Pancreatic Cancer

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Pancreatic Cancer

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Overview
The pancreas is a gland behind your stomach and
in front of your spine. It produces juices that help
break down food and hormones that help control
blood sugar levels. Cancer of the pancreas is the
fourth-leading cause of cancer death in the U.S.

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Symptoms
Early cancer of the pancreas often doesn’t cause
symptoms. When the cancer grows larger, you may
notice one or more of these common symptoms:
-- Dark urine, pale stools, and yellow skin and eyes
from jaundice
-- Pain in the upper part of your belly


Symptoms
-- Pain in the middle part of your back that doesn’t
go away when you shift your position
-- Nausea and vomiting
-- Stools that float in the toilet
Also, advanced cancer may cause these general
symptoms:


Symptoms
-- Weakness or feeling very tired
-- Loss of appetite or feelings of fullness
-- Weight loss for no known reason


Symptoms
These symptoms may be caused by pancreatic
cancer or by other health problems. People with
these symptoms should tell their doctor so that
problems can be diagnosed and treated as early as
possible.


Diagnosis
If you have symptoms that suggest cancer of the
pancreas, your doctor will try to find out what’s
causing the problems.
You may have blood or other lab tests. Also, you
may have one or more of the following tests:


Diagnosis
**Physical exam**
: Your doctor feels your abdomen to check for
changes in areas near the
pancreas, liver, gallbladder, and spleen. Your
doctor also checks for an abnormal buildup of fluid
in the abdomen. Also, your skin and eyes may be
checked for signs of jaundice.


Diagnosis
**CT scan**
: An x-ray machine linked to a computer takes a
series of detailed pictures of your pancreas, nearby
organs, and blood vessels in your abdomen. You
may receive an injection of contrast material so
your pancreas shows up clearly in the pictures.
Also, you may be asked to drink water so your
stomach and duodenum show up better. On the CT
scan, your doctor may see a tumor in the pancreas
or elsewhere in the abdomen.


Diagnosis
**Ultrasound**
: Your doctor places the ultrasound device on your
abdomen and slowly moves it around. The
ultrasound device uses sound waves that can’t be
heard by humans. The sound waves make a
pattern of echoes as they bounce off internal
organs. The echoes create a picture of your
pancreas and other organs in the abdomen. The
picture may show a tumor or blocked ducts.


Diagnosis
**EUS**
: Your doctor passes a thin, lighted tube
(endoscope) down your throat, through your
stomach, and into the first part of the small
intestine. An ultrasound probe at the end of the
tube sends out sound waves that you can’t hear.
The waves bounce off tissues in your pancreas and
other organs. As your doctor slowly withdraws the
probe from the intestine toward the stomach, the
computer creates a picture of the pancreas from
the echoes. The picture can show a tumor in the
pancreas. It can also sho

Diagnosis
**EUS**
Some doctors use the following tests also:
-- **ERCP**


Diagnosis
**EUS**
: The doctor passes an endoscope through your
mouth and stomach, down into the first part of
your small intestine. Your doctor slips a smaller
tube through the endoscope into the bile ducts
and pancreatic ducts. (See picture of ducts.) After
injecting dye through the smaller tube into the
ducts, the doctor takes x-ray pictures. The x-rays
can show whether the ducts are narrowed or
blocked by a tumor or other condition.


Diagnosis
**EUS**
-- **MRI**
: A large machine with a strong magnet linked to a
computer is used to make detailed pictures of
areas inside your body.
-- **PET scan**


Diagnosis
**EUS**
: You’ll receive an injection of a small amount of
radioactive sugar. The radioactive sugar gives off
signals that the PET scanner picks up. The PET
scanner makes a picture of the places in your body
where the sugar is being taken up. Cancer cells
show up brighter in the picture because they take
up sugar faster than normal cells do. A PET scan
may show a tumor in the pancreas. It can also
show cancer that has spread to other parts of the
body.

Diagnosis
**EUS**
-- **Needle biopsy**
: The doctor uses a thin needle to remove a small
sample of tissue from the pancreas. EUS or CT may
be used to guide the needle. A pathologist uses a
microscope to look for cancer cells in the tissue.
You may want to ask the doctor these questions
before having a biopsy:


Diagnosis
**EUS**
-- Do you recommend that I have a biopsy? If
so, why?
-- How long will it take? Will I be awake? Will it
hurt?
-- Is there a risk that a needle biopsy procedure will
cause the cancer to spread? What are the chances
of infection or bleeding after the biopsy?


