Symptoms Of Pancreatic Cancer
In the early stages, a tumour in the pancreas doesn’t usually cause any symptoms, which can make it difficult to diagnose.
It’s important to remember that these symptoms can be caused by many different conditions, and aren’t usually the result of cancer. But you should contact your GP if you’re concerned, or if these symptoms start suddenly.
The first noticeable symptoms of pancreatic cancer are often:
- pain in the back or stomach area which may come and go at first and is often worse when you lie down or after you’ve eaten
- unexpected weight loss
- jaundice the most obvious sign is yellowing of the skin and whites of the eyes it also causes your urine to be dark yellow or orange and your stools to be pale-coloured
Other possible symptoms of pancreatic cancer include:
- nausea and vomiting
Read more about treating pancreatic cancer.
What Is The Location Of The Pancreas Cancer
The location of the pancreas cancer, as visualized by CT scan, will determine the type of the operation.
Cancers of the head of the pancreas may be surgically removable with a pancreaticoduodenectomy or Whipple operation.
Cancers of the body or tail of the pancreas may be surgically removable with a distal pancreatectomy. In removing the body and tail of the pancreas, we often also remove the spleen, because of the very close contact of the two organs, and to better remove the lymph nodes between the two organs. In selected cases tumors in the body or tail of the pancreas may be removed using minimally invasive approaches such as robotic and laparoscopic pancreatectomy.
How Is Pancreatic Cancer Diagnosed
Its difficult to detect pancreatic cancer in the early stages. This is because healthcare providers cannot feel the pancreas in a routine exam. If your provider suspects that you may have pancreatic cancer, they may order imaging tests to take pictures of the internal organs. An endoscopic ultrasound can also be done.
An endoscopic ultrasound is a thin tube with a camera at the tip that is passed through the mouth and into the stomach. The ultrasound probe at the end of the endoscope allows imaging of the pancreas through the stomach wall. If necessary, an ultrasound-guided biopsy from the pancreas can be obtained during the procedure.
A blood test can find a substance called a tumor marker. For pancreatic cancer, high levels of carbohydrate antigen 19-9 a type of protein released by pancreatic cancer cells might indicate a tumor.
Everyone who is newly diagnosed with pancreatic cancer should talk to their doctor about doing genetic counseling and testing to see if there is a hereditary reason they developed pancreatic cancer. This is based on recommendations from two of the largest cancer organizations, the National Comprehensive Cancer Network and the American Society of Clinical Oncology .
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Blood Tests For Pancreatic Cancer
Doctors may perform different blood tests to help diagnose pancreatic cancer. These can include liver-function tests to check for abnormal levels of bilirubin and tumor-marker tests. Tumor markers are specific proteins found in the blood when a person has cancer. Tumor markers that may be helpful in diagnosing pancreatic cancer are carcinoembryonic antigen and CA 19-9.
Questions To Ask The Doctor
- Do you know the stage of the cancer?
- If not, how and when will you find out the stage of the cancer?
- Would you explain to me what the stage means in my case?
- Based on the stage of the cancer, how long do you think Ill live?
- What is the grade of the cancer and what will that mean for treatment?
- What will happen next?
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Treating Borderline Resectable Cancer
A small number of pancreatic cancers have reached nearby blood vessels but have not grown deeply into them or surrounded them. These cancers might still be removable by surgery, but the odds of removing all of the cancer are lower, so they are considered borderline resectable.
These cancers are often treated first with neoadjuvant chemotherapy to try to shrink the cancer and make it easier to remove. Imaging tests are then done to make sure the cancer hasnt grown too much to be removed. As long as it hasnt, surgery is then done to remove it. This might be followed by more chemotherapy.
Another option might be to have surgery first, followed by adjuvant chemotherapy . If, during the surgery, it becomes clear that not all of the cancer can be removed, continuing the operation might do more harm than good. The surgery might be stopped, or the surgeon might continue with a smaller operation with a goal of relieving or preventing problems such as bile duct blockage.
