Pancreatic cancer is a disease in which malignant (cancer)
cells form in the tissues of the pancreas.
Smoking and health history can affect the risk of pancreatic cancer.
Signs and symptoms of pancreatic cancer include jaundice, pain, and
weight loss.
Pancreatic cancer is difficult to diagnose
early.
Tests that examine the pancreas are used to diagnose and stage pancreatic cancer.
Certain factors affect prognosis (chance
of recovery) and treatment options.
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 between the stomach and the spine.EnlargeAnatomy of the pancreas. The pancreas has three areas: head, body, and tail. It is found in the abdomen near the stomach, intestines, and other organs.
The pancreas has two main jobs in the body:
To make juices
that help digest (break down) food.
To make 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.
Smoking and health history can affect the risk of pancreatic cancer.
Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer. Talk with your doctor if you think you may be at risk.
Risk
factors for pancreatic cancer include the following:
Signs and symptoms of pancreatic cancer include jaundice, pain, and
weight loss.
Pancreatic cancer may not cause early signs or symptoms. Signs and symptoms may be caused by pancreatic cancer or by other conditions. Check with your doctor if you have any of the following:
Jaundice
(yellowing of the skin and whites of the eyes).
Tests that examine the pancreas are used to diagnose and stage pancreatic cancer.
Pancreatic cancer is usually diagnosed with tests and procedures
that make pictures of the pancreas and the area around it. The process used
to find out if cancercells 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 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:
Physical exam and health history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
Blood chemistry studies: A procedure in which a blood sample is checked to measure the amounts of certain substances, such as bilirubin, released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease.
Tumor marker test: A procedure in which a sample of blood, urine, or tissue is checked to measure the amounts of certain substances, such as CA 19-9, and carcinoembryonic antigen (CEA), made by organs, tissues, or tumor cells in the body. Certain substances are linked to specific types of cancer when found in increased levels in the body. These are called tumor markers.
MRI (magnetic
resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
CT scan (CAT
scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. A spiral or helical CTscan makes a series of very detailed pictures of areas inside the body using an x-ray machine that scans the body in a spiral path.
PET scan (positron
emission tomography scan): A procedure to find malignanttumor cells in the body. A small amount of radioactiveglucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do. A PET scan and CT scan may be done at the same time. This is called a PET-CT.
Abdominal ultrasound: An ultrasound exam used to make pictures of the inside of the abdomen. The ultrasound transducer is pressed against the skin of the abdomen and directs high-energy sound waves (ultrasound) into the abdomen. The sound waves bounce off the internal tissues and organs and make echoes. The transducer receives the echoes and sends them to a computer, which uses the echoes to make pictures called sonograms. The picture can be printed to be looked at later.
Endoscopic
ultrasound (EUS): A procedure in which an endoscope is inserted into the body, usually through the mouth or rectum. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. A probe at the end of the endoscope is used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. This procedure is also called endosonography.
Endoscopic
retrograde cholangiopancreatography (ERCP): A procedure used to x-ray the ducts (tubes) that carry bile from the liver to the gallbladder and from the gallbladder to the small intestine. Sometimes pancreatic cancer causes these ducts to narrow and block or slow the flow of bile, causing jaundice. 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 fine tube may be inserted into the duct to unblock it. This tube (or stent) may be left in place to keep the duct open. Tissue samples may also be taken.
Percutaneous
transhepatic cholangiography (PTC): A procedure used to x-ray the liver and 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 an x-ray is taken. If a blockage is found, a thin, flexible tube called a stent 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.
Laparoscopy: A surgical procedure to look at the organs inside the abdomen to check for signs of disease. Small incisions (cuts) are made in the wall of the abdomen and a laparoscope (a thin, lighted tube) is inserted into one of the incisions. The laparoscope may have an ultrasound probe at the end in order to bounce high-energy sound waves off internal organs, such as the pancreas. This is called laparoscopic ultrasound. Other instruments may be inserted through the same or other incisions to perform procedures such as taking tissue samples from the pancreas or a sample of fluid from the abdomen to check for cancer.
Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. There are several ways to do a biopsy for pancreatic cancer.
A fine needle or a core needle may be inserted into the pancreas during an x-ray or
ultrasound to remove cells. Tissue
may also be removed during a laparoscopy or surgery to remove the tumor.
Certain factors affect prognosis (chance
of recovery) and treatment options.
The prognosis and treatment options depend on the following:
Whether or not the tumor can be removed by surgery.
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).
The patient’s general
health.
Whether the cancer has just been diagnosed or has recurred (come back).
Pancreatic cancer can be controlled only if it is found before it
has spread, when it can be completely removed by surgery. If the cancer has spread,
palliative treatment can improve the patient's
quality of life by controlling the
symptoms and complications of this disease.
Stages of Pancreatic Cancer
Key Points
Tests and procedures to stage pancreatic cancer are usually
done at the same time as diagnosis.
There are three ways that cancer spreads in the body.
Cancer may spread from where it began to other parts of the body.
The following stages are used for pancreatic
cancer:
Stage 0 (Carcinoma in Situ)
Stage I
Stage II
Stage III
Stage IV
The following groups are used to plan treatment:
Resectable pancreatic cancer
Borderline resectable pancreatic cancer
Locally advanced pancreatic cancer
Metastatic pancreatic cancer
Recurrent pancreatic cancer
Tests and procedures to stage pancreatic cancer are usually
done at the same time as diagnosis.
The process used to find out if cancer has spread within the pancreas or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage of the disease in order to plan treatment. The results of some of the tests used to diagnosepancreatic cancer are often also used to stage the disease. See the General Information section for more information.