Diagnosis
**EUS**
-- Are there any other risks?
-- How soon will I know the results? How do I get a
copy of the pathology report?
-- If I do have cancer, who will talk with me about
treatment? When?


Treatment
Treatment options for people with cancer of the
pancreas are surgery, chemotherapy, targeted
therapy, and radiation therapy. You’ll probably
receive more than one type of treatment.
The treatment that’s right for you depends mainly
on the following:


Treatment
-- The location of the tumor in your pancreas
-- Whether the disease has spread
-- Your age and general health


Treatment
At this time, cancer of the pancreas can be cured
only when it’s found at an early stage (before it has
spread) and only if surgery can completely remove
the tumor. For people who can’t have surgery,
other treatments may be able to help them live
longer and feel better.


Treatment
You may want to talk with your doctor about
taking part in a clinical trial. Clinical trials are
research studies testing new treatments. They are
an important option for people with all stages of
cancer of the pancreas. See the Taking Part in
Cancer Research section.


Treatment
You may have a team of specialists to help plan
your treatment. Your doctor may refer you to a
specialist, or you may ask for a referral. Specialists
who treat cancer of the pancreas include
surgeons, medical oncologists, radiation
oncologists, and gastroenterologists. Your health
care team may also include an oncology nurse.


Treatment
For help relieving or reducing pain, you may work
with a specially trained doctor, a nurse, a palliative
care team, or another pain control specialist. See
the Supportive Care section.
For help reducing eating problems and maintaining
your weight, you may work with a registered
dietitian. See the Nutrition section.


Treatment
Your health care team can describe your treatment
choices, the expected results of each, and the
possible side effects. Because cancer treatments
often damage healthy cells and tissues, side effects
are common. These side effects depend on many
factors, including the type and extent of treatment.
Side effects may not be the same for each person,
and they may even change from one treatment
session to the next. Before treatment starts, ask
your health care team about possible side effects
and how

Treatment
You may want to ask your doctor these questions
before you begin treatment:
-- What is the stage of the disease? Has the cancer
spread?
-- Do I need any more tests to find out whether I
can have surgery?


Treatment
-- What is the goal of treatment? What are my
treatment choices? Which do you suggest for me?
Why?
-- What are the expected benefits of each kind of
treatment?
-- What can I do to prepare for treatment?
-- Will I need to stay in the hospital? If so, for how
long?


Treatment
-- What are the risks and possible side effects of
each treatment? How can side effects be
managed?
-- How will you treat my pain?
-- What is the treatment likely to cost? Will my
insurance cover it?


Treatment
-- How will treatment affect my normal activities?
Am I likely to have eating problems or other
problems?
-- Would a research study (clinical trial) be a good
choice for me?
-- Can you recommend other doctors who could
give me a second opinion about my treatment
options?


Treatment
-- How often should I have checkups?
**Surgery**
Surgery may be an option for people with an early
stage of pancreatic cancer. The surgeon usually
removes only the part of the pancreas that has
cancer. But, in some cases, the whole pancreas
may be removed.


Treatment
The type of surgery depends on the location of the
tumor in the pancreas. Surgery to remove a tumor
in the head of the pancreas is called a Whipple
procedure. The Whipple procedure is the most
common type of surgery for pancreatic cancer. You
and your surgeon may talk about the types of
surgery and which may be right for you.


Treatment
In addition to part or all of your pancreas, the
surgeon usually removes the following nearby
tissues:
-- Duodenum
-- Gallbladder
-- Common bile duct
-- Part of your stomach


Treatment
Also, the surgeon may remove your spleen and
nearby lymph nodes.
Surgery for pancreatic cancer is a major operation.
You will need to stay in the hospital for one to two
weeks afterward. Your health care team will watch
for signs of bleeding, infection, or other problems.


Treatment
It takes time to heal after surgery, and the time
needed to recover is different for each person. You
may have pain or discomfort for the first few days.
Medicine can help control your pain. Before
surgery, you should discuss the plan for pain relief
with your health care team. After surgery, they can
adjust the plan if you need more pain control. See
the Supportive Care section.


Treatment
It’s common to feel weak or tired for a while. You
may need to rest at home for one to three months
after leaving the hospital.