Radiation Therapy For Pancreatic Cancer
Radiation therapy uses high-energy rays to kill cancer cells. It may be used before surgery to shrink the tumor or after surgery to destroy any remaining cancer cells. Radiation is often given in combination with chemotherapy, which is known as chemoradiation or chemoradiotherapy.
External-beam radiation therapy is the primary type of radiation therapy used for treating pancreatic cancer and focuses radiation from a source outside of the body on the cancer.
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What Are Endocrine Tumors
Endocrine tumors are cancers that originate in the hormone-producing cells of the pancreas,* the islet of Langerhans cells. Because endocrine tumors begin in cells that produce hormones, the tumors themselves may produce hormones that cause symptoms in addition to the problems caused by the presence of an abnormal mass.
Of all pancreatic cancers, endocrine tumors account for less than 5%. They may also be called neuroendocrine or islet cell tumors. Islet cell tumors affect approximately 2500 people in the United States annually. Some of these tumors secrete excessive amounts of hormone and are referred to as functional neuroendocrine tumors. More common functional islet cell tumors include insulinomas and glucagonomas, whereas VIPomas and somatostatinomas are much more unusual. Nonfunctional tumors are less common and do not secrete excess hormones.
*Note: Endocrine tumors may also form in hormone-producing cells in other parts of the body such as the adrenal gland, thyroid, parathyroid, pituitary gland, lung and gastrointestinal tract.
Insulinomas arise from the islet cells of the pancreas and produce excessive amounts of insulin, resulting in low blood sugar. Typically small and noninvasive, these tumors are benign 90% of the time.
Symptoms include dizziness, fatigue, weakness, uncontrolled shaking, hunger, and at times psychiatric disturbances. A history of fainting related to low blood sugar and weight gain commonly affects patients.
Pancreatic Cancer: The Basics
The pancreas is a gland in the abdomen that makes enzymes for digestion and hormones that control sugar levels in the blood. Benign or malignant tumors may form if the process of cellular division in this gland breaks down. Malignant tumors of the pancreas are called pancreatic cancer.
About 62,000 Americans will be diagnosed with pancreatic cancer this year, according to the American Cancer Society . Pancreatic cancer accounts for 3 percent of all cancers in the United States and for about 7 percent of all cancer deaths.
The two major types of pancreatic cancer are the exocrine tumor and the neuroendocrine tumor, or islet cell tumor. They are determined by the type of cell in which they originate, and specific risk factors may be related to each type.
Initial signs and symptoms of pancreatic cancer are often vague and include:
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What Are The Risk Factors For Pancreatic Cancer
The average lifetime risk of developing pancreatic cancer is about 1 in 64. A risk factor is something that raises the chance that you will get a disease. There are risk factors that are a result of behavior and that can be changed. For pancreatic cancer, these types of risk factors include:
- Smoking cigarettes, cigars and using other forms of tobacco.
- Obesity is also a risk factor. Carrying weight around the waist is a risk factor even if you do not have obesity.
- Having diabetes, especially type 2 diabetes, which is linked to obesity. The new development of diabetes at an older age and in someone with a normal weight or body mass index could be a sign of pancreatic cancer.
- Being exposed to chemicals used by dry cleaners and metal workers.
- Having chronic pancreatitis, a permanent inflammation of the pancreas usually associated with smoking and drinking a lot of alcohol.
There are also risk factors that you cant change. These include:
- Hereditary chronic pancreatitis due to gene changes passed from parent to child.
- Hereditary syndromes with gene changes in genes such as BRCA genes passed from parent to child.
- Being older than 45.
- Being of Ashkenazi Jewish descent.
Your healthcare provider might suspect pancreatic cancer if you have certain symptoms or if youve recently developed diabetes or pancreatitis.
Benign And Precancerous Growths In The Pancreas
Some growths in the pancreas are simply benign , while others might become cancer over time if left untreated . Because people are getting imaging tests such as CT scans more often than in the past , these types of pancreatic growths are now being found more often.
Serous cystic neoplasms are tumors that have sacs filled with fluid. SCNs are almost always benign, and most dont need to be treated unless they grow large or cause symptoms.
