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Pancreas / Pancreatic Cancer
Description of Pancreatic Cancer
Cancer of the pancreas is a disease in which cancer (malignant) cells are found in the tissues of the pancreas. The pancreas is about 6 inches long and is shaped something like a thin pear, wider at one end and narrowing at the other. The pancreas lies behind the stomach, inside a loop formed by part of the small intestine. The broader right end of the pancreas is called the head, the middle section is called the body, and the narrow left end is the tail.
The pancreas has two basic jobs in your body. It produces juices that help you break down (digest) your food, and hormones (such as insulin) that regulate how your body stores and uses food. The area of the pancreas that produces digestive juices is called the exocrine pancreas. About 95% of pancreatic cancers begin in the exocrine pancreas. The hormone-producing area of the pancreas is called the endocrine pancreas. Only about 5% of pancreatic cancers start here. This statement has information on cancer of the exocrine pancreas. For more information on cancer of the endocrine pancreas (also called islet cell cancer) see the PDQ Patient Information Statement on Islet Cell Carcinoma.
Cancer of the pancreas is hard to find (diagnose) because the organ is hidden behind other organs. Organs around the pancreas include the stomach, small intestine, bile ducts (tubes through which bile, a digestive juice made by the liver, flows from the liver to the small intestine), gallbladder (the small sac below the liver that stores bile), the liver, and the spleen (the organ that stores red blood cells and filters blood to remove excess blood cells). The signs of pancreatic cancer are like many other illnesses, and there may be no signs in the first stages. You should see your doctor if you have any of the following: nausea, loss of appetite, weight loss without trying to lose weight, pain in the upper or middle of your abdomen, or yellowing of your skin (jaundice).
If you have symptoms, your doctor will examine you and order tests to see if you have cancer and what your treatment should be. You may have an ultrasound, a test that uses sound waves to find tumors. A CT scan, a special type of x-ray that uses a computer to make a picture of the inside of your abdomen, may also be done. Another special scan called magnetic resonance imaging (MRI), which uses magnetic waves to make a picture of the inside of your abdomen, may be done as well.
A test called an ERCP (endoscopic retrograde cholangiopancreatography) may also be done. During this test, a flexible tube is put down the throat, through the stomach, and into the small intestine. Your doctor can see through the tube and inject dye into the drainage tube (duct) of the pancreas so that the area can be seen more clearly on an x-ray. During ERCP, your doctor may also put a fine needle into the pancreas to take out some cells. This is called a biopsy. The cells can then be looked at under a microscope to see if they contain cancer.
PTC (percutaneous transhepatic cholangiography) is another test that can help find cancer of the pancreas. During this test, a thin needle is put into the liver through your right side. Dye is injected into the bile ducts in the liver so that blockages can be seen on x-rays.
In some cases, a needle can be inserted into the pancreas during an x-ray or ultrasound so that cells can be taken out to see if they contain cancer. You may need surgery to see if you have cancer of the pancreas. If this is the case, your doctor will cut into the abdomen and look at the pancreas and the tissues around it for cancer. If you have cancer and it looks like it has not spread to other tissues, your doctor may remove the cancer or relieve blockages caused by the tumor.
Stages Of Cancer Of The Pancreas
Once cancer of the pancreas is found, more tests will be done to find out if the cancer has spread from the pancreas to the tissues around it or to other parts of the body. This is called staging. The following stages are used for cancer of the pancreas:
Stage I Cancer is found only in the pancreas itself, or has started to spread just to the tissues next to the pancreas, such as the small intestine, the stomach, or the bile duct.
Stage II Cancer has spread to nearby organs such as the stomach, spleen, or colon, but has not entered the lymph nodes. (Lymph nodes are small, bean-shaped structures that are found throughout the body; they produce and store infection-fighting cells).
Stage III Cancer has spread to lymph nodes near the pancreas. The cancer may or may not have spread to nearby organs.
Stage IV Cancer has spread to places far away from the pancreas, such as the liver or lungs.
Recurrent Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the pancreas or in another part of the body.
How Cancer Of The Pancreas Is Treated
There are treatments for all patients with cancer of the pancreas. Three kinds of treatment are used: surgery (taking out the cancer or relieving symptoms caused by the cancer) radiation therapy (using high-dose x-rays or other high-energy rays to kill cancer cells) chemotherapy (using drugs to kill cancer cells).
