Pancreatic carcinoma

Pancreatic carcinoma is cancer of the pancreas.

Pancreatic cancer; Cancer - pancreas

Pancreatic cancer is slightly more common in men than in women. The risk increases with age.

The cause is unknown, but it is more common in smokers and in people who are obese. Almost a third of cases of pancreatic cancer are due to cigarette smoking.

There is controversy as to whether type 2 diabetes is a risk factor for pancreatic cancer. A small number of cases are known to be related to syndromes that are passed down through families.

• Abdominal pain
• Back pain
• Clay-colored stools
• Depression
• Diarrhea
• Fatigue
• Indigestion
• Jaundice
• Loss of appetite
• Nausea and vomiting
• Paleness
• Weakness
• Weight loss

• Abdominal CT scan
• Abdominal MRI
• Abdominal ultrasound
• Endoscopic retrograde cholangiopancreatography (ERCP)
• Endoscopic ultrasound
• Pancreatic biopsy

This disease may also affect the results of the following tests:

• Liver function tests
• Serum bilirubin

At the time of diagnosis, only about 20% of pancreatic tumors can be removed by surgery. The standard procedure is called a pancreaticoduodenectomy (Whipple procedure).

This surgery should be done at centers that perform the procedure frequently. Some studies suggest that surgery is best performed at hospitals that do at least nine of these surgeries per year.

When the tumor is confined to the pancreas but cannot be removed, a combination of radiation therapy and chemotherapy may be recommended.

When the tumor has spread (metastasized) to other organs such as the liver, chemotherapy alone is usually used. The standard chemotherapy drug is gemcitabine, but other drugs may be used. Gemcitabine can help approximately 25% of patients.

For patients who have a blockage of the tubes that transport bile (biliary obstruction) and the tumor cannot be totally removed, the blockage must be relieved. There are generally two approaches to this:

• Surgery
• Placement of a tiny metal tube (biliary stent) that is similar to stents placed in the arteries of the heart, to relieve blockages during ERCP

Management of pain and other symptoms is an important part of treating advanced pancreatic cancer. Hospice can help with pain and symptom management, and provide psychological support for patients and their families during the illness.

You can ease the stress of illness by joining a support group with members who share common experiences and problems (see cancer - support group).

Some patients with pancreatic cancer that can be surgically removed are cured. However, in more than 80% of patients the tumor has already spread and cannot be completely removed at the time of diagnosis.

Chemotherapy and radiation are often given after surgery to increase the cure rate. For pancreatic cancer that cannot be removed completely with surgery, or cancer that has spread beyond the pancreas, a cure is not possible and the average survival is usually less than 1 year. Such patients might consider enrolling in a clinical trial (a medical research study to determine the best treatment).

This cancer has a 5-year survival rate of less than 5%, meaning 95% of the people diagnosed with it will not be alive 5 years later.

• Blood clots
• Depression
• Infections
• Liver problems
• Pain
• Weight loss

Call for an appointment with your health care provider if you have:

• Back pain
• Fatigue
• Loss of appetite
• Persistent abdominal pain
• Other symptoms of this disorder

• If you smoke, stop smoking.
• Eat a diet high in fruits, vegetables, and whole grains.
• Exercise regularly.

Brand R. Pancreatic cancer. Dis Mon. 2004;50:545-555.