Mucinous cystic neoplasms are slow-growing tumors that have cysts filled with a jelly-like substance called mucin. These tumors almost always occur in women. While they are not cancer, some of them can progress to cancer over time if not treated, so these tumors are typically removed with surgery.
Intraductal papillary mucinous neoplasms are benign tumors that grow in the pancreatic ducts. Like MCNs, these tumors make mucin, and over time they sometimes become cancer if not treated. Some IPMNs can just be followed closely over time, but some might need to be removed with surgery if they have certain features, such as if they are in the main pancreatic duct.
Solid pseudopapillary neoplasms are rare, slow-growing tumors that almost always develop in young women. Even though these tumors tend to grow slowly, they can sometimes spread to other parts of the body, so they are best treated with surgery. The outlook for people with these tumors is usually very good.
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I Have A Neuroendocrine Tumor
Although neuroendocrine tumors are rare, they are important to recognize because their treatment is completely different from most other tumors of the pancreas.
Third Degree Relatives – First cousins, great-aunts and uncles
An inherited genetic variation in DNA that you are born with
Second Degree Relatives – Aunts, uncles, grandparents, nieces and nephews
First Degree relatives – Blood relatives in your immediate family: parents, children, and siblings
This is an experimental type of treatment. It is a medication made of killed or weakened cells, organisms or manufactured materials, which is used to boost the body’s immune system. Ideally, this will allow the body to fight and kill the cancer cells more effectively. Vaccines include whole killed cancer cells or specific proteins from the cancer.
Also known as a pancreatoduodenectomy, the Whipple procedure is the surgery typically performed to remove cancers of the head of the pancreas . It typically involves the surgical removal of the head of the pancreas, a portion of the duodenum and a portion of the bile ducts.
The part of the pancreas that bends backwards, hooking around two very important blood vessels, the superior mesenteric artery and vein. The word “uncinate” comes from the word uncus which means “hook.”
Unable to be surgically removed. This usually means that the cancer has spread beyond the areas that can be removed surgically.
The long thin part of gland in the left part of abdomen, near the spleen.
Pancreatic Cancer Survival Rates And Prognosis
Pancreatic cancer prognosis depends on the type of cancer and the stage at which it is diagnosed. Although pancreatic cancer accounts for only 3% of all cancers in the United States, it leads to about 7% of all cancer deaths.
The five-year survival rate for patients with localized pancreatic cancer where the tumor is still confined to the pancreas is 37%. Approximately10% of all pancreatic cancers are discovered at this stage.
Pancreatic cancer survival rate decreases as the cancer spreads beyond the immediate area of the pancreas. The five-year survival rate for patients with regional pancreatic cancer , is about 12%, and 37% of cases are diagnosed at this point.
The survival rate for patients with distant pancreatic cancer is 3%. This accounts for about 53% of all diagnoses.
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Why Come To Cu Cancer Center For Pancreatic Cancer
As the only National Cancer Institute Designated Comprehensive Cancer Center in the state of Colorado and one of only four in the Rocky Mountain region, the University of Colorado Cancer Center has doctors who provide patient-centered pancreatic cancer care and researchers dedicated to diagnostic and treatment innovations.
Veterans Pancreatic Cancer Caught At Just the Right Time
The CU Cancer Center is home to the Pancreas and Biliary Cancer Multidisciplinary Clinic, which offers patients an all in one approach to clinical care. At a multidisciplinary clinic, patients are evaluated in one day by specialists who treat this specific cancer, including world-class surgeons, oncologists, radiologists, gastroenterologists, nurse practitioners, and others, who then collaborate on care. This multidisciplinary approach has proven to be the new standard of care for pancreatic cancer.
The CU Cancer Center also has a Pancreas Surveillance Clinic for high-risk patients, those who need lifelong surveillance following surgery, and those who have pre-malignant pancreatic cysts.
