Definition

By Mayo Clinic staff

Pancreatic cancer begins in the tissues of your pancreas a large organ that lies horizontally behind the lower part of your stomach. Your pancreas secretes enzymes that aid digestion and hormones that help regulate the metabolism of sugars. Pancreatic cancer often has a poor prognosis, even when diagnosed early. Pancreatic cancer typically spreads rapidly and is seldom detected in its early stages, which is a major reason why it's a leading cause of cancer death. Signs and symptoms may not appear until pancreatic cancer is uite advanced and surgical removal isn't possible.

Symptoms
By Mayo Clinic staff
Signs and symptoms of pancreatic cancer often don't occur until the disease is advanced. !hen signs and symptoms do appear, they may include"

#pper abdominal pain that may radiate to your bac$ Yellowing of your s$in and the whites of your eyes %jaundice& 'oss of appetite !eight loss (epression

Causes
By Mayo Clinic staff
Pancrea s

Pancreatic cancer occurs when cells in your pancreas develop genetic mutations. )hese mutations cause the cells to grow uncontrollably and to continue living after normal cells would die. )hese accumulating cells can form a tumor. Understanding your pancreas Your pancreas is about * inches %+, centimeters& long and loo$s something li$e a pear lying on its side. )he pancreas is a crucial part of your digestive system. -t secretes hormones, including insulin, to help your body process sugar. .nd it produces digestive juices to help your body digest food. Types of pancreatic cancer )he types of cells involved in a pancreatic cancer help determine the best treatment. )ypes of pancreatic cancer include"

Cancer that forms in the pancreas ducts (adenocarcinoma). /ells that line the ducts of the pancreas help produce digestive juices. )he majority of pancreatic cancers are adenocarcinomas. Sometimes these cancers are called e0ocrine tumors. Cancer that forms in the hormone-producing cells. /ancer that forms in the hormone1producing cells of the pancreas is called endocrine cancer. 2ndocrine cancers of the pancreas are very rare.

Risk factors
By Mayo Clinic staff
3actors that may increase your ris$ of pancreatic cancer include"

Smo$ing. 4eing overweight or obese. Personal or family history of chronic inflammation of the pancreas %pancreatitis&. Personal or family history of pancreatic cancer. 3amily history of genetic syndromes that can increase cancer ris$, including a 45/.6 gene mutation, Peutz17eghers syndrome, 'ynch syndrome and familial atypical mole1 malignant melanoma %3.888&. 9lder age. Pancreatic cancer occurs most often in older adults. 8ost people diagnosed with pancreatic cancer are in their :;s and <;s.

4eing blac$. Pancreatic cancer occurs more fre uently in blac$s than in whites. Diagnosing pancreatic cancer -f your doctor suspects pancreatic cancer, you may have one or more of the following tests to diagnose the cancer"

Ultrasound. #ltrasound uses high1fre uency sound waves to create moving images of your internal organs, including your pancreas. )he ultrasound sensor %transducer& is placed on your upper abdomen to obtain images. Computerized tomography (CT) scan. /) scan uses =1ray images to help your doctor visualize your internal organs. -n some cases you may receive an injection of dye into a vein in your arm to help highlight the areas your doctor wants to see. Magnetic resonance imaging (MRI). 85- uses a powerful magnetic field and radio waves to create images of your pancreas. ndoscopic retrograde cholangiopancreatography ( RC!). )his procedure uses a dye to highlight the bile ducts in your pancreas. (uring 25/P, a thin, fle0ible tube %endoscope& is gently passed down your throat, through your stomach and into the upper part of your small intestine. .ir is used to inflate your intestinal tract so that your doctor can more easily see the openings of your pancreatic and bile ducts. . dye is then injected into the ducts through a small hollow tube %catheter& that's passed through the endoscope. 3inally, =1rays are ta$en of the ducts. . tissue or cell sample %biopsy& can be collected during 25/P.

ndoscopic ultrasound ( U"). 2#S uses an ultrasound device to ma$e images of your pancreas from inside your abdomen. )he ultrasound device is passed through an endoscope into your stomach in order to obtain the images. Your doctor may also collect a sample of cells %biopsy& during 2#S. !ercutaneous transhepatic cholangiography (!TC). P)/ involves injecting a dye into your liver to highlight your bile ducts. Your doctor carefully inserts a thin needle into your liver and injects the dye into the bile ducts in your liver. . special =1ray machine %fluoroscope& trac$s the dye as it moves through the ducts. #iopsy. (uring a biopsy, your doctor obtains a small sample of tissue from the pancreas for e0amination under a microscope. . biopsy sample can be obtained by inserting a needle through your s$in and into your pancreas %fine1needle aspiration&. 9r it can be done using endoscopic ultrasound to guide special tools into your pancreas where a sample of cells can be obtained for testing. "taging pancreatic cancer 9nce a diagnosis of pancreatic cancer is confirmed, your doctor will wor$ to determine the e0tent, or stage, of the cancer. Your cancer's stage helps determine what treatments are available to you. -n order to determine the stage of your pancreatic cancer, your doctor may recommend"

