center for pancreatic cancer

Description of Pancreatic cancer | Stages of Cancer of the Pancreas | How cancer of the pancreas is treated | Treatment by Stage
 
description of pancreatic cancer TOP

Cancer of the pancreas is a disease in which cancer (malignant) cells are found in the tissues of the pancreas. The pancreas is about 6 inches long and is shaped something like a thin pear, wider at one end and narrowing at the other. The pancreas lies behind the stomach, inside a loop formed by part of the small intestine. The broader right end of the pancreas is called the head, the middle section is called the body, and the narrow left end is the tail.

The pancreas has two basic jobs in your body. It produces juices that help you break down (digest) your food, and hormones (such as insulin) that regulate how your body stores and uses food. The area of the pancreas that produces digestive juices is called the exocrine pancreas. About 95% of pancreatic cancers begin in the exocrine pancreas. The hormone-producing area of the pancreas is called the endocrine pancreas. Only about 5% of pancreatic cancers start here. This statement has information on cancer of the exocrine pancreas. For more information on cancer of the endocrine pancreas (also called islet cell cancer) see the PDQ Patient Information Statement on Islet Cell Carcinoma.

Cancer of the pancreas is hard to find (diagnose) because the organ is hidden behind other organs. Organs around the pancreas include the stomach, small intestine, bile ducts (tubes through which bile, a digestive juice made by the liver, flows from the liver to the small intestine), gallbladder (the small sac below the liver that stores bile), the liver, and the spleen (the organ that stores red blood cells and filters blood to remove excess blood cells). The signs of pancreatic cancer are like many other illnesses, and there may be no signs in the first stages. You should see your doctor if you have any of the following: nausea, loss of appetite, weight loss without trying to lose weight, pain in the upper or middle of your abdomen, or yellowing of your skin (jaundice).

If you have symptoms, your doctor will examine you and order tests to see if you have cancer and what your treatment should be. You may have an ultrasound, a test that uses sound waves to find tumors. A CT scan, a special type of x-ray that uses a computer to make a picture of the inside of your abdomen, may also be done. Another special scan called magnetic resonance imaging (MRI), which uses magnetic waves to make a picture of the inside of your abdomen, may be done as well.

A test called an ERCP (endoscopic retrograde cholangiopancreatography) may also be done. During this test, a flexible tube is put down the throat, through the stomach, and into the small intestine. Your doctor can see through the tube and inject dye into the drainage tube (duct) of the pancreas so that the area can be seen more clearly on an x-ray. During ERCP, your doctor may also put a fine needle into the pancreas to take out some cells. This is called a biopsy. The cells can then be looked at under a microscope to see if they contain cancer.

PTC (percutaneous transhepatic cholangiography) is another test that can help find cancer of the pancreas. During this test, a thin needle is put into the liver through your right side. Dye is injected into the bile ducts in the liver so that blockages can be seen on x-rays.

In some cases, a needle can be inserted into the pancreas during an x-ray or ultrasound so that cells can be taken out to see if they contain cancer. You may need surgery to see if you have cancer of the pancreas. If this is the case, your doctor will cut into the abdomen and look at the pancreas and the tissues around it for cancer. If you have cancer and it looks like it has not spread to other tissues, your doctor may remove the cancer or relieve blockages caused by the tumor.

stages of cancer of the pancreas TOP

Once cancer of the pancreas is found, more tests will be done to find out if the cancer has spread from the pancreas to the tissues around it or to other parts of the body. This is called staging. The following stages are used for cancer of the pancreas:

Stage I
Cancer is found only in the pancreas itself, or has started to spread just to the tissues next to the pancreas, such as the small intestine, the stomach, or the bile duct.

Stage II
Cancer has spread to nearby organs such as the stomach, spleen, or colon, but has not entered the lymph nodes. (Lymph nodes are small, bean-shaped structures that are found throughout the body; they produce and store infection-fighting cells).

Stage III
Cancer has spread to lymph nodes near the pancreas. The cancer may or may not have spread to nearby organs.

Stage IV
Cancer has spread to places far away from the pancreas, such as the liver or lungs.

Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the pancreas or in another part of the body.

how cancer of the pancreas is treated TOP

There are treatments for all patients with cancer of the pancreas. Three kinds of treatment are used: surgery (taking out the cancer or relieving symptoms caused by the cancer) radiation therapy (using high-dose x-rays or other high-energy rays to kill cancer cells) chemotherapy (using drugs to kill cancer cells).

The use of biological therapy (using the body's immune system to fight cancer) is being tested for pancreatic cancer.

