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Information from PDQ for Patients
Pancreatic cancer
208/00046
** GENERAL INFORMATION ABOUT PANCREATIC CANCER **
Pancreatic cancer is a disease in which malignant (cancer) cells form in the
tissues of the pancreas. The pancreas is a gland about 6 inches long that is
shaped like a thin pear lying on its side. The wider end of the pancreas is
called the head, the middle section is called the body, and the narrow end is
called the tail. The pancreas lies behind the stomach and in front of the
spine.
The pancreas has two main jobs in the body:
- To produce juices that help digest (break down) food.
- To produce hormones, such as insulin and glucagon, that help control blood
sugar levels. Both of these hormones help the body use and store the energy it
gets from food.
The digestive juices are produced by exocrine pancreas cells and the hormones
are produced by endocrine pancreas cells. About 95% of pancreatic cancers
begin in exocrine cells.
This summary provides information on exocrine pancreatic cancer. Refer to the
PDQ summary on Islet Cell Carcinoma (Endocrine Pancreas) Treatment for
information on endocrine pancreatic cancer.
Smoking and health history can affect the risk of developing pancreatic cancer.
The following are possible risk factors for pancreatic cancer:
- Smoking.
- Long-standing diabetes.
- Chronic pancreatitis.
- Certain hereditary conditions such as hereditary pancreatitis, multiple
endocrine neoplasia type 1 syndrome, hereditary nonpolyposis colon cancer
(HNPCC; Lynch syndrome), von Hippel-Lindau syndrome, ataxia-telangiectasia, and
the familial atypical mole melanoma syndrome.
Possible signs of pancreatic cancer include jaundice, pain, and weight loss.
These symptoms can be caused by pancreatic cancer or other conditions. A
doctor should be consulted if any of the following problems occur:
- Jaundice (yellowing of the skin and whites of the eyes).
- Pain in the upper or middle abdomen and back.
- Unexplained weight loss.
- Loss of appetite.
- Fatigue.
Pancreatic cancer is difficult to detect (find) and diagnose early. Pancreatic
cancer is difficult to detect and diagnose for the following reasons:
- There aren't any noticeable signs or symptoms in the early stages of
pancreatic cancer.
- The signs of pancreatic cancer, when present, are like the signs of many
other illnesses.
- The pancreas is hidden behind other organs such as the stomach, small
intestine, liver, gallbladder, spleen, and bile ducts.
Tests that examine the pancreas are used to detect (find), diagnose, and stage
pancreatic cancer. Pancreatic cancer is usually diagnosed with tests and
procedures that produce pictures of the pancreas and the area around it. The
process used to find out if cancer cells have spread within and around the
pancreas is called staging. Tests and procedures to detect, diagnose, and
stage pancreatic cancer are usually done at the same time. In order to plan
the best treatment, it is important to know the stage of the disease and
whether or not the pancreatic cancer can be removed by surgery. The following
tests and procedures may be used:
Chest x-ray: Brief exposure of the chest to radiation to produce an image of
the chest and its internal structures.
Physical exam: A check of general signs of health, including looking for
anything unusual such as lumps or growths.
CT scan (CAT scan): A CT scan creates a series of pictures of areas inside the
body, taken from different angles. The pictures are created by a computer
linked to an x-ray machine. This test is also called computed tomography,
computerized tomography, or computerized axial tomography. A spiral or helical
CT scan takes detailed pictures of areas inside the body as it scans the body
in a spiral path.
MRI (magnetic resonance imaging): A procedure in which a magnet linked to a
computer is used to create detailed pictures of areas inside the body. This
test is also called nuclear magnetic resonance imaging (NMRI).
PET scan (positron emission tomography scan): A PET scan creates a picture
showing the location of tumor cells in the body. A substance called
radionuclide glucose (sugar) is injected into a vein and the PET scanner
rotates around the body to create the picture. Malignant tumor cells show up
brighter in the picture because they are more active and take up more glucose
than normal cells.
Endoscopic ultrasound (EUS): A test that uses sound waves to create images of
body tissues. High-energy sound waves are bounced off internal tissues and
organs. The echoes are changed into pictures called sonograms. An endoscopic
ultrasound uses an endoscope (a flexible tube inserted into the body).