$aparoscopy. 'aparoscopy uses a lighted tube with a video camera to e0plore your pancreas and surrounding tissue. )he surgeon passes the laparoscope through an incision in your abdomen. )he camera on the end of the scope transmits video to a screen in the operating room. )his allows your doctor to loo$ for signs cancer has spread within your abdomen. Chest %-ray. . chest =1ray helps your doctor loo$ for signs that cancer has spread to your lungs. CT scan. /) scans allow your doctor to see your pancreas and assess whether the cancer has spread to nearby tissues, lymph nodes or other organs. MRI. 85- images may show if the cancer has spread beyond the pancreas. !ositron emission tomography (! T) scan. P2) scans use a radioactive tracer injected into a vein in order to help your doctor loo$ for areas where cancer has spread beyond the pancreas. P2) scans aren't typically used for pancreatic cancer, but they may offer another way to e0amine unusual areas found with a /) scan or 85-. #one scan. 4one scans use radioactive tracers to loo$ for evidence that cancer cells have spread to your bones. #lood test. Your doctor may test your blood for specific proteins %tumor mar$ers& shed by pancreatic cancer cells. 9ne tumor mar$er test used in pancreatic cancer is called /.+>1>. Some research indicates that the more elevated your level of /.+>1> is, the more advanced the cancer. 4ut the test isn't always reliable, and it isn't clear how best to use the /.+>1> test results. Some doctors measure your levels before, during and after treatment. 9thers use it to gauge your prognosis. "tages of pancreatic cancer )he stages of pancreatic cancer can be e0pressed in different ways. 9ne description of the stages uses three broad categories"

Resecta&le. .ll the tumor nodules can be removed. $ocally ad'anced. )he tumor can no longer be removed with surgery because the cancer has spread to tissues around the pancreas or into the blood vessels. Metastatic. .t this stage, the cancer has spread to distant organs, such as the lungs and liver. .nother description of the stages uses numerals"

"tage I. /ancer is confined to the pancreas. "tage II. /ancer has spread beyond the pancreas to nearby tissues and organs and may have spread to the lymph nodes. "tage III. /ancer has spread beyond the pancreas to the major blood vessels around the pancreas and may have spread to the lymph nodes. "tage I(. /ancer has spread to distant sites beyond the pancreas, such as the liver, lungs and the lining that surrounds your abdominal organs %peritoneum&.

Complications
By Mayo Clinic staff
.s pancreatic cancer progresses, it can cause complications such as"

)aundice. Pancreatic cancer that bloc$s the liver's bile duct can cause jaundice. Signs include yellow s$in and eyes, dar$1colored urine and very pale stools. Your doctor may recommend that a plastic or metal tube %stent& be placed inside the bile duct to hold it open. -n some cases a bypass may be needed to create a new way for bile to flow from the liver to the intestines.

!ain. . growing tumor may press on nerves in your abdomen, causing pain that can become severe. Pain medications can help you feel more comfortable. 5adiation therapy may help stop tumor growth temporarily to give you some relief. -n severe cases, your doctor may recommend a procedure to inject alcohol into the nerves that control pain in your abdomen %celiac ple0us bloc$&. )his procedure stops the nerves from sending pain signals to your brain.

#o*el o&struction. Pancreatic cancer that grows into or presses on the small intestine %duodenum& can bloc$ the flow of digested food from your stomach into your intestines. Your doctor may recommend a tube %stent& be placed in your small intestine to hold it open. 9r bypass surgery may be necessary to attach your stomach to a lower point in your intestines that isn't bloc$ed by cancer.

+eight loss. . number of factors may cause weight loss in people with pancreatic cancer. ?ausea and vomiting caused by cancer treatments or a tumor pressing on your stomach may ma$e it difficult to eat. 9r your body may have difficulty properly processing nutrients from food because your pancreas isn't ma$ing enough digestive juices. Your doctor will wor$ to correct the factors contributing to your weight loss. Pancreatic enzyme supplements may be recommended to aid in digestion. )ry to maintain your weight by adding e0tra calories where you can and ma$ing mealtime as pleasant and rela0ed as possible.

Death. Pancreatic cancer leads to death for most people diagnosed with the disease. 2ven people diagnosed when their cancer is at an early stage face a high ris$ of recurrence and death.

