Pancreatic Cancer

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Information written by:
Robert P. Zimmerman, MD

Pancreatic Cancer

BACKGROUND

The pancreas is located in the abdomen and is surrounded by the stomach, intestines, and the main blood vessels called the aorta and vena cava. The organ is divided into three portions. The widest portion is located next to the duodenum and is called the head. The central portion is called the body and the narrowest part near the spleen is called the tail. The pancreas is part of the endocrine system which is involved with digestion and metabolism. It secretes enzymes directly into the intestines to aid in digestion, particularly the breakdown of fats. In the pancreatic head, the duct which carries these enzymes joins a duct from the from the gallbladder and liver called the common bile duct. This empties directly into the duodenum to digest food. The pancreas also produces insulin, which is released into the bloodstream to lower the level of sugar. Cancer of the pancreas can begin in any part of the gland.

Epidemiology

Approximately 28,000 cases of pancreatic cancer are diagnosed each year in the United States. The typical age at diagnosis is 70 years and males are more commonly affected. Pancreatic cancer is the forth leading cause of cancer death in adults. Risk factors for the disease include cigarette smoking (doubles the risk), a high fat diet, chronic pancreatic inflammation (pancreatitis), and exposure to certain chemicals (benzidine, B-naphthylamine). Diabetics are twice as likely to be diagnosed with pancreatic cancer.

Signs and Symptoms

Pancreatic cancer is difficult to detect in its early stages. Patients are typically diagnosed when the tumor blocks the ducts carrying bile and digestive enzymes causing a condition called jaundice (yellowing of the skin). Tumors of the body or tail of the pancreas may go undetected until they invade the spine causing back pain. Other common symptoms include loss of appetite, unexplained weight loss and fatigue.

Diagnostic tests

If your doctor suspects pancreatic cancer, one or more of the following tests may be ordered:

Ultrasound

This test uses sound waves to look at the liver, gallbladder, and bile ducts. Tumors of the head of the pancreas cause the bile ducts to be enlarged or dilated.

CT or MRI scan

These scans show cross sections of internal anatomy. Most tumors of the pancreas can be seen on this type of scan. These tests are needed to help determine if the cancer can be removed surgically. Sometimes a biopsy can be performed during the scanning process to confirm the diagnosis.

ERCP

This test is done by a Gastroenterologist who passes a camera down the throat, past the stomach, and into the duodenum. A small tube is used to inject dye into the pancreatic and bile ducts to evaluate for a possible blockage.