Treatment
After surgery, it may be hard to digest food. For
four to six weeks after Whipple surgery, you may
feel bloated or full, and you may have nausea and
vomiting. A dietitian can help you change your diet
to reduce your discomfort. Problems with eating
usually go away within three months. See the
Nutrition section.
before having surgery:


Treatment
-- What type of surgery do you recommend for
me? Why?
-- Will tissues other than the tumor in the pancreas
be removed
-- Why?
-- How many times have you performed this
surgery? How many pancreatic cancer patients do
you treat each year?


Treatment
-- How will I feel after surgery?
-- Am I likely to have eating problems? Will I need a
special diet
-- Who can help me if I have a problem?
-- If I have pain, how will you control it?


Treatment
-- How long will I be in the hospital?
-- Will I have any long-term effects because of the
surgery?


Treatment
**Chemotherapy**
Chemotherapy uses drugs to kill cancer cells. Most
people with pancreatic cancer get chemotherapy.
For early pancreatic cancer, chemotherapy is
usually given after surgery, but in some cases, it’s
given before surgery. For advanced
cancer, chemotherapy is used alone, with targeted
therapy, or with radiation therapy.


Treatment
**Chemotherapy**
Chemotherapy for pancreatic cancer is usually
given by vein (intravenous). The drugs enter the
bloodstream and travel throughout your body.
Chemotherapy may be given in an outpatient part
of the hospital, at the doctor’s office, or at home.
Rarely, you may need to stay in the hospital.


Treatment
**Chemotherapy**
The side effects depend mainly on which drugs are
given and how much. Chemotherapy kills fast-
growing cancer cells, but the drugs can also harm
normal cells that divide rapidly:


Treatment
**Chemotherapy**
Blood cells: When drugs lower the levels of healthy
blood cells, you’re more likely to get
infections, bruise or bleed easily, and feel very
weak and tired. Your health care team will check
for low levels of blood cells. If your levels are
low, your health care team may stop the
chemotherapy for a while or reduce the dose of
the drug. There are also medicines that can help
your body make new blood cells.


Treatment
**Chemotherapy**
Cells in hair roots: Chemotherapy may cause hair
loss. If you lose your hair, it will grow back after
treatment, but the color and texture may be
changed.
Cells that line the digestive tract: Chemotherapy
can cause a poor appetite, nausea and
vomiting, diarrhea, or mouth and lip sores. Your
health care team can give you medicines and
suggest other ways to help with these problems.
They usually go away when treatment ends.

Treatment
**Chemotherapy**
Some drugs used for pancreatic cancer also may
cause tingling or numbness in your hands and feet.
Your health care team can suggest ways to control
many of these side effects.
You may wish to read the NCI booklet
Chemotherapy and You.


Treatment
**Targeted Therapy**
People with cancer of the pancreas who can’t have
surgery may receive a type of drug called targeted
therapy along with chemotherapy.
Targeted therapy slows the growth of pancreatic
cancer. It also helps prevent cancer cells from
spreading. The drug is taken by mouth.


Treatment
Side effects may include diarrhea, nausea,
vomiting, a rash, and shortness of breath. You may
want to read the NCI fact sheet Targeted Cancer
Therapies.
about chemotherapy or targeted therapy:
-- Why do I need this treatment?


Treatment
-- Which drug or drugs will I have?
-- How do the drugs work?
-- When will treatment start? When will it end?
-- Will I have any long-term side effects?


Treatment
**Radiation Therapy**
Radiation therapy uses high-energy rays to kill
cancer cells. It can be given along with other
treatments, including chemotherapy.


Treatment
The radiation comes from a large machine. The
machine aims beams of radiation at the cancer in
the abdomen. You’ll go to a hospital or clinic 5 days
a week for several weeks to receive radiation
therapy. Each session takes about 30 minutes.


Treatment
Although radiation therapy is painless, it may
cause other side effects. The side effects include
nausea, vomiting, or diarrhea. You may also feel
very tired. Your health care team can suggest ways
to treat or control these side effects.
You may find it helpful to read the NCI booklet
Radiation Therapy and You.


Treatment
about radiation
-- Why do I need this treatment?
-- When will the treatments begin? When will they
end?
-- How will I feel during treatment?


Treatment
-- How will we know if the radiation treatment is
working?
-- Will I have any long-term side effects?


Risks
Some risk factors for developing pancreatic cancer
include:
-- Smoking
-- Long-term diabetes
-- Chronic pancreatitis


Risks
-- Certain hereditary disorders


Pancreatic Cancer

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