Pancreatic cancer
Table of Contents
- DESCRIPTION
What is cancer of the pancreas?
- STAGE EXPLANATION
Stages of cancer of the pancreas
- Stage I
- Stage II
- Stage III
- Stage IVA
- Stage IVB
- Recurrent
- TREATMENT OPTION OVERVIEW
How cancer of the pancreas is
treated
- Treatment by stage
- STAGE I PANCREATIC CANCER
- STAGE II PANCREATIC CANCER
- STAGE III PANCREATIC CANCER
- STAGE IVA PANCREATIC CANCER
- STAGE IVB PANCREATIC CANCER
- RECURRENT PANCREATIC CANCER
- TO LEARN MORE
What is cancer of the pancreas?
Cancer of the pancreas is a disease in which
cancer (malignant) cells are found in the tissues of the pancreas. The
pancreas is about 6 inches long and is shaped something like a thin pear,
wider at one end and narrowing at the other. The pancreas lies behind the
stomach, inside a loop formed by part of the small intestine. The broader
right end of the pancreas is called the head, the middle section is called the
body, and the narrow left end is the tail.
The pancreas has two basic jobs in the body. It
produces juices that help break down (digest) food, and hormones (such as
insulin) that regulate how the body stores and uses food. The area of the
pancreas that produces digestive juices is called the exocrine pancreas. About
95% of pancreatic cancers begin in the exocrine pancreas. The
hormone-producing area of the pancreas is called the endocrine pancreas. Only
about 5% of pancreatic cancers start here. This summary has information on
cancer of the exocrine pancreas. For more information on cancer of the
endocrine pancreas (also called islet cell cancer) see the PDQ patient
information summary on islet cell carcinoma.
Cancer of the pancreas is hard to find
(diagnose) because the organ is hidden behind other organs. Organs around the
pancreas include the stomach, small intestine, bile ducts (tubes through which
bile, a digestive juice made by the liver, flows from the liver to the small
intestine), gallbladder (the small sac below the liver that stores bile), the
liver, and the spleen (an organ that filters blood to remove excess or damaged
blood cells). The signs of pancreatic cancer are like many other illnesses,
and there may be no signs in the first stages. A doctor should be seen if
there are any of the following symptoms: nausea, loss of appetite, weight loss
without trying to lose weight, pain in the upper or middle of the abdomen, or
yellowing of the skin (jaundice).
If there are symptoms, a doctor will conduct an
examination and order tests to see if there is cancer and determine what the
treatment should be. Patients may have an ultrasound, a test that uses sound
waves to find tumors. A CT (computed tomographic) scan, a special type of
x-ray that uses a computer to make a picture of the inside of the abdomen, may
also be done. Another special scan called MRI (magnetic resonance imaging),
which uses magnetic waves to make a picture of the inside of the abdomen, may
be done as well if there are questions as to whether the blood supply to
unaffected organs has been partially blocked by the cancer.
A test called an ERCP (endoscopic retrograde
cholangiopancreatography) may also be done. During this test, a flexible tube
is put down the throat, through the stomach, and into the small intestine. The
doctor can see through the tube and inject dye into the drainage tube (duct)
of the pancreas so that the area can be seen more clearly on an x-ray. During
ERCP, the doctor may also put a fine needle or a brush like a pipe cleaner
into the pancreas to take out some cells. This is called a biopsy. The cells
can then be looked at under a microscope to see if they contain cancer. More
important, if there is jaundice, a catheter or fine tube may be inserted into
the bile duct through the pancreas duct to relieve the janudice.
PTC (percutaneous transhepatic cholangiography)
is another test that can help find cancer of the pancreas. During this test, a
thin needle is put into the liver through the right side. Dye is injected into
the bile ducts in the liver so that blockages can be seen on x-rays. To
relieve janudice, a fine tube is sometimes left in the right side of the liver
to drain it.
In some cases, a needle can be inserted into
the pancreas during an x-ray or ultrasound so that cells can be taken out to
see if they contain cancer. Surgery may be needed to see if there is cancer of
the pancreas. If this is the case, the doctor will cut into the abdomen and
look at the pancreas and the tissues around it for cancer. If cancer is found
and it looks like it has not spread to other tissues, the doctor may remove
the cancer or relieve blockages caused by the tumor.