The use of biological therapy (using the body's immune system to fight cancer) is being tested for pancreatic cancer.
Surgery may be used to take out the tumor. Your doctor may take out the cancer using one of the following operations:
A Whipple procedure removes the head of the pancreas, part of the small intestine, and some of the tissues around it. Enough of the pancreas is left to continue making digestive juices and insulin.
Total pancreatectomy takes out the whole pancreas, part of the small intestine, part of the stomach, the bile duct, the gallbladder, spleen, and most of the lymph nodes in the area.
Distal pancreatectomy takes out only the tail of the pancreas.
If your cancer has spread and it cannot be removed, your doctor may do surgery to relieve symptoms. If the cancer is blocking the small intestine and bile builds up in the gallbladder, your doctor may do surgery to go around (bypass) all or part of the small intestine. During this operation, your doctor will cut the gallbladder or bile duct and sew it to the small intestine. This is called biliary bypass. Surgery or x-ray procedures may also be done to put in a tube (catheter) to drain bile that has built up in the area. During these procedures, your doctor may make the catheter drain through a tube to the outside of the body or the catheter may go around the blocked area and drain the bile to the small intestine. In addition, if the cancer is blocking the flow of food from the stomach, the stomach may be sewn directly to the small intestine so you can continue to eat normally.
Radiation therapy uses high-energy x-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes in the area where the cancer cells are found (internal radiation therapy).
Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by a needle in the vein or muscle. Chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells outside the pancreas.
Biological therapy tries to get your own body to fight cancer. It uses materials made by your own body or made in a laboratory to boost, direct, or restore your body's natural defenses against disease. Biological therapy is sometimes called biological response modifier (BRM) therapy or immunotherapy. Biological therapy is being tested in clinical trials.
Treatment By Stage
Treatment for cancer of the pancreas depends on the stage of your disease, your age, and your overall condition.
You may receive treatment that is considered standard based on its effectiveness in a number of patients in past studies, or you may choose to go into a clinical trial. Most patients with cancer of the pancreas are not cured with standard therapy and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Clinical trials are going on in most parts of the country for all stages of cancer of the pancreas. If you wish to know more about clinical trials, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.
STAGE I PANCREATIC CANCER
Your treatment may be one of the following: 1. Surgery to remove the head of the pancreas, part of the small intestine, and some of the surrounding tissues (Whipple procedure). 2. Surgery to remove the entire pancreas and the organs around it (total pancreatectomy). 3. Surgery to remove the tail of the pancreas (distal pancreatectomy) for tumors in the tail of the pancreas. 4. Surgery followed by chemotherapy and radiation therapy. 5. Clinical trials of radiation therapy with or without chemotherapy given before, during, or after surgery.
STAGE II PANCREATIC CANCER
Your treatment may be one of the following: 1. Surgery or other treatments to reduce symptoms. 2. External radiation therapy with or without chemotherapy. 3. Surgery to remove all or part of the pancreas with or without chemotherapy and radiation therapy. 4. Clinical trials of radiation therapy and chemotherapy given before surgery. 5. Clinical trials of radiation therapy plus drugs to make cancer cells more sensitive to radiation (radiosensitizers). 6. Clinical trials of chemotherapy. 7. Clinical trials of radiation therapy given during surgery with or without internal radiation therapy.
STAGE III PANCREATIC CANCER
Your treatment may be one of the following: 1. Surgery or other treatments to reduce symptoms. 2. External radiation therapy with or without chemotherapy. 3. Surgery to remove all or part of the pancreas with or without chemotherapy and radiation therapy. 4. Clinical trials of radiation therapy given before surgery. 5. Clinical trials of surgery plus radiation therapy plus drugs to make cancer cells more sensitive to radiation (radiosensitizers). 6. Clinical trials of chemotherapy. 7. Clinical trials of radiation therapy given during surgery, with or without internal radiation therapy.
STAGE IV PANCREATIC CANCER
Your treatment may be one of the following: 1. Surgery or other treatments to reduce symptoms. 2. Treatments for pain. 3. Clinical trials of chemotherapy or biological therapy.
