Pancreatic cancer is the fourth leading cause of cancer-related death in the United States among both men and women.  Approximately 43,000 Americans are diagnosed with pancreatic cancer annually.  There are two types of pancreatic cancer.  The first, which is the most common, is cancer of the exocrine pancreas, or pancreatic adenocarcinoma.  This cancer begins in the pancreatic ducts which carry pancreatic juices to the intestines to aid in digestion.  The second type of pancreatic cancer is called pancreatic endocrine cancer.  This cancer originates from the cells of the pancreas which secrete hormones, including insulin.  Pancreatic cancer occurs rarely before age 45.  It occurs more frequently in males versus females, and in African Americans.

Environmental risk factors for pancreatic cancer include tobacco use, obesity and physical inactivity, and alcohol intake.  There are also genetic risk factors for pancreatic cancer.  Approximately 5-10% of individuals with pancreatic adenocarcinoma have a first degree relative with the disease.  The risk is higher if you have a family member who developed the disease at a young age.  Smoking is noted to increase this risk.

Individuals from high-risk families can be screened for pancreatic cancer, however, the most effective screening method has not been established.  Current screening methods include endoscopic ultrasound (a medical procedure during which a probe is inserted through the mouth and ultrasound images are taken of the internal organs of the chest and abdomen) and CT scans.

The most common signs of pancreatic cancer include upper abdominal pain, weight loss, and yellowing of the skin or eyes.  The pain is usually described as a dull ache which radiates to the back.  It may worsen after eating.  Bowel movements may change in appearance.  They may appear gray, greasy, or float in the bowl.

The symptoms of pancreatic cancer can be treated to provide relief.  Treatments include pain medications, pancreatic enzyme supplementation, which can aid digestion, medications to improve appetite, and medications to combat nausea and vomiting.  Stents, or small tubes which are inserted in the body, can also be placed if the tumor causes a blockage of the flow of bile or a blockage in the upper intestine.

Testing for pancreatic cancer includes imaging tests such as a CT scan or an abdominal ultrasound.  Blood tests can also be ordered.  If you are found to have a growth in the pancreas you may be sent for additional tests.  In some cases a biopsy will be recommended to confirm the diagnosis.  A biopsy is done by removing a small piece of tissue from the mass and examining the tissue under a microscope.

There are several treatment strategies for pancreatic cancer, including surgery, chemotherapy, and radiation.  If pancreatic cancer is discovered early, surgery may offer a cure.  When a tumor is found in the head of the pancreas the most likely surgical procedure performed is a Whipple procedure during which the surgeon removes the pancreatic head, the first part of the small intestine (the duodenum), part of the second part of the small intestine (the jejunum), the common bile duct, the gallbladder, and part of the stomach.

If you would like more information about pancreatic cancer please contact our office

Fernandez-del Castillo, C.  Clinical Manifestations, diagnosis, and surgical staging of exocrine pancreatic cancer.  In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA, 2011.

Fernandez-del Castillo, C. & Jimenez, R. Epidemiology and risk factors for exocrine pancreatic cancer.  In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA, 2011.