Treatments and drugs

By Mayo Clinic staff
)reatment for pancreatic cancer depends on the stage and location of the cancer as well as on your age, overall health and personal preferences. )he first goal of pancreatic cancer treatment is to eliminate the cancer, when possible. !hen that isn't an option, the focus may be on preventing the pancreatic cancer from growing or causing more harm. !hen pancreatic cancer is advanced and treatments aren't li$ely to offer a benefit, your doctor may suggest ways to relieve symptoms and ma$e you as comfortable as possible. "urgery 9nly a small portion of pancreatic cancers are considered resectable that is, they have a good chance of being removed completely with surgery. 9nce the cancer has spread beyond the pancreas to other organs, lymph nodes or blood vessels, surgery is usually no longer an option. !hen surgery is possible, your surgeon may recommend"

"urgery for tumors in the pancreatic head. -f your pancreatic cancer is located in the head of the pancreas, you may consider an operation called a !hipple procedure %pancreatoduodenectomy&. )he !hipple procedure involves removing the head of your pancreas, as well as a portion of your small intestine %duodenum&, your gallbladder and part of your bile duct. Part of your stomach may be removed as well. Your surgeon reconnects the remaining parts of your pancreas, stomach and intestines to allow you to digest food. !hipple surgery carries a ris$ of infection and bleeding. -t can cause temporary diabetes until your pancreas recovers from surgery. .nd some people e0perience nausea and vomiting that can occur if the stomach has difficulty emptying after surgery %delayed gastric emptying&. 20pect a long recovery after a !hipple procedure. You'll spend +; days or more in the hospital and then recover for several more wee$s at home. "urgery for tumors in the pancreatic tail and &ody. Surgery to remove the tail of the pancreas or the tail and a small portion of the body is called distal pancreatectomy. Your surgeon may also remove your spleen. Surgery carries a ris$ of bleeding and infection. 5esearch shows pancreatic cancer surgery tends to cause fewer complications when done by e0perienced surgeons. (on't hesitate to as$ about your surgeon's e0perience with pancreatic cancer surgery. -f you have any doubts, get a second opinion.

Radiation therapy 5adiation therapy uses high1energy beams to destroy cancer cells. You may receive radiation treatments before or after cancer surgery, often in combination with chemotherapy. 9r, your doctor may recommend a combination of radiation and chemotherapy treatments when your cancer can't be treated surgically. 5adiation therapy can come from a machine outside your body %e0ternal beam radiation&, or it can be placed inside your body near your cancer %brachytherapy&. 5adiation therapy can also be used during surgery %intraoperative radiation&. Chemotherapy /hemotherapy uses drugs to help $ill cancer cells. /hemotherapy can be injected into a vein or ta$en orally. You may receive only one chemotherapy drug, or you may receive a combination of chemotherapy drugs. /hemotherapy can also be combined with radiation therapy %chemoradiation&. /hemoradiation is typically used to treat cancer that has spread beyond the pancreas, but only to nearby organs and not to distant regions of the body. )his combination may also be used after surgery to reduce the ris$ that pancreatic cancer may recur. -n people with advanced pancreatic cancer, chemotherapy may be combined with targeted drug therapy. Targeted drug therapy )argeted drug therapy is an emerging area of cancer treatment. )argeted drugs attac$ specific abnormalities within cancer cells. )he targeted drug erlotinib %)arceva& bloc$s chemicals that signal cancer cells to grow and divide. 2rlotinib is usually combined with chemotherapy for use in people with advanced pancreatic cancer. 8any other targeted drug treatments are under investigation in clinical trials. 9ne such drug being studied is cetu0imab %2rbitu0&, which targets the same signals as erlotinib but goes about it a different way. Clinical trials /linical trials are studies to test new forms of treatment, such as new drugs, new approaches to surgery or radiation treatments, and novel methods such as gene therapy. -f the treatment being studied proves to be safer or more effective than are current treatments, it will become the new standard of care. /linical trials can't guarantee a cure, and they may have serious or une0pected side effects. 9n the other hand, cancer clinical trials are closely monitored by the federal government to ensure they're conducted as safely as possible. .nd they offer access to treatments that wouldn't otherwise be available to you. )al$ to your doctor about what clinical trials are available and whether these may be appropriate for you. ?ew treatments currently under investigation in clinical trials include"

Drugs that stop cancer from gro*ing ne* &lood 'essels. (rugs called angiogenesis inhibitors may help stop cancer from using new blood vessels to get the nutrients it needs to grow. 4lood vessels also give cancer cells a pathway to spread to other parts of the body. !ancreatic cancer 'accines. /ancer vaccines are being studied to treat cancer, rather than prevent disease, as vaccines are traditionally used. /ancer treatment vaccines use various strategies to enhance the immune system to help it recognize cancer cells as intruders. -n one e0ample, a vaccine may help train the immune system to attac$ a certain protein secreted by pancreatic cancer cells.

Jaundice, cholestasis, and biliary cirrhosis may occur from the chronic inflammatory reaction around the intrapancreatic portion of the common bile duct. Twenty years after the diagnosis of chronic pancreatitis, the cumulative risk of pancreatic carcinoma is 4%. Patients with hereditary pancreatitis are at a tenfold( !" lipat# higher risk for pancreatic cancer.($arrison, part % section %!&#