How is Pancreatic Cancer Treated

General Information

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 very hard to control. This disease can be cured only when it is found at an early stage, before it has spread. However, treatment can improve the quality of a persons life by controlling the symptoms and complications of this disease.

     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 jaundice.

     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 jaundice, 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.

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