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The pancreas is a gland, about six inches long, located in the abdomen. It is shaped like a flat pear and is surrounded by the stomach, small intestine, liver, spleen, and gallbladder.
The pancreas is classified as both an exocrine gland and endocrine gland. Exocrine cells of the pancreas produce enzymes that mix with food in the intestines and help with digestion. When food enters the stomach, exocrine cells release the pancreatic enzymes into a system of small ducts that lead to the main pancreatic duct. The pancreatic duct runs the length of the pancreas and carries pancreatic enzymes and other secretions, collectively called pancreatic juice, into the intestines.
The endocrine function of the pancreas produces hormones—mainly insulin and glucagon—that go into the blood stream. Together, these two hormones work to maintain the proper level of sugar in the blood.
Risk Factors for Pancreatic Cancer
- Smoking — Smoking is a significant risk factor in about 25 percent of all pancreatic cancer cases. People who smoke cigarettes are two times more likely to develop pancreatic cancer than people who do not smoke.
- Age — The chance of developing pancreatic cancer increases with age. Most people diagnosed with pancreatic cancer are over the age of 60.
Diagnosing pancreatic cancer
More than 95 percent of pancreatic cancers are classified as exocrine tumors because they start in the cells that produce digestive enzymes. Cancer of the pancreas is sometimes called a “silent” disease because symptoms are not usually present in early stages. Symptoms that commonly lead to diagnosis include:
- Jaundice (yellowing of the skin)
- Abdominal or back pain
- Unexplained weight loss
- Loss of appetite
If you experience one or more of the symptoms mentioned, it does not mean that you have pancreatic cancer. There are other common medical problems or conditions that also cause these or similar symptoms. Therefore, anyone experiencing these symptoms should consult with a doctor.
Diagnosing pancreatic cancer can be difficult because symptoms are not always obvious and usually develop gradually. If you have symptoms that suggest pancreatic cancer, a variety of tests may be performed to make an accurate diagnosis.
First, the doctor will ask about your medical and family history and will perform a physical exam. The doctor will examine your body, including skin and eyes, and feel the abdomen to check for changes in the area near the pancreas, liver and gallbladder. Visual evidence of a pancreatic tumor is often first noted on a radiographic study such as a computed tomography (CT) scan or magnetic resonance imaging (MRI).
Treating pancreatic cancer
Depending on the type and stage of the cancer, patients may be treated with surgery, radiation therapy, chemotherapy, targeted therapy and/or palliative therapies. Some patients may receive more than one or a combination of these treatments.
Surgery — Surgery to remove a tumor offers the best chance for long-term control of all types of pancreatic cancer. If a tumor is able to be surgically removed, it is called resectable. About 15 percent to 20 percent of patients with pancreatic cancer have tumors that are considered surgically resectable.
The Whipple Procedure, or pancreaticoduodenectomy, is the most commonly performed surgery to remove tumors in the pancreas. In a standard Whipple procedure, the surgeon removes the head of the pancreas, the gallbladder, part of the duodenum (the uppermost portion of the small intestine), a small portion of the stomach called the pylorus, and the lymph nodes near the head of the pancreas. The surgeon then reconnects the remaining pancreas and digestive organs so pancreatic digestive enzymes, bile, and stomach contents will flow into the small intestine during digestion. The surgery usually lasts between three and six hours.
Pancreatic surgery is very complicated, especially the most common surgery, the Whipple procedure. It is important to seek out a surgeon at a hospital that does a large number of these procedures. Studies show that patients who undergo pancreatic surgery performed by an experienced surgeon have fewer complications and better outcomes. At Continuum Cancer Centers of New York, we are a high volume pancreatic surgery center: our surgeons perform between 60 and 100 pancreatectomies each year.