Learn more about this designation:
University of Colorado Cancer Center Earns Distinguished Title from National Pancreas Foundation Academic Center of Excellence
There are numerous pancreatic cancer clinical trials being offered by CU Cancer Center members at any time. These trials offer patients options to traditional pancreatic cancer treatment and can result in remission or increased life spans.
For Connecting And Sharing During A Cancer Journey
Anyone with cancer, their caregivers, families, and friends, can benefit from help and support. The American Cancer Society offers the Cancer Survivors Network , a safe place to connect with others who share similar interests and experiences. We also partner with CaringBridge, a free online tool that helps people dealing with illnesses like cancer stay in touch with their friends, family members, and support network by creating their own personal page where they share their journey and health updates.
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How Can I Prevent Pancreatic Cancer
We dont know what actually causes pancreatic cancer, so its difficult to know how to prevent it. However, you can change your day-to-day behaviors to become healthier. These tips may help reduce the risk of getting pancreatic cancer:
- Dont smoke. If you do smoke or use tobacco in any form, try to quit.
- Try to reach and maintain a normal weight by eating healthy and exercising.
- Drink alcohol in moderation, or quit drinking altogether.
- Try to avoid getting diabetes. If you have it, control your blood sugar levels.
- Use safety equipment if your work exposes you to toxins.
What Is The Pancreas
The pancreas is a small, hockey stick-shaped gland located behind the stomach. The main jobs of the pancreas are to aid in food digestion and regulate blood sugar levels in the body. The pancreas is involved in maintaining blood sugar levels because it makes insulin and glucagon, two hormones that control blood sugar levels.
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Looking For More Of An Introduction
If you would like more of an introduction, explore these related items. Please note that these links will take you to other sections on Cancer.Net:
- ASCO Answers Fact Sheet:Read a 2-page fact sheet that offers an introduction to pancreatic cancer. This free fact sheet is available as a PDF, so it is easy to print.
- Cancer.Net Patient Education Video: View a short video led by an ASCO expert in pancreatic cancer that provides basic information and areas of research.
How Is The Stage Determined
The staging system used most often for pancreatic cancer is the AJCC TNM system, which is based on 3 key pieces of information:
- The extent of the tumor : How large is the tumor and has it grown outside the pancreas into nearby blood vessels?
- The spread to nearby lymph nodes: Has the cancer spread to nearby lymph nodes? If so, how many of the lymph nodes have cancer?
- The spread to distant sites : Has the cancer spread to distant lymph nodes or distant organs such as the liver, peritoneum , lungs or bones?
The system described below is the most recent AJCC system, effective January 2018. It is used to stage most pancreatic cancers except for well-differentiated pancreatic neuroendocrine tumors , which have their own staging system.
Numbers or letters after T, N, and M provide more details about each of these factors. Higher numbers mean the cancer is more advanced. Once a persons T, N, and M categories have been determined, this information is combined in a process called stage grouping to assign an overall stage.
Cancer staging can be complex. If you have any questions about your stage, please ask your doctor to explain it to you in a way you understand.
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Moffitt Cancer Centers Approach To Treating Pancreatic Cancer
Within Moffitt Cancer Centers Gastrointestinal Oncology Program, we take a multispecialty approach to pancreatic cancer care. In a single location, our patients have access to a comprehensive range of treatments provided by a collaborative team of highly experienced and specialized professionals, including:
- Board-certified surgeons
These experts meet weekly as a tumor board to review patient cases and work together to deliver comprehensive, individualized care. As a result, each Moffitt patient receives the benefit of having multiple expert opinions at each phase of his or her evaluation and treatment. Additionally, our compassionate oncology nurses, social workers and dietitians provide a full range of supportive care to our patients.
As the only National Cancer Institute-designated Comprehensive Cancer Center based in Florida, Moffitt continues to blaze new trails that advance cancer research. In addition to our extensive portfolio of clinical trials, Moffitt administers several molecular therapy, immunotherapy and chemotherapy drugs that are not readily available elsewhere, allowing us to provide our patients with opportunities to be among the first to receive highly advanced therapies
To learn more about Moffitts comprehensive pancreatic cancer services, call or complete a new patient registration form online.