Laparoscopy: A laparoscope (a thin, lighted tube) is inserted through an
incision in the abdominal wall to determine if the cancer is within the
pancreas only or has spread to nearby tissues and if it can be removed by
surgery later. Tissue samples may be removed for biopsy.
ERCP (endoscopic retrograde cholangiopancreatography): A procedure to x-ray the
ducts (tubes) that carry bile from the liver to the gallbladder and from the
gallbladder to the small intestine. Pancreatic cancer can cause these ducts to
narrow and block or slow the flow of bile, causing jaundice. In ERCP, an
endoscope (a thin, lighted tube) is passed through the mouth, esophagus, and
stomach into the first part of the small intestine. A catheter (a smaller
tube) is then inserted through the endoscope into the pancreatic ducts. A dye
is injected through the catheter into the ducts and an x-ray is taken. If the
ducts are blocked by a tumor, a stent (a thin tube) may be inserted into the
duct to unblock it. The stent may be left in place to keep the duct open.
Tissue samples may also be taken with a fine needle or a brush like a
pipecleaner.
PTC (percutaneous transhepatic cholangiography): A procedure to x-ray the liver
and common bile ducts. A thin needle is inserted through the skin below the
ribs and into the liver. Dye is injected into the liver or bile ducts and the
ducts are then x-rayed to find the blockages. To relieve jaundice, a stent (a
thin tube) is sometimes left in the liver to drain bile into the small
intestine or a collection bag outside the body. This test is done only if ERCP
cannot be done.
Biopsy: Cells, tissues, or fluid are removed and viewed under a microscope to
see if cancer cells are present. There are several ways to do a biopsy for
pancreatic cancer. A fine needle may be inserted into the pancreas during an
x-ray or ultrasound to remove cells. Tissue may also be removed during a
laparoscopy (a surgical incision made in the wall of the abdomen).
Certain factors affect treatment options and prognosis (chance of recovery).
The treatment options and prognosis (chance of recovery) depend on the stage of
the cancer (the size of the tumor and whether the cancer has spread outside the
pancreas to nearby tissues or lymph nodes or to other places in the body) and
the patient's general health.
Pancreatic cancer can be controlled only if it is found before it has spread,
when it can be removed by surgery. If the cancer has spread, palliative
treatment can improve the quality of life by controlling the symptoms and
complications of this disease.
Taking part in one of the clinical trials being done to improve treatment
should be considered. Information about ongoing clinical trials is available
from the NCI cancer.gov Web site (http://cancer.gov/clinical_trials).
** STAGES OF PANCREATIC CANCER **
Tests and procedures to stage pancreatic cancer are usually done at the same
time as diagnosis.
The following stages are used for pancreatic cancer:
-- Stage I --
In stage I, cancer is found in the pancreas only.
-- Stage II --
In stage II, cancer has spread to nearby tissue and organs, such as bile ducts
or the small intestine.
-- Stage III --
In stage III, cancer has spread to lymph nodes near the pancreas and may have
spread to nearby tissue and organs, such as bile ducts or the small intestine.
-- Stage IV --
In stage IV, cancer has spread to other parts of the body. Stage IV is divided
into stage IVA and stage IVB, depending on where the cancer has spread.
Stage IVA: Cancer has spread to organs and tissues that are near the pancreas
(such as the stomach, spleen, or colon), but has not spread to distant organs
(such as the lungs). The cancer may have spread to lymph nodes near the
pancreas.
Stage IVB: Cancer has spread to distant organs (such as the lungs). It may have
also spread to organs and tissues near the pancreas or to lymph nodes.
** RECURRENT PANCREATIC CANCER **
Recurrent pancreatic cancer is cancer that has recurred (come back) after it
has been treated. Recurrent pancreatic cancer may come back in the pancreas or
in other parts of the body.
** TREATMENT OPTION OVERVIEW **
Different types of treatment are available for patients with pancreatic cancer.
