The pancreas is an organ in the abdomen that makes digestive juices, insulin, and other hormones. The digestive juices flow through ducts into the intestine. Most pancreatic cancers occur in these ducts.
About 5,800 Canadians are diagnosed with pancreatic cancer each year. Pancreatic cancer is the fourth most common cause of cancer deaths in Canada. The risk of developing pancreatic cancer is about the same for both men and women.
Pancreatic cancer is sometimes called a "silent disease" because it is difficult to detect and symptoms do not usually appear until the cancer has grown for quite some time.
Cancer is caused by uncontrolled growth of abnormal cells. When these cells grow and form a mass it is called a tumour. When pancreatic cancer cells break away and enter the bloodstream or lymphatic system, they can spread the cancer. The spread of cancer is called metastasis, and places where the cancer has spread are called metastases.
The reason for the development of cancer cells in the pancreas is not known, but research has shown that people with certain risk factors are more likely to develop pancreatic cancer than others.
Studies have shown that the following factors increase risk for pancreatic cancer:
- age: Pancreatic cancer risk increases with age. Most occur in people over age 60.
- chronic pancreatitis or pancreatic cysts: Someone with chronic pancreatitis (painful inflammation of the pancreas) may have increased risk for pancreatic cancer.
- diabetes: Pancreatic cancer is more common in people who have diabetes.
- family history: Someone with a mother, father, sister, or brother who has had pancreatic cancer is at 3 times the risk for the condition.
- obesity: Being overweight or obese is linked to double the risk of pancreatic cancer.
- smoking: People who smoke cigarettes are 2 to 3 times as likely to develop pancreatic cancer as people who do not smoke.
Of these risk factors, smoking is the most significant, accounting for an estimated one-quarter of pancreatic cancer cases.
Symptoms and Complications
The early stages of pancreatic cancer often have no symptoms. As the cancer grows, the following symptoms may occur:
- dark urine
- excess fat in the stools
- loss of appetite
- leg swelling due to blood clot in the veins
- nausea, vomiting, or diarrhea
- pain in the upper abdomen or upper back
- symptoms of increased blood sugar (e.g., unusual thirst, frequent urination, blurred vision)
- unintended weight loss
- weakness or fatigue
- yellow skin and eyes, dark urine (a condition known as jaundice)
Making the Diagnosis
If your doctor suspects pancreatic cancer, they will consider your medical history and conduct a physical examination. Your doctor may also order the following tests:
- blood tests to check blood cells and to determine if your liver is working properly
- magnetic resonance imaging (MRI) or computerized tomography (CT, CAT) scan of the abdomen (pictures of the abdomen) to find any masses or blockages
- endoscopic retrograde cholangiopancreatography (ERCP), in which a lighted scope is placed down the throat through the stomach and into the intestine (dye is then injected so that the pancreatic and bile ducts can be more easily seen; in addition, biopsies [samples of tissue] are removed to determine if any cancer cells are present)
- endoscopic ultrasound, in which a scope is placed down the throat through the stomach and into the intestine to closely define the local extent of the cancer through sound waves; a biopsy may also be performed using this technique
- ultrasound of the abdomen (sound waves passed through the abdomen) to find any masses that may be blocking the pancreatic or bile ducts
Once pancreatic cancer has been diagnosed, your doctor will determine how far it has progressed in a process called staging. Staging may require more testing. This will help your doctor determine the most appropriate treatment.
Treatment and Prevention
Although it may not be possible to prevent pancreatic cancer, you can reduce your risk for developing the disease by not smoking. Lowering your risk for type 2 diabetes by maintaining a healthy weight, following a healthy diet, and being physically active may also reduce your risk for pancreatic cancer.
Pancreatic cancer can be cured only if it is found at an early stage, before it has spread to other parts of the body. However, about 80% to 90% of people with pancreatic cancer have advanced disease by the time it is diagnosed. For advanced disease, treatment cannot cure the cancer but may improve the quality of life and extend life.
Treatment for pancreatic cancer can include surgery, chemotherapy, and radiation. Your treatment plan will depend on your general health, the stage of the cancer, and whether the tumour can be surgically removed.
Surgery to remove the cancer is usually the first choice for treatment. The following are different types of surgery to remove pancreatic cancer:
- whipple procedure: This surgery is performed if the tumour is in the head of the pancreas (the widest part). The head of the pancreas and part of the small intestine, bile duct, and stomach are removed.
- distal pancreatectomy: The body and tail of the pancreas are removed if the tumour is located in one of these two areas. The spleen is also removed.
- total pancreatectomy: the entire pancreas, part of the small intestine, part of the stomach, the common bile duct, the gallbladder, the spleen, and nearby lymph nodes are removed.
Some surgical procedures are performed to help with symptoms when pancreatic cancer cannot be completely removed. A metal tube or stent can be placed into the bile duct to prevent or relieve a blockage. Bypass procedures may help when the bile duct or stomach is blocked.
After surgery, your doctor may recommend chemotherapy (treatment with medications that kill cancer cells) or radiation therapy (high-energy X-rays that kill cancer cells). These treatments may also be used in those cases where surgery is not possible due to the location of the cancer.
If cure or control of the disease isn't possible, treatment will focus on improving quality of life by controlling pain and other problems and symptoms caused by the disease.