There are three ways that cancer spreads in the body.
Tissue. The cancer spreads from where it began by growing into nearby areas.
Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.
Cancer may spread from where it began to other parts of the body.
When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.
Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.
Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.
The metastatic tumor is the same type of cancer as the primary tumor. For example, if pancreatic cancer spreads to the liver, the cancer cells in the liver are actually pancreatic cancer cells. The disease is metastatic pancreatic cancer, not liver cancer.
Many cancer deaths are caused when cancer moves from the original tumor and spreads to other tissues and organs. This is called metastatic cancer. This animation shows how cancer cells travel from the place in the body where they first formed to other parts of the body.
The following stages are used for pancreatic
cancer:
Stage 0 (Carcinoma in Situ)
EnlargeStage 0 pancreatic cancer. Abnormal cells are found in the lining of the pancreas. These abnormal cells may become cancer and spread into nearby normal tissue.
EnlargeStage I pancreatic cancer. Cancer is found in the pancreas only. In stage IA, the tumor is 2 centimeters or smaller. In stage IB, the tumor is larger than 2 centimeters but not larger than 4 centimeters.
In stage I, cancer has formed and is
found in the pancreas only. Stage I is divided into
stages IA and IB, depending on the size of the tumor.
Stage IB: The tumor is larger than 2 centimeters but not larger than 4 centimeters.
Stage II
Stage II is divided into
stages IIA and IIB, depending on the size of the tumor and where the
cancer has spread.
Stage IIA: The tumor is larger than 4 centimeters.EnlargeStage IIA pancreatic cancer. The tumor is larger than 4 centimeters.
Stage IIB: The tumor is any size and cancer has spread to 1 to 3 nearby lymph nodes.EnlargeStage IIB pancreatic cancer. The tumor is any size and cancer has spread to 1 to 3 nearby lymph nodes.
Stage III
EnlargeStage III pancreatic cancer. The tumor is any size and cancer has spread to (a) 4 or more nearby lymph nodes; or (b) the major blood vessels near the pancreas. These include the portal vein, common hepatic artery, celiac axis (trunk), and superior mesenteric artery.
EnlargeStage IV pancreatic cancer. The tumor is any size and cancer has spread to other parts of the body, such as the lung, liver, or peritoneal cavity (the body cavity that contains most of the organs in the abdomen).
Resectable pancreatic cancer can be removed by surgery because it has not grown into important blood vessels near the tumor.
Borderline resectable pancreatic cancer
Borderline resectable pancreatic cancer has grown into a major blood vessel or nearby tissue or organs. It may be possible to remove the tumor, but there is a high risk that all of the cancer cells will not be removed with surgery.
Locally advanced pancreatic cancer
Locally advanced pancreatic cancer has grown into or close to nearby lymph nodes or blood vessels, so surgery cannot completely remove the cancer.
Metastatic pancreatic cancer
Metastatic pancreatic cancer has spread to other organs, so surgery cannot completely remove the cancer.
There are different types of treatment for patients with
pancreatic cancer.
The following types of treatment are used:
Surgery
Radiation therapy
Chemotherapy
Chemoradiation therapy
Targeted therapy
There are treatments for pain caused by pancreatic
cancer.
Patients with pancreatic cancer have special nutritional
needs.
New types of treatment are being tested in clinical trials.
Treatment for pancreatic cancer may cause side effects.
Patients may want to think about taking part in a clinical trial.
Patients can enter clinical trials before, during, or after starting their cancer treatment.
Follow-up tests may be needed.
There are different types of treatment for patients with
pancreatic cancer.
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. 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. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
The following types of treatment are used:
Surgery
One of the following types of surgery may be used to take out the
tumor:
Biliary bypass: If cancer is blocking the bile duct
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 in the area before the blockage and sew it to the small intestine to
create a new pathway around the blocked area.
Endoscopicstent 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 the bile into a bag on 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 a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. External radiation therapy uses a machine outside the body to send radiation toward the area of the body with cancer.
Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). Combination chemotherapy is treatment using more than one anticancer drug.
Chemoradiationtherapy combines chemotherapy and radiation therapy to increase the effects of both.
Targeted therapy
Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells. Tyrosine kinase inhibitors (TKIs) are targeted therapy drugs that block signals needed for tumors to grow.
Erlotinib is a type of TKI used to treat pancreatic cancer.
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.
See the PDQ summary on Cancer Pain for more information.
Patients with pancreatic cancer have special nutritional
needs.
Surgery to remove the pancreas may affect its ability to make 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.
New types of treatment are being tested in clinical trials.
This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI website.
Treatment for pancreatic cancer may cause side effects.
Patients may want to think about taking part in a clinical trial.
For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.
Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
Patients can enter clinical trials before, during, or after starting their cancer treatment.
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.
Clinical trials are taking place in many parts of the country. Information about clinical trials supported by NCI can be found on NCI’s clinical trials search webpage. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.
Follow-up tests may be needed.
Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.
Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.
Treatment of Resectable or Borderline Resectable Pancreatic Cancer
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.
Treatment of Metastatic or Recurrent Pancreatic Cancer
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.
Physician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database. 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 come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in Spanish.
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Purpose of This Summary
This PDQ cancer information summary has current information about the treatment of adult pancreatic cancer. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.
Reviewers and Updates
Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Updated") is the date of the most recent change.
The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Adult Treatment Editorial Board.
Clinical Trial Information
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 the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Clinical trials can be found online at NCI's website. For more information, call the Cancer Information Service (CIS), NCI's contact center, at 1-800-4-CANCER (1-800-422-6237).
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