Some treatments are standard (the currently used treatment), and some are being
tested in clinical trials. Before starting treatment, patients may want to
think about taking part in a clinical trial. A treatment clinical trial is a
research study meant to help improve current treatments or obtain information
on new treatments for patients with cancer. When clinical trials show that a
new treatment is better than the "standard" treatment, the new treatment may
become the standard treatment.
Clinical trials are taking place in many parts of the country. Information
about ongoing clinical trials is available from the NCI cancer.gov Web site
(http://cancer.gov/clinical_trials). Choosing the most appropriate cancer
treatment is a decision that ideally involves the patient, family, and health
care team.
Three types of standard treatment are used:
-- Surgery --
One of the following types of surgery may be used to take out the tumor:
Whipple procedure: The head of the pancreas, the gallbladder, part of the
stomach, part of the small intestine, and the bile duct are removed. Enough of
the pancreas is left to produce digestive juices and insulin.
Total pancreatectomy: This operation removes the whole pancreas, part of the
stomach, part of the small intestine, the common bile duct, the gallbladder,
the spleen, and nearby lymph nodes.
Distal pancreatectomy: The body and the tail of the pancreas and usually the
spleen are removed.
If the cancer has spread and cannot be removed, the following types of
palliative surgery may be done to relieve symptoms:
Surgical biliary bypass: If cancer is blocking the small intestine and bile is
building up in the gallbladder, a biliary bypass may be done. During this
operation, the doctor will cut the gallbladder or bile duct and sew it to the
small intestine to create a new pathway around the blocked area.
Endoscopic stent placement: If the tumor is blocking the bile duct, surgery may
be done to put in a stent (a thin tube) to drain bile that has built up in the
area. The doctor may place the stent through a catheter that drains to the
outside of the body or the stent may go around the blocked area and drain the
bile into the small intestine.
Gastric bypass: If the tumor is blocking the flow of food from the stomach, the
stomach may be sewn directly to the small intestine so the patient can continue
to eat normally.
-- Radiation therapy --
Radiation therapy is the use of x-rays or other types of radiation to kill
cancer cells and shrink tumors. Radiation therapy may use external radiation
(using a machine outside the body) or internal radiation. Internal radiation
involves putting radioisotopes (materials that produce radiation) through thin
plastic tubes into the area where cancer cells are found. Both external and
internal radiation therapy may be used to treat pancreatic cancer.
-- Chemotherapy --
Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be
taken by mouth, or it may be put into the body by inserting a needle into a
vein or muscle. Either type of chemotherapy is called systemic treatment
because the drugs enter the bloodstream, travel through the body, and can kill
cancer cells throughout the body.
Other types of treatment are being tested in clinical trials.
-- Biological therapy --
Biological therapy is treatment to stimulate the ability of the immune system
to fight cancer. Substances made by the body or made in a laboratory are used
to boost, direct, or restore the body's natural defenses against disease.
Biological therapy is sometimes called biological response modifier (BRM)
therapy or immunotherapy.
This summary section refers to specific treatments under study in clinical
trials, but it may not mention every new treatment being studied. Information
about ongoing clinical trials is available from the NCI cancer.gov Web site
(http://cancer.gov/clinical_trials).
There are treatments for pain caused by pancreatic cancer. Pain can occur when
the tumor presses on nerves or other organs near the pancreas. When pain
medicine is not enough, there are treatments that act on nerves in the abdomen
to relieve the pain. The doctor may inject medicine into the area around
affected nerves or may cut the nerves to block the feeling of pain. Radiation
therapy with or without chemotherapy can also help relieve pain by shrinking
the tumor.
Patients with pancreatic cancer have special nutritional needs. Surgery to
remove the pancreas may interfere with the production of pancreatic enzymes
that help to digest food. As a result, patients may have problems digesting
food and absorbing nutrients into the body. To prevent malnutrition, the
doctor may prescribe medicines that replace these enzymes.
** TREATMENT OPTIONS FOR STAGE I PANCREATIC CANCER **
Treatment of stage I pancreatic cancer may include the following:
- Surgery alone.
- Surgery with chemotherapy and radiation therapy.
- A clinical trial of surgery followed by radiation therapy with chemotherapy.
Chemotherapy is given before, during, and after the radiation therapy.
