Pancreatic carcinoma

Also known as: Pancreatic cancer and Cancer - pancreas

Definition

Pancreatic carcinoma is cancer of the pancreas.

Causes, incidence, and risk factors

The pancreas is a large organ that is found behind the stomach. It makes and releases enzymes that help the body absorb foods, especially fats. Hormones called insulin and glucagon are also made in the pancreas. These hormones help your body control blood sugar levels.

The exact cause is unknown, but pancreatic cancer is more common in smokers and people who are obese. Pancreatic cancer is slightly more common in women than in men. The risk increases with age.

A small number of cases are related to genetic syndromes that are passed down through families.

Symptoms

A tumor or cancer in the pancreas may often grow without any symptoms at first. This may mean pancreatic cancer is more advanced when it is first found.

Early symptoms of pancreatic cancer include:

• Pain or discomfort in the upper part of the belly or abdomen
• Loss of appetite and weight loss
• Jaundice (a yellow color in the skin, mucus membranes, or the eyes)
• Dark urine and clay-colored stools
• Fatigue and weakness
• Nausea and vomiting

Other possible symptoms are:

• Back pain
• Blood clots
• Depression
• Diarrhea
• Difficulty sleeping
• Indigestion

Signs and tests

• CT scan of the abdomen
• MRI of the abdomen
• Endoscopic retrograde cholangiopancreatography (ERCP)
• Endoscopic ultrasound
• Pancreatic biopsy

This disease may also affect the results of the following tests:

• Liver function tests
• Serum bilirubin
• Complete blood count (CBC)

Treatment

Because pancreatic cancer is often advanced when it is first found, very few pancreatic tumors can be removed by surgery. The standard procedure is called a pancreaticoduodenectomy (Whipple procedure).

This surgery should be done at centers that perform the procedure frequently. Some studies suggest that surgery is best performed at hospitals that do more than five of these surgeries per year.

When the tumor has not spread out of the pancreas but cannot be removed, radiation therapy and chemotherapy together may be recommended.

When the tumor has spread (metastasized) to other organs such as the liver, chemotherapy alone is usually used. The standard chemotherapy drug is gemcitabine, but other drugs may be used. Gemcitabine can help approximately 25% of patients.

Patients whose tumor cannot be totally removed, but who have a blockage of the tubes that transport bile (biliary obstruction) must have that blockage relieved. There are generally two approaches to this:

• Surgery
• Placement of a tiny metal tube (biliary stent) during ERCP

Management of pain and other symptoms is an important part of treating advanced pancreatic cancer. Hospice can help with pain and symptom management, and provide psychological support for patients and their families during the illness.

Support Groups

You can ease the stress of illness by joining a support group with members who share common experiences and problems (see cancer - support group).

Expectations (prognosis)

Some patients with pancreatic cancer that can be surgically removed are cured. However, in more than 80% of patients the tumor has already spread and cannot be completely removed at the time of diagnosis.

Chemotherapy and radiation are often given after surgery to increase the cure rate (this is called adjuvant therapy). For pancreatic cancer that cannot be removed completely with surgery, or cancer that has spread beyond the pancreas, a cure is not possible and the average survival is usually less than 1 year. Such patients should consider enrolling in a clinical trial (a medical research study to determine the best treatment).

Ninety-five percent of the people diagnosed with this cancer will not be alive 5 years later.

Complications

• Blood clots
• Depression
• Infections
• Liver problems
• Pain
• Weight loss

Calling your health care provider

Call for an appointment with your health care provider if you have:

• Back pain
• Unexplained fatigue or weight loss
• Loss of appetite
• Persistent abdominal pain
• Other symptoms of this disorder

Prevention

• If you smoke, stop smoking.
• Eat a diet high in fruits, vegetables, and whole grains.
• Exercise regularly.

References

National Cancer Institute. . Updated July 31, 2008.

Tempero M, Brand R. Pancreatic cancer. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 204.

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Review date:

August 9, 2009

Reviewed by:

David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, Uniersity of Washington School of Medicine; and Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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