Neoadjuvant Therapy — Sometimes, cancer treatment is given before the surgery to remove a pancreatic tumor. This treatment, called neoadjuvant therapy, generally involves chemotherapy or chemotherapy with radiation therapy. The goal of neoadjuvant treatment is to reduce the size of the tumor so it is more easily removed during surgery.
Chemotherapy — Chemotherapy is cancer treatment that uses drugs to kill cancer cells by damaging their ability to grow and divide. We call drug treatments systemic therapy because they go everywhere in the body to attack all cells, including cancer cells and healthy cells. Chemotherapy often prevents pancreatic tumors from growing and sometimes shrinks them.
There are two chemotherapy agents approved by the U.S. Food and Drug Administration (FDA) to treat pancreatic cancer. In 1996, gemcitabine (Gemzar®) was approved as the standard treatment for pancreatic cancer. Prior to gemcitabine, fluorouracil (5-FU) was used as the first-line treatment (the first drug used in each patient). Both of these medicines are still used today. In addition, clinical trials are in progress to study other chemotherapy agents and the effectiveness of various drug combinations.
Chemotherapy may be given alone or in combination with surgery, targeted therapy (drug treatments aimed at specific cell processes or molecules), immunotherapy (the use of antibodies that attack very specific parts of cells), and/or radiation. Chemotherapy may enhance the effect of the radiation on the tumor. The chemotherapy drugs most commonly used in conjunction with radiation therapy are fluorouracil (5-FU) and gemcitabine (Gemzar®).
Chemotherapy drugs can be administered through a vein into the bloodstream (intravenously) but some can be given orally (by mouth). Usually, patients receive chemotherapy as an outpatient treatment at a hospital, clinic or doctor’s office. The time needed for each treatment session depends on the type of chemotherapy.
Radiation Therapy — Radiation therapy uses high-energy X-rays or other types of high-energy waves to kill cancer cells or prevent them from dividing. Radiation treatment often prevents pancreatic tumors from growing and sometimes shrinks them.
Since radiation therapy only affects the cancer cells in the area at which it is directed, it is considered a local treatment, like surgery.
Adjuvant Chemotherapy or Radiation Therapy — Adjuvant treatments are given after all the cancer we can see has been removed by surgery or treated with radiation. Often, adjuvant chemotherapy or radiation therapy is given after pancreatic cancer surgery to reduce the risk of recurrance, or reappearance, of the cancer. Recurrence can occur when a microscopic amount of the cancer spreads prior to the surgery. The aim of adjuvant therapy is to kill microscopic cancer cells while their numbers are small and these treatments are more effective, thereby preventing recurrence of a tumor.
Pancreatic cancer clinical trials are necessary to determine whether new treatments developed in the laboratory are beneficial to people living with pancreatic cancer. The FDA reviews and analyzes data from successful clinical trials to determine whether an experimental treatment should be approved for a specific disease or disorder, such as pancreatic cancer.
- Clinical trials are the only way that researchers can develop new treatment options for pancreatic cancer. Currently, only about 3 percent of adult cancer patients enroll in a clinical trial, slowing treatment progress. Many patients are not aware of this option.
- It is important for you to know that inactive treatments, or placebos, are never used when an active cancer treatment is available. Participants in a cancer clinical trial will receive either the standard of care treatment option or the new treatment.
- Clinical trials for pancreatic cancer may be carried out using completely new treatment options or may seek to develop treatments that are already available for other cancers or conditions.
The Pancreatic Cancer Action Network is a nationwide network of people dedicated to working together to advance research, support patients, and create hope for those affected by pancreatic cancer.
With more than 30,000 members who are leaders in advancing cancer care, the American Society of Clinical Oncology (ASCO) is the voice of the world’s cancer physicians. ASCO’s patient information website — Cancer.Net — brings the expertise and resources of ASCO to people living with cancer and those who care for and care about them.
At NCCN.com, the National Comprehensive Cancer Network (NCCN) aims to provide both people with cancer and the general public state-of-the-art cancer treatment information in easy-to-understand language.