Pancreatic Cancer

Symptoms

The symptoms of pancreatic cancer are often vague or not apparent, making the disease difficult to diagnose. Frequently, it reaches an advanced stage before symptoms occur. The most common are:

• Abdominal pain
• Loss of appetite, nausea or weight loss
• Jaundice (a yellowish discoloration of the skin and whites of the eyes)
• Back pain
• Feeling of weakness

Causes and Risk Factors

An individual's risk of getting pancreatic cancer increases if he or she:

• Uses tobacco
• Eats a high fat diet
• Has chronic pancreatitis
• Has a hereditary form of pancreatitis or pancreatic cancer
• Works with metals or chemicals
• Is African American

Diagnosis

The exocrine part of the pancreas (which produces the digestive fluids that help break down fats, proteins and carbohydrates) is where 95 percent of all pancreatic cancers, or adenocarcinomas, begin. The other five percent grow in the endocrine section, where hormones (like insulin) are made. Identifying the type of tumor is important since they behave, develop and respond to treatment differently.

Pancreatic cancer's symptoms are like those of many other pancreatic conditions. That's why it's important to be seen by an expert, who may use any of the following tests for an accurate diagnosis:

• Basic blood tests and a lab test called CA19-9
• Ultrasound. Though not a definitive test for tumors, it is a good way to find gallstones or cysts in the pancreas.
• Computed tomography (CT) scan. These three-dimensional X-rays are accurate tests for cancer. A CT scan is also used to guide a biopsy needle exactly to the tumor to take a tissue sample for lab analysis.
• Magnetic resonance imaging (MRI). This uses magnetic fields and radio waves to create detailed images of soft tissue. A special type, magnetic resonance cholangiopancreatography (MRCP), can find blockages in the pancreatic and bile ducts.
• Endoscopic retrograde cholangiopancreatography (ERCP). This minimally invasive procedure is considered the gold standard for pancreatic and biliary diagnosis, but there is a two to five percent risk of causing pancreatitis.

Currently, there are no effective screening tests to detect pancreatic cancer. It is often difficult for a doctor to distinguish between pancreatitis (inflammation of the pancreas) and pancreatic cancer. Both conditions present similar symptoms and may look the same on radiology scans. Most patients require exploratory surgery to establish a diagnosis of pancreatic cancer and determine the extent of the disease.

Treatment

Treatment for pancreatic cancer includes surgery, chemotherapy, radiation therapy or a combination, depending on the stage of the disease.

Exploratory surgery is performed through an incision in the abdomen (laparotomy). This allows the surgeon to assess the extent of the disease. If the tumor can be removed, a Whipple procedure (pancreatoduodenectomy) is used, which can be very effective and results in few complications. Only five to 20% of patients have tumors that can be surgically removed.

Laparoscopy, a less invasive procedure, is sometimes done. The surgeon inserts a laparoscope (flexible telescope with a camera attached) into the abdomen to see how far the disease has progressed.

Chemotherapy or radiation may benefit the patient if the tumor cannot be removed. Neither can be done until the patient has sufficiently recovered from the exploratory surgery, which usually takes about six weeks.

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