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What is pancreatic cancer?
Pancreatic cancer develops in the pancreas, a small organ in your upper abdomen (belly). In adults, the pancreas is about six inches long. The larger end is called the head, and the smaller end is called the tail. Most pancreatic tumors develop in the head.
How does pancreatic cancer develop?
Pancreatic cancer happens when cells that aren't normal multiply and form tumors. Many people won’t realize they have pancreatic cancer its early stages, because it rarely produces symptoms.
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Pancreatic Cancer Symptoms
Pancreatic cancer is sometimes called a "silent" disease because symptoms often appear only after the cancer has spread. Signs of pancreatic cancer include:
- Pain in the back or upper abdomen: Pain in the upper part of the belly or the middle of the back can result from tumors pressing on other organs or nerve endings. As the disease progresses, pain can be severe.
- Jaundice (yellowing of the skin and whites of the eyes): Jaundice can occur when a growing tumor presses the bile duct closed. Bile ducts are tubes that carry bile (digestive juices) through your body. Signs of jaundice also include dark urine, itchy skin, and light-colored or greasy stools.
- Poor appetite and weight loss: Pancreatic cancer can press on the stomach, causing digestive problems, a change in appetite, and weight loss. Some people also experience nausea, vomiting, and diarrhea.
- Blood clots: Also called deep vein thrombosis (DVT), these clots usually develop in the legs. DVT symptoms include pain, warmth, and tenderness in the area near the clot.
- Swelling of the abdomen (ascites): This symptom occurs when fluid builds up in the belly, causing it to swell and bloat. This typically occurs after the disease has spread through the abdomen.
- Onset of diabetes: People over 50 who don’t have a history of diabetes can suddenly develop the condition due to changes in insulin levels. Insulin is a hormone the pancreas produces to control levels of sugar in the blood.
Pancreatic Cancer Risk Factors
Risk factors increase the chance of developing certain types of cancer and other conditions. People who smoke have a much higher chance of getting pancreatic cancer than nonsmokers. Your risk of pancreatic cancer is also higher if you have:
- Obesity, especially if you carry extra weight around the waist
- Diabetes
- Chronic pancreatitis (inflammation of the pancreas), which is more common among people who smoke or drink alcohol excessively
- A family history of pancreatic cancer
- Certain rare inherited conditions, such as hereditary pancreatitis and hereditary breast cancer or ovarian cancer
- Peutz-Jeghers syndrome and Lynch syndrome, genetic disorders that increase the risk of certain cancers
- A history of exposure to certain chemicals, such as pesticides or chemicals used in dry cleaning
Types of Pancreatic Cancer
Pancreatic cancers either start in exocrine cells or endocrine cells in the pancreas. Exocrine cells make enzymes that help your body digest food. Endocrine cells (or neuroendocrine cells) make hormones that control different processes throughout the body. The vast majority of pancreatic cancers start in exocrine cells.
Exocrine and endocrine tumors respond differently to treatments. Your cancer care team will determine the specific type of pancreatic cancer you have and develop a treatment plan just for you.
Types of Exocrine Pancreatic Cancer
The most common type of pancreatic cancer is adenocarcinoma. More than 90% of people with pancreatic cancer have adenocarcinoma. It starts in the lining of the pancreatic duct. This duct (tube) drains digestive fluids from the pancreas into the intestines.
Other types of exocrine pancreatic cancer are very rare. They include:
- Adenosquamous carcinoma
- Colloid carcinoma
- Hepatoid carcinoma
- Medullary carcinoma
- Squamous cell carcinoma
- Signet ring cell carcinoma
- Acinar cell carcinoma
- Undifferentiated carcinoma (also called anaplastic, sarcomatoid, or carcinosarcoma)
Types of Neuroendocrine Pancreatic Cancer
Less commonly, tumors can develop in endocrine cells in the pancreas. These tumors are also called pancreatic neuroendocrine tumors, PNETs, or islet cell tumors. PNETs typically grow slowly and have a better outlook than exocrine tumors. Sometimes, PNETs themselves can actually produce hormones. The types of PNETs include:
- Gastrinoma: These tumors come from cells that make gastrin, a hormone that stimulates the stomach to secrete acids and enzymes. Long-standing symptoms are typically stomach ulcers despite medical treatment.
- Glucagonoma: This pancreatic tumor starts in cells that produce glucagon, a hormone that raises levels of glucose in the blood. A characteristic rash, called necrolytic migratory erythema, can develop that moves or spreads across the skin.
- Insulinoma: This rare pancreatic tumor starts in cells that make insulin, the hormone that lowers glucose levels in the blood. Symptoms of low blood sugar may occur.