This summary section refers to specific treatments under study in clinical
trials, but it may not mention every new treatment being studied. Information
about ongoing clinical trials is available from the NCI cancer.gov Web site
(http://cancer.gov/clinical_trials).
** TREATMENT OPTIONS FOR STAGE II PANCREATIC CANCER **
Treatment of stage II pancreatic cancer may include the following:
- Surgery with or without chemotherapy and radiation therapy.
- Radiation therapy with chemotherapy.
- Palliative surgery to bypass blocked areas in ducts or the small intestine.
- A clinical trial of surgery followed by radiation therapy with chemotherapy.
Chemotherapy is given before, during, and after the radiation therapy.
- A clinical trial of radiation therapy combined with chemotherapy and/or
radiosensitizers (drugs that make cancer cells more sensitive to radiation so
more tumor cells are killed), followed by surgery.
- A clinical trial of chemotherapy.
- A clinical trial of radiation therapy given during surgery or internal
radiation therapy.
This summary section refers to specific treatments under study in clinical
trials, but it may not mention every new treatment being studied. Information
about ongoing clinical trials is available from the NCI cancer.gov Web site
(http://cancer.gov/clinical_trials).
** TREATMENT OPTIONS FOR STAGE III PANCREATIC CANCER **
Treatment of stage III pancreatic cancer may include the following:
- Surgery with or without chemotherapy and radiation therapy.
- Radiation therapy with chemotherapy.
- Palliative surgery or stent placement to bypass blocked areas in ducts or the
small intestine.
- A clinical trial of surgery followed by radiation therapy with chemotherapy.
Chemotherapy is given before, during, and after the radiation therapy.
- A clinical trial of radiation therapy combined with chemotherapy and/or
radiosensitizers, followed by surgery.
- A clinical trial of chemotherapy.
- A clinical trial of radiation therapy given during surgery or internal
radiation therapy.
This summary section refers to specific treatments under study in clinical
trials, but it may not mention every new treatment being studied. Information
about ongoing clinical trials is available from the NCI cancer.gov Web site
(http://cancer.gov/clinical_trials).
** TREATMENT OPTIONS FOR STAGE IVA PANCREATIC CANCER **
Treatment of stage IVA pancreatic cancer may include the following:
- Surgery with or without chemotherapy and radiation therapy.
- Radiation therapy with chemotherapy.
- Palliative surgery or stent placement to bypass blocked areas in ducts or the
small intestine.
- A clinical trial of surgery followed by radiation therapy with chemotherapy.
Chemotherapy is given before, during, and after the radiation therapy.
- A clinical trial of radiation therapy combined with chemotherapy and/or
radiosensitizers, followed by surgery.
- A clinical trial of chemotherapy.
- A clinical trial of radiation therapy given during surgery or internal
radiation therapy.
This summary section refers to specific treatments under study in clinical
trials, but it may not mention every new treatment being studied. Information
about ongoing clinical trials is available from the NCI cancer.gov Web site
(http://cancer.gov/clinical_trials).
** TREATMENT OPTIONS FOR STAGE IVB PANCREATIC CANCER **
Treatment of stage IVB pancreatic cancer may include the following:
- Chemotherapy.
- Palliative treatments for pain, such as nerve blocks, and other supportive
care.
- Palliative surgery or stent placement to bypass blocked areas in ducts or the
small intestine.
- Clinical trials of chemotherapy or biological therapy.
This summary section refers to specific treatments under study in clinical
trials, but it may not mention every new treatment being studied. Information
about ongoing clinical trials is available from the NCI cancer.gov Web site
(http://cancer.gov/clinical_trials).
** TREATMENT OPTIONS FOR RECURRENT PANCREATIC CANCER **
Treatment of recurrent pancreatic cancer may include the following:
- Chemotherapy.
- Palliative surgery to bypass blocked areas in ducts or the small intestine.
- Palliative radiation therapy.
- Other palliative medical care to reduce symptoms, such as nerve blocks to
relieve pain.
- Clinical trials of chemotherapy or biological therapy.