Stages of cancer of the pancreas
Once cancer of the pancreas is found, more
tests will be done to find out if the cancer has spread from the pancreas to
the tissues around it or to other parts of the body. This is called staging.
The following stages are used for cancer of the pancreas:
Stage I
Cancer is found only in the pancreas itself and
has not spread to other organs.
Stage II
Cancer has spread to nearby organs, such as the
duodenum or bile duct, but has not entered the lymph nodes. (Lymph nodes are
small, bean-shaped structures that are found throughout the body; they produce
and store infection-fighting cells).
Stage III
Cancer has spread to lymph nodes near the
pancreas. The cancer may or may not have spread to nearby organs.
Stage IVA
Cancer has spread to organs, such as the
stomach, spleen, or colon, that are near the pancreas but has not spread
distant organs, such as the liver or lungs.
Stage IVB
Cancer has spread to organs, such as the
stomach, spleen, or colon, that are near the pancreas or to places far away
from the pancreas, such as the liver or lungs.
Recurrent
Recurrent disease means that the cancer has
come back (recurred) after it has been treated. It may come back in the
pancreas or in another part of the body.
How cancer of the pancreas is
treated
There are treatments for all patients with
cancer of the pancreas. Three kinds of treatment are used:
- surgery (taking out the cancer or relieving
symptoms caused by the cancer)
- radiation therapy (using high-dose x-rays or
other high-energy rays to kill cancer cells)
- chemotherapy (using drugs to kill cancer
cells)
Surgery may be used to take out the tumor. A
doctor may take out the cancer using one of the following operations:
- A Whipple procedure removes the head of the
pancreas, part of the small intestine, and some of the tissues around it.
Enough of the pancreas is left to continue making digestive juices and
insulin.
- Total pancreatectomy takes out the whole
pancreas, part of the small intestine, part of the stomach, the bile duct,
the gallbladder, spleen, and most of the lymph nodes in the area.
- Distal pancreatectomy takes out the body and
tail of the pancreas.
If the cancer has spread and it cannot be removed,
the doctor may do surgery to relieve symptoms. If the cancer is blocking the
small intestine and bile builds up in the gallbladder, the doctor may do
surgery to go around (bypass) all or part of the small intestine. During this
operation, the doctor will cut the gallbladder or bile duct and sew it to the
small intestine. This is called biliary bypass. Surgery or x-ray procedures
may also be done to put in a tube (catheter) to drain bile that has built up
in the area. During these procedures, the doctor may make the catheter drain
through a tube to the outside of the body or the catheter may go around the
blocked area and drain the bile to the small intestine. In addition, if the
cancer 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 uses high-energy x-rays to
kill cancer cells and shrink tumors. Radiation may come from a machine outside
the body (external radiation therapy) or from putting materials that produce
radiation (radioisotopes) through thin plastic tubes in the area where the
cancer cells are found (internal radiation therapy).
Chemotherapy uses drugs to kill cancer cells.
Chemotherapy may be taken by pill, or it may be put into the body by a needle
in the vein or muscle. Chemotherapy is called a systemic treatment because the
drug enters the bloodstream, travels through the body, and can kill cancer
cells outside the pancreas.
The use of biological therapy (using the body's
immune system to fight cancer) is being tested in clinical trials for
pancreatic cancer. Biological therapy searches for ways that the cancer tissue
is different from normal pancreas tissue, and tries to get the body to fight
the cancer. It uses materials made by the body or made in a laboratory to
boost, direct, or restore the body's natural defenses against disease. Some
biological therapies are sometimes called biological response modifier (BRM)
therapy or immunotherapy.
Treatment by stage
Treatment of cancer of the pancreas depends on
the stage of the disease, and the patient's age and overall condition.
Standard treatment may be considered because of
its effectiveness in patients in past studies, or participation in a clinical
trial may be considered. Most patients with cancer of the pancreas are not
cured with standard therapy and some standard treatments may have more side
effects than are desired. For these reasons, clinical trials are designed to
find better ways to treat cancer patients and are based on the most up-to-date
information. Clinical trials are ongoing in most parts of the country for all
stages of cancer of the pancreas. To learn more about clinical trials, call
the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at
1-800-332-8615.
