Pancreatic Cancer: The Facts

What is it?

As the name implies, Pancreatic Cancer originates in the pancreas, which is located behind the stomach and above the intestines. The Pancreas is hidden between several abdominal structures, which makes it difficult to access during a physical exam. The functions of the pancreas include production of certain digestive enzymes and the release of certain hormones. Digestive pancreatic juice is released by way of ducts that connect to the common bile duct, which carries bile from the liver. The common bile duct delivers these secretions to part of the small intestine, the duodenum, where they aid in digestion. One of the main hormonal functions of the pancreas is the production and release of insulin and glucagon. Insulin and glucagon help maintain the level of sugar in the blood that cells use for energy..

When malignant tumor cells grow in the pancreas it is known as Pancreatic Cancer. Depending on where in the pancreas the cancer is located, digestive and/or endocrine (hormonal) functions of the pancreas can be affected. Ninety-five percent of Pancreatic Cancers begin in the ducts that carry the digestive enzymes produced by the pancreas. Two-thirds of cancers also begin in the head of the pancreas, with the remaining third occurring in the tail. Although uncommon, the cancer can also begin in the specialized pancreatic cells that produce insulin and other hormones. This type of cancer is referred to as Islet Cell Cancer.

Pancreatic Cancer is a complicated disease and not a lot is known about it. It is currently an area of intense research and more is being learned everyday. Pancreatic specialists have the most current information on the disease and should be consulted for the most conclusive explanation of this illness

Who gets it?

Pancreatic Cancer is the 11th most commonly diagnosed cancer in the U.S. About 29,000 people are expected to be newly diagnosed with Pancreatic Cancer each year. Males and females seem to develop Pancreatic Cancer at an equivalent rate. This disease rarely occurs before the age of 40, and most commonly occurs in people between 60 and 80 years of age. African- Americans seem to have a slightly higher rate of incidence of Pancreatic Cancer than do Caucasians.

There are several conditions that have been associated with Pancreatic Cancer, but it is not known if these are causes or results of the cancer. Some of these conditions are:

• Recent onset of diabetes
  
• Chronic pancreatitis
  
• Hormonal imbalance
  

It is not known exactly how Pancreatic Cancer begins, but there are certain risk factors that have been attributed to a higher chance of developing it. The primary risk factors include:

• Age between 60 to 80
  
• Smoking
  
• Obesity and poor diet
  
• Certain occupational hazards (affects mainly chemists, coal gas workers, and those who work with DDT)
  
• Family history of Pancreatic Cancer
  
• Long-standing Diabetes
  

Rhode Island residents are diagnosed with Pancreatic Cancer at rates very similar to the national average. The rate of diagnoses for males is slightly higher and the rate for females is slightly lower, but overall there is little difference from the national rates.

How is it detected?

Pancreatic Cancer is very difficult to diagnose because it normally does not cause obvious symptoms until the cancer is well developed. The concealed location of the pancreas makes it difficult for a physician to detect abnormalities upon physical examination.

If Pancreatic Cancer is suspected, a wide range of diagnostic tests can be performed in addition to a physical exam and medical history. Some of the tests used include:

Diagnostic Tests:

• Ultrasonography: Sound waves are used to create an image of the abdominal structures. Changes in the pancreas or nearby structures can be indications of the location and extent of the cancer.
  
  
• CT Scan: X-ray pictures are taken from a variety of different angles to create an overall series of cross sectional images. These are used to view cancerous regions or obstructions in the digestive tract.
  
  
• MRI: Radio waves and Magnetic fields are used to create detailed images of the internal structures of the body. MRI does not use x-rays.
  
  
• Endoscopic Retrograde Cholangiopancreatography (ERCP): A thin flexible tube called an endoscope is placed down the throat, through the stomach, and into the bile duct. A special dye is injected in this area to enhance x-ray images of the organ structures.
  
  
• Percutaneous transhepatic cholangiography (PTC): This test is done if an ERCP cannot be performed on the patient. A needle is used to inject a special dye into the bile duct to enhance later x-ray images of the structure.
  
  
• Angiography: A special dye is injected into the blood stream in order to x-ray the blood vessels. This test helps show if the cancer has spread to other organs or is causing obstructions.
  
  
• Biopsy: Tissue samples are removed and examined to determine cancerous state of the cells. The tissue may be removed with a long needle, during an ERCP, or using laparoscopy surgery.
  

Symptoms:

Most Pancreatic Cancers do not produce symptoms at the early stages. When symptoms do occur they are often vague and nonspecific. These symptoms can be caused by other diseases and do not necessarily mean that cancer is present. The occurrence of any of these symptoms should be reported to a physician so that the cause can be determined.

• Jaundice: This includes a yellow color in the eyes, skin, and fingernails. Dark colored urine and clay colored stool are also sometimes associated with jaundice.
  
  
• Pain in the abdomen or back.
  
  
• Weight loss: Unwanted or unexpected.
  
  
• Digestive Problems: Includes vomiting, nausea, and diarrhea.
  
  
• Change in diabetes status: Patients with diabetes may find a need for increased insulin intake.
  

Is it curable?

Pancreatic Cancer is an extremely difficult disease to treat, particularly because of how hard it is to diagnose. It is the 5th leading cause of cancer death despite only being the 11th most common cancer. If performed early enough, certain surgical procedures can cure patients of the cancer. Unfortunately, most cases are not diagnosed early enough for this to be the case. About 20% of patients diagnosed with Pancreatic Cancer survive the first year and only about 3% survive 5 years. Although these numbers may be disheartening, they are based on a large number of patients and do not predict what will happen for each individual case. Certain surgical procedures have been proven to dramatically increase the survival rate and are being used more commonly. There are also many experimental procedures and treatments that show a lot of promise and may offer hope for Pancreatic Cancer patients.

It's easier to prevent cancer than to treat it....

Certain lifestyle and dietary habits may reduce your risk of developing Pancreatic Cancer (as well as other cancers). Some of these include:

• Not smoking
  
• Regular exercise
  
• Moderate, if any, consumption of alcohol
  
• Low fat diet
  

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