This summary section refers to specific treatments under study in clinical
trials, but it may not mention every new treatment being studied. Information
about ongoing clinical trials is available from the NCI cancer.gov Web site
(http://cancer.gov/clinical_trials).
** TO LEARN MORE **
Call
For more information, U.S. residents may call the National Cancer Institute's
(NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237)
Monday through Friday from 9:00 a.m. to 4:30 p.m. Deaf and hard-of-hearing
callers with TTY equipment may call 1-800-332-8615. The call is free and a
trained Cancer Information Specialist is available to answer your questions.
Web sites and Organizations
The NCI's Cancer.gov Web site (http://cancer.gov) provides online access to
information on cancer, clinical trials, and other Web sites and organizations
that offer support and resources for cancer patients and their families. There
are also many other places where people can get materials and information about
cancer treatment and services. Local hospitals may have information on local
and regional agencies that offer information about finances, getting to and
from treatment, receiving care at home, and dealing with problems associated
with cancer treatment.
Publications
The NCI has booklets and other materials for patients, health professionals,
and the public. These publications discuss types of cancer, methods of cancer
treatment, coping with cancer, and clinical trials. Some publications provide
information on tests for cancer, cancer causes and prevention, cancer
statistics, and NCI research activities. NCI materials on these and other
topics may be ordered online or printed directly from the NCI Publications
Locator (https://cissecure.nci.nih.gov/ncipubs). These materials can also be
ordered by telephone from the Cancer Information Service toll-free at
1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.
LiveHelp
The NCI's LiveHelp service, a program available on several of the Institute's
Web sites, provides Internet users with the ability to chat online with an
Information Specialist. The service is available from 9:00 a.m. to 10:00 p.m.
Eastern time, Monday through Friday. Information Specialists can help Internet
users find information on NCI Web sites and answer questions about cancer.
Write
For more information from the NCI, please write to this address:
National Cancer Institute
Office of Communications
31 Center Drive, MSC 2580
Bethesda, MD 20892-2580
** ABOUT PDQ **
PDQ is a comprehensive cancer database available on Cancer.gov.
PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information
database. Most of the information contained in PDQ is available online at
Cancer.gov (http://cancer.gov), the NCI's Web site. PDQ is provided as a
service of the NCI. The NCI is part of the National Institutes of Health, the
federal government's focal point for biomedical research.
PDQ contains cancer information summaries.
The PDQ database contains summaries of the latest published information on
cancer prevention, detection, genetics, treatment, supportive care, and
complementary and alternative medicine. Most summaries are available in two
versions. The health professional versions provide detailed information
written in technical language. The patient versions are written in
easy-to-understand, non-technical language. Both versions provide current and
accurate cancer information.
The PDQ cancer information summaries are developed by cancer experts and
reviewed regularly.
Editorial Boards made up of experts in oncology and related specialties are
responsible for writing and maintaining the cancer information summaries. The
summaries are reviewed regularly and changes are made as new information
becomes available. The date on each summary ("Date Last Modified") indicates
the time of the most recent change.
PDQ also contains information on clinical trials.
Before starting treatment, patients may want to think about taking part in a
clinical trial. A clinical trial is a study to answer a scientific question,
such as whether one treatment is better than another. Trials are based on past
studies and what has been learned in the laboratory. Each trial answers
certain scientific questions in order to find new and better ways to help
cancer patients. During treatment clinical trials, information is collected
about new treatments, the risks involved, and how well they do or do not work.
If a clinical trial shows that a new treatment is better than one currently
being used, the new treatment may become "standard."
Listings of clinical trials are included in PDQ and are available online at
Cancer.gov (http://cancer.gov/clinical_trials). Descriptions of the trials are
available in health professional and patient versions. Many cancer doctors who
take part in clinical trials are also listed in PDQ. For more information,
call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237); TTY at
1-800-332-8615.
Date Last Modified: 09/2002
******************************************************************************
* If you want to know more about cancer and how it is treated, or if you *
* if you wish to know about clinical trials for your type of cancer, you *
* can call the NCI's Cancer Information Service at 1-800-422-6237, toll *
* free. A trained information specialist can talk with you and answer *
* your questions. *
******************************************************************************
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