Treatment may be one of the following:
- 1. Surgery to remove the head of the
pancreas, part of the small intestine, and some of the surrounding tissues
(Whipple procedure).
2. Surgery to remove the entire pancreas
and the organs around it (total pancreatectomy).
3. Surgery to remove the body and tail of
the pancreas (distal pancreatectomy).
4. Surgery followed by chemotherapy and
radiation therapy.
5. Clinical trials of radiation therapy
with or without chemotherapy given before, during, or after surgery.
Treatment may be one of the following:
- 1. Surgery to remove all or part of the
pancreas with or without chemotherapy and radiation therapy.
2. External radiation therapy with or
without chemotherapy.
3. Surgery or other treatments to reduce
symptoms.
4. Clinical trials of radiation therapy and
chemotherapy given before surgery.
5. Clinical trials of radiation therapy
plus drugs to make cancer cells more sensitive to radiation (radiosensitizers).
6. Clinical trials of chemotherapy.
7. Clinical trials of radiation therapy
given during surgery with or without internal radiation therapy.
Treatment may be one of the following:
- 1. Surgery to remove all or part of the
pancreas with or without chemotherapy and radiation therapy.
2. External radiation therapy with or
without chemotherapy.
3. Surgery or other treatments to reduce
symptoms.
4. Clinical trials of radiation therapy and
chemotherapy given before surgery.
5. Clinical trials of surgery plus
radiation therapy plus drugs to make cancer cells more sensitive to
radiation (radiosensitizers).
6. Clinical trials of chemotherapy.
7. Clinical trials of radiation therapy
given during surgery, with or without internal radiation therapy.
Treatment may be one of the following:
- 1. Surgery to remove all or part of the
pancreas with or without chemotherapy and radiation therapy.
2. External radiation therapy with or
without chemotherapy.
3. Surgery or other treatments to reduce
symptoms.
4. Clinical trials of radiation therapy and
chemotherapy given before surgery.
5. Clinical trials of surgery plus
radiation therapy plus drugs to make cancer cells more sensitive to
radiation (radiosensitizers).
6. Clinical trials of chemotherapy.
7. Clinical trials of radiation therapy
given during surgery, with or without internal radiation therapy.
Treatment may be one of the following:
- 1. Chemotherapy.
2. Treatments for pain and other symptoms.
3. Surgery or other treatments to reduce
symptoms.
4. Clinical trials of chemotherapy or
biological therapy.
Treatment may be one of the following:
- 1. Chemotherapy.
2. Surgery or other treatments to reduce
symptoms.
3. External radiation therapy to reduce
symptoms.
4. Treatments for pain.
5. Other medical care to reduce symptoms.
6. Clinical trials of chemotherapy or
biological therapy.
TO LEARN MORE..... CALL 1-800-4-CANCER
To learn more about cancer of the pancreas,
call the National Cancer Institute's Cancer Information Service at
1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615. By dialing this
toll-free number, you can speak with a trained information specialist who can
answer your questions.
The Cancer Information Service also has
booklets about cancer that are available to the public and can be sent on
request. The following booklet about cancer of the pancreas may be helpful:
- What You Need To Know About Cancer of the
Pancreas
The following general booklets on questions
related to cancer may also be helpful:
- What You Need To Know About Cancer
Taking Time: Support for People with Cancer and the People Who Care About
Them
What Are Clinical Trials All About?
Chemotherapy and You: A Guide to Self-Help During Treatment
Radiation Therapy and You: A Guide to Self-Help During Treatment
Eating Hints for Cancer Patients
Advanced Cancer: Living Each Day
When Cancer Recurs: Meeting the Challenge Again
There are many other places where people can get
material and information about cancer treatment and services. The social
service office at a hospital can be checked for local and national agencies
that help with getting information about finances, getting to and from
treatment, getting care at home, and dealing with problems.
For more information from the National Cancer
Institute, please write to this address:
- National Cancer Institute
Office of Cancer Communications
31 Center Drive, MSC 2580
Bethesda, MD 20892-2580
Date Last Modified: 04/1999
If you want to know more about cancer and
how it is treated, or 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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