- VIPoma: This type of tumor comes from cells that make vasoactive intestinal polypeptide (VIP), a hormone that helps with digestion. Uncontrolled, watery diarrhea is typical.
- Somatostatinoma: This tumor starts in cells that produce somatostatin, a hormone that regulates activity in the gastrointestinal (GI) tract.
Pancreatic Cancer Stages
Doctors use a process called staging to determine if cancer has spread and, if so, how far. Staging helps doctors develop a treatment plan. When determining the stage, doctors look at many factors, including:
- Size and location of the tumor
- Whether cancer has spread to nearby lymph nodes or blood vessels
- Whether cancer has spread to other organs or parts of the body farther away from the pancreas
For pancreatic cancer, doctors also group tumors into categories based on whether they can be surgically removed. These stages are known as resectable, borderline resectable, and locally advanced.
The stages of pancreatic cancer are:
- Stage 0: The tumor is only in the top layer of the pancreatic duct cells. Doctors usually call this stage pancreatic cancer in situ.
- Stage 1A: Cancer is only in the pancreas and is no larger than 2 centimeters (about the size of a peanut).
- Stage 1B: Cancer is only in the pancreas. It is larger than 2 centimeters but smaller than 4 centimeters. Four centimeters is about the size of a walnut.
- Stage 2A: The tumor is only in the pancreas. It is larger than 4 centimeters.
- Stage 2B: The cancer has spread to nearby lymph nodes, but has not spread to nearby major blood vessels or nerves or to distant parts of the body.
- Stage 3: The cancer has spread to nearby major blood vessels and four or more nearby lymph nodes, but it has not spread to distant sites.
- Stage 4: The cancer has spread to organs farther away from the pancreas. This might include the liver, lining of the abdomen (called the peritoneum), or the lungs.
- Recurrent: Cancer has returned following treatment. It may come back in the pancreas or in another part of the body.
Cancer staging can be very complicated. Your doctor will explain the staging process to you and help you understand the extent of the cancer you have.
Diagnostic Tests for Pancreatic Cancer
Your doctor begins by doing a comprehensive physical examination. They will also ask questions about your:
- Symptoms
- Medical history
- Family history of cancer and other conditions
- Lifestyle habits, such as whether you smoke or drink alcohol
- Other risk factors, such as a history of working with pesticides or chemicals
To diagnose pancreatic cancer, your doctor may recommend specialized tests, such as:
Imaging tests provide detailed pictures of tissues and bones inside your body. Your doctor may order several imaging studies, such as:
- Computed tomography scan (CT scan): This test uses special X-ray and computer equipment to create images of bones, tissues, and organs.
- Magnetic Resonance Imaging (MRI): An MRI uses powerful magnets, radio waves, and a computer to create pictures.
- Positron emission tomography (PET scan): A PET scan is a type of nuclear medicine imaging that measures cell activity in the body. You receive a small, safe amount of a tracer (a radioactive substance) that travels through your body. The tracer detects areas of increased cell activity, called hot spots. These hot spots show up brighter on the scan, which typically indicate cancerous cells.
- Ultrasound: This test uses sound waves to create images of tissues in the body.
- Endoscopic retrograde cholangiopancreatography (ERCP): This procedure uses X-rays to look at the ducts (tubes) that carry bile from the liver to the gallbladder and from the gallbladder to the small intestine.
- Percutaneous transhepatic cholangiography (PTC): A PTC is an X-ray examination of the bile ducts. Your doctor inserts a needle into the liver and delivers a dye (contrast). The dye helps your doctor view the bile ducts on the X-ray.
- Magnetic resonance cholangiopancreatography (MRCP): This test uses MRI technology to produce cross-section images of the pancreas, gallbladder, and pancreatic and bile ducts.
- PET/CT scan: The PET/CT combination provides more accurate diagnoses than the two scans performed separately.
- Angiogram: This test shows pictures of blood vessels and helps doctors plan surgical treatments. You receive dye through an IV or a catheter (long, thin tube). Your doctor then does an X-ray, MRI, or CT scan to look at images of blood vessels and evaluate blood flow.
A pancreas biopsy is a procedure doctors use to look for cancerous cells. This is typically performed by an endoscopist under anesthesia through an ultrasound inserted in your stomach, also known as endoscopic ultrasound. Your doctor removes a sample of pancreatic tissue with a needle. They send the sample to a lab for testing.
Your doctor may take small samples of your blood to test in the lab. Blood tests provide information about your health, including how your organs are working and if cancer has spread. To diagnose pancreatic cancer, your doctor will test your blood to evaluate your liver function and check for tumor markers (substances in the blood that may indicate cancer).
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