Surgery may be used to take out the tumor. Your doctor may take out the cancer using one of the following operations:

A Whipple procedure removes the head of the pancreas, part of the small intestine, and some of the tissues around it. Enough of the pancreas is left to continue making digestive juices and insulin.

Total pancreatectomy takes out the whole pancreas, part of the small intestine, part of the stomach, the bile duct, the gallbladder, spleen, and most of the lymph nodes in the area.

Distal pancreatectomy takes out only the tail of the pancreas.

If your cancer has spread and it cannot be removed, your doctor may do surgery to relieve symptoms. If the cancer is blocking the small intestine and bile builds up in the gallbladder, your doctor may do surgery to go around (bypass) all or part of the small intestine. During this operation, your doctor will cut the gallbladder or bile duct and sew it to the small intestine. This is called biliary bypass. Surgery or x-ray procedures may also be done to put in a tube (catheter) to drain bile that has built up in the area. During these procedures, your doctor may make the catheter drain through a tube to the outside of the body or the catheter may go around the blocked area and drain the bile to the small intestine. In addition, if the cancer is blocking the flow of food from the stomach, the stomach may be sewn directly to the small intestine so you can continue to eat normally.

Radiation therapy uses high-energy x-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes in the area where the cancer cells are found (internal radiation therapy).

Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by a needle in the vein or muscle. Chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells outside the pancreas.

Biological therapy tries to get your own body to fight cancer. It uses materials made by your own body or made in a laboratory to boost, direct, or restore your body's natural defenses against disease. Biological therapy is sometimes called biological response modifier (BRM) therapy or immunotherapy. Biological therapy is being tested in clinical trials.

treatment by stage TOP

Treatment for cancer of the pancreas depends on the stage of your disease, your age, and your overall condition.

You may receive treatment that is considered standard based on its effectiveness in a number of patients in past studies, or you may choose to go into a clinical trial. Most patients with cancer of the pancreas are not cured with standard therapy and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Clinical trials are going on in most parts of the country for all stages of cancer of the pancreas. If you wish to know more about clinical trials, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.

STAGE I PANCREATIC CANCER

Your treatment may be one of the following:

  • Surgery to remove the head of the pancreas, part of the small intestine, and some of the surrounding tissues (Whipple procedure).
  • Surgery to remove the entire pancreas and the organs around it (total pancreatectomy).
  • Surgery to remove the tail of the pancreas (distal pancreatectomy) for tumors in the tail of the pancreas.
  • Surgery followed by chemotherapy and radiation therapy.
  • Clinical trials of radiation therapy with or without chemotherapy given before, during, or after surgery.

STAGE II PANCREATIC CANCER

Your treatment may be one of the following:

  • Surgery or other treatments to reduce symptoms.
  • External radiation therapy with or without chemotherapy.
  • Surgery to remove all or part of the pancreas with or without chemotherapy and radiation therapy.
  • Clinical trials of radiation therapy and chemotherapy given before surgery.
  • Clinical trials of radiation therapy plus drugs to make cancer cells more sensitive to radiation (radiosensitizers).
  • Clinical trials of chemotherapy.
  • Clinical trials of radiation therapy given during surgery with or without internal radiation therapy.

STAGE III PANCREATIC CANCER

Your treatment may be one of the following:

  • Surgery or other treatments to reduce symptoms.
  • External radiation therapy with or without chemotherapy.
  • Surgery to remove all or part of the pancreas with or without chemotherapy and radiation therapy.
  • Clinical trials of radiation therapy given before surgery.
  • Clinical trials of surgery plus radiation therapy plus drugs to make cancer cells more sensitive to radiation (radiosensitizers).
  • Clinical trials of chemotherapy.
  • Clinical trials of radiation therapy given during surgery, with or without internal radiation therapy.

STAGE IV PANCREATIC CANCER

Your treatment may be one of the following:

  • Surgery or other treatments to reduce symptoms.
  • Treatments for pain.
  • Clinical trials of chemotherapy or biological therapy.

RECURRENT PANCREATIC CANCER

Your treatment may be one of the following:

  • Chemotherapy.
  • Surgery or other treatments to reduce symptoms.
  • External radiation therapy to reduce symptoms.
  • Treatments for pain.
  • Other medical care to reduce symptoms.
  • Clinical trials of chemotherapy or biological therapy

Contact us for additional information on Pancreatic Cancer and other Diseases of the Pancreas

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Pancreatic cancer symptoms, stages and treatment