Pancreatic Cancer

Definition

Pancreatic cancer is the growth of cancer cells in the pancreas. The pancreas is a digestive organ. It makes digestive enzymes and hormones.

The Pancreas

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Causes

Cancer happens when cells divide without control or order. These cells grow together to form a tumor. They can invade and damage nearby tissues. They can also spread to other parts of the body.

It is not clear what causes changes in the cells. It is likely a combination of genes and environment.

Risk Factors

Pancreatic cancer is more common in men and people aged 55 years old and older. Other things that raise the risk are:

• Smoking and using smokeless tobacco
• Certain genes, or family history of pancreatic cancer
• Obesity
• Long-term pancreatitis
• Diabetes—and certain medicines to treat it
• Certain chemicals
• Alcohol use disorder
• High-fat diet

Symptoms

Pancreatic cancer does not usually cause symptoms in the early stages. When symptoms occur, the cancer has often spread outside the pancreas.

Symptoms may be:

• Weight loss without trying
• Pain—in the upper belly, which may spread to the back
• Dark urine, tan stool, loose stools, or stool that floats
• Lack of hunger
• Weakness
• Nausea and vomiting
• Itching
• Jaundice—yellowing of the skin and whites of the eyes

Diagnosis

The doctor will ask about your symptoms and health history. A physical exam will be done. The doctor may order blood and urine tests, as well as check for hidden blood in the stool.

Imaging tests check the pancreas and surrounding structures. They may include:

• Upper gastrointestinal (GI) series
• CT scan
• MRI scan
• Ultrasound
• Endoscopic retrograde cholangiopancreatography (ERCP)
• Percutaneous transhepatic cholangiography (PTC)
• PET scan
• Angiography

A biopsy may be done—a sample of pancreatic tissue will be taken and tested.

The exam and test results are used to diagnose the cancer. They are also used for staging. Staging outlines how far and fast cancer has spread.

Treatment

The goal is to remove the cancer, if possible, and to ease symptoms. Treatment for pancreatic cancer depends on the stage of the cancer. It may include:

• Surgery, such as:
  • Whipple procedure—to remove part of the pancreas, part of the small intestine, and some tissues around it
  • Total pancreatectomy—to remove the whole pancreas, part of the small intestine, part of the stomach, the bile duct, the gallbladder, spleen, and nearby lymph nodes
  • Distal pancreatectomy—to remove the body and tail of the pancreas
• External or internal radiation—to kill cancer cells and shrink tumors
• Chemotherapy by mouth, injection, or IV—to kill cancer cells
• Biological therapy—medicines that help the body fight cancer

Most times, pancreatic cancer is found at a later stage. This means that surgery may not be helpful. If surgery cannot be done, then chemotherapy and radiation may be given together. This may increase survival time.

Prevention

The risk of pancreatic cancer may be lowered by:

• Not smoking
• Reaching and keeping a healthy weight
• Eating a healthful, low fat diet
• Getting regular physical activity
• Limiting alcohol to:
  • 2 drinks or less per day for men
  • 1 drink per day for women

References

• General information about pancreatic cancer. National Cancer Institute website. Available at: https://www.cancer.gov/types/pancreatic/patient/pancreatic-treatment-pdq. Accessed March 21, 2021.
• Pancreatic cancer. American Cancer Society website. Available at: https://www.cancer.org/cancer/pancreatic-cancer.html. Accessed March 21, 2021.
• Pancreatic adenocarcinoma. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/pancreatic-adenocarcinoma. Accessed March 21, 2021.
• Saluja A, Maitra A. Pancreatitis and pancreatic cancer. Gastroenterology. 2019;156(7):1937-1940.