RECURRENT PANCREATIC CANCER
Your treatment may be one of the following: 1. Chemotherapy. 2. Surgery or other treatments to reduce symptoms. 3. External radiation therapy to reduce symptoms. 4. Treatments for pain. 5. Other medical care to reduce symptoms. 6. Clinical trials of chemotherapy or biological therapy
| RESEARCHERS FIND
REGION OF GENE FOR INHERITED PANCREATIC CANCER CONTACT: FOR IMMEDIATE RELEASE RESEARCHERS FIND REGION OF GENE FOR INHERITED PANCREATIC CANCER PITTSBURGH, Feb. 28 - Researchers at the University of Pittsburgh School of Medicine, in collaboration with the Fred Hutchinson Cancer Research Center and the University of Washington School of Medicine have mapped the location of a gene associated with inherited pancreatic cancer, which accounts for about 10 percent of all such malignancies. Study co-directors David C.
Whitcomb, M.D., Ph.D., director of the division of gastroenterology, hepatology and
nutrition at the University of Pittsburgh; Leonid Kruglyak, Ph.D., a Fred Hutchinson
statistical geneticist; and Teresa Brentnall, M.D., a UW gastroenterologist report their
findings in an early electronic edition of the April issue of the "By understanding the genetics of pancreatic cancer, we can begin to understand the mechanism by which the disease develops, availing new methods of how to detect, prevent and treat this deadly cancer," said Dr. Whitcomb, who is also director of the University of Pittsburgh Center for Genomic Sciences. Pancreatic cancer is one of the most difficult cancers to treat in that it is undetectable by a physical exam, asymptomatic, and progresses quickly - most patients die within 6 months of diagnosis. These factors also limit the amount of data available for research, hindering significant advances in the understanding of the disease. "Pancreatic cancer is a very aggressive cancer with extremely low survival rates," said Ronald B. Herberman, M.D., associate vice chancellor for research, health sciences at the University of Pittsburgh and director of the University of Pittsburgh Cancer Institute. "Until now, we have had very limited ability to identify people at high risk for this disease or to make the diagnosis of the disease before it has invaded the rest of the body. This discovery represents a significant finding that may permit identification of individuals at risk so that they can be monitored regularly, to detect the cancer when it can be treated while still in an early stage, which might substantially enhance the likelihood of survival." Researchers were able to gather sufficient genetic data for this study through the cooperation of a large Northwestern family known in scientific communities as "Family X." Family X is the largest pancreatic cancer family ever studied. Twenty affected family members were studied; nine have died of the disease, including five out of six brothers. Dr. Brentnall has been working with Family X for more than seven years. The DNA samples collected by Brentnall's University of Washington group from Family X were genotyped by a team of researchers at the University of Pittsburgh, led by Dr. Whitcomb. The Pitt group sequenced DNA from hundreds of areas of the genome known to contain a high degree of genetic variability. This information was then sent to Kruglyak's group at Fred Hutchinson, who, by using sophisticated computer software, were able to determine which genetic variations are always present in the family members with pancreatic cancer or its precursor, dysplasia. Virtually every member of Family X with pancreatic cancer or its precursor was found to harbor a specific genetic marker on the long arm of chromosome 4, where the single-gene mutation responsible for pancreatic cancer is thought to exist. None of the unaffected family members inherited this marker, supporting the significance of the findings. According to researchers, identifying these markers may lead to the discovery of a specific pancreatic cancer gene - a finding that will allow doctors to screen people for genetic risk for pancreatic cancer with a simple blood test. Dr. Whitcomb stresses the importance of the collaborative effort that resulted in this advancement. "Those of us who are working with complex and mysterious medical problems like pancreatic cancer recognize that no independent physician or scientists can go from the bed to the bench and back again alone. It takes physician-scientist teamwork, as demonstrated here, to make the big breakthroughs." Of the 29,000 Americans who this year will learn they have pancreatic cancer, all but 100 will die within 12 months of diagnosis. While pancreatic cancer is the fifth leading cause of cancer death in the United States, it is one of the least well-funded areas of cancer research. Due to the limited knowledge about
pancreatic cancer, researchers stress that patients seeking treatment for pancreatic
cancer or who are looking to be screened for the disease should visit a center that
specializes in pancreatic disorders such as the Digestive Disease Center at the University
of Pittsburgh or the University of Washington. For more information on pancreatic cancer and other diseases of the pancreas, visit www.pancreas.org or the National Pancreas Foundation at www.pancreasfoundation.org. For more information about the University of Pittsburgh divisionof gastroenterology, hepatology and nutrition visit their Web site at http://www.gi.pitt.edu. |