful, where patients or their family members can get together to share what they have learned about coping with their disease and the effects of treatment. Doctors, nurses, and other members of the health-care team can answer questions about treatment, diet, working, or other matters. Meeting with a social worker, counselor, or member of the clergy can be helpful to those who want to talk about their feelings or discuss their concerns. Often, a social worker can suggest resources for financial aid, transportation, home care, emotional support, or other services

Many avenues for support exist within the local community and beyond, both for the patient and for the patient's family and friends. A list of programs and services for cancer patients can be found on the following slide.

Cancer programs and services.

Many avenues for support exist within the local community and beyond, both for the patient and for the patient's family and friends. Here are a list of programs and services for cancer patients.

What does the future hold for pancreatic cancer?

Laboratory scientists are studying the pancreas to learn more about it. They are studying the possible causes of pancreatic cancer and are researching new ways to detect tumors. They also are looking for new therapies that may kill cancer cells. In trials with people who have pancreatic cancer, doctors are studying new drugs, new combinations of chemotherapy, and combinations of chemotherapy and radiation before and after surgery. Biological therapy (discussed earlier) is under investigation as well as the study of several cancer vaccines to help the immune system fight cancer. Other studies use monoclonal antibodies to slow or stop the growth of cancer.

More Reading on Pancreatic Cancer

• Pancreatic Cancer (Cancer of the Pancreas)
• Patrick Swayze Has Pancreatic Cancer
• Ruth Bader Ginsburg Has Pancreatic Cancer Surgery
• Steve Jobs' Hormonal Imbalance: FAQ
• Pancreatic Cancer, the Silent Disease
• Cancer
• Cancer, Detection & Treatment
• Chemotherapy
• Radiation Therapy