What Is Cancer of the Pancreas?
The pancreas is a gland found behind the stomach. It is shaped a little bit like a fish. It is about 6 inches long and less than 2 inches wide. It extends across the abdomen.

The pancreas is really 2 separate glands inside the same organ. The exocrine gland makes pancreatic juice that has enzymes to break down fats and proteins in foods so the body can use them. Most of the cells in the pancreas are part of the exocrine system. A smaller number of cells in the pancreas are endocrine cells. These cells are arranged in clusters called islets (or islets of Langerhans). They make hormones (such as insulin) that help balance the amount of sugar in the blood.

Types of Tumors of the Pancreas
Both the exocrine and endocrine cells of the pancreas can form tumors. But those formed by the exocrine pancreas are much more common. Not all of these tumors are cancer. A small number of tumors are benign (not cancer).

It is important to know whether a tumor is from the exocrine or endocrine part of the gland. Each type of tumor has distinct signs and symptoms, is found using different tests, is treated in different ways, and has a different outlook for survival (prognosis).

Tumors of the exocrine part of the gland are likely to be cancer. These cancers are called adenocarcinomas. About two thirds of these cancers are found in the head of the pancreas; the rest are in the tail. There are several sub-types. But treatment of cancer of the exocrine pancreas is mostly based on the stage of the cancer, not its exact type. The stage of the cancer describes how far it has progressed. Staging is explained later in this document.

Tumors of the endocrine pancreas are much less common. They are known as islet cell tumors. There are also several sub-types. Most of these are benign, but there are a few that are cancerous. This overview does not cover islet cell cancers.

A special type of cancer (ampullary cancer) can occur where the bile duct (from the liver) and the pancreatic duct empty into the small intestine. Because this type of cancer often causes signs such as yellowing of the skin and eyes, it is usually found at an earlier stage than most pancreatic cancers. Finding it early means that the chances of successful treatment are better.

The information in this article refers only to exocrine cancer and ampullary cancer.

How Many People Get Pancreatic Cancer?
The American Cancer Society predicts that, in 2006, about 33,730 people in the United States will be found to have pancreatic cancer and about 32,300 will die of the disease.

What Causes Pancreatic Cancer? Can It Be Prevented?
We still do not know exactly what causes most cases of pancreatic cancer. Several risk factors have been linked to the disease. A risk factor is something that affects a person's chance of getting a disease such as cancer. Some risk factors, such as smoking, can be controlled. Others, like a person's age or race, can't be changed. But keep in mind that having one or more risk factors does not mean that a person will get the disease.

Risk Factors for Pancreatic Cancer
Age: The risk of this cancer goes up with age. Almost 90% of patients are older than 55.

Gender: Men have this cancer more often than women.

Race: African Americans are more likely to have this cancer than are whites.

Smoking: The risk of this cancer is higher among smokers. Heavy smoking raises the risk 2 to 3 times. About 3 out of 10 cases of pancreatic cancer are thought to be caused by smoking.

Diet: There may be a link with eating a lot of red meat and pork, especially processed meat (such as sausage and bacon).

Obesity: Very overweight people are 20% more likely to develop pancreatic cancer.

Diabetes: Pancreatic cancer is more common in people with this disease.
Chronic pancreatitis: This is a long-term inflammation of the pancreas. It is linked with a slightly higher risk of pancreatic cancer.

Work exposure: Some chemicals such as certain bug sprays, dyes, or gasoline products may raise the risk of this cancer.

Family history: Cancer of the pancreas seems to run in some families. It seems to account for about 1 in 10 cases. Changes in DNA that increase the risk for certain other cancers also increase the risk of this cancer.

Stomach problems: Having too much stomach acid or having bacteria called H. pylori in the stomach may increase the risk of pancreatic cancer.

Can Pancreatic Cancer Be Prevented?
There is no sure way to prevent cancer of the pancreas at this time. For now, the best advice is to avoid smoking and to eat a healthy diet with plenty of fruits, vegetables, and whole grains. Cut down on red meats, especially those that are processed or high in fat. Keeping a healthy weight and exercising are also important.

How Is Pancreatic Cancer Found?
The main reason for the low survival rate from pancreatic cancer is that it is hard to find this cancer early. By the time a person has symptoms, the cancer has often reached a large size and spread to other organs. And because the pancreas is deep inside the body, the doctor cannot see or feel tumors during a routine physical exam.

Right now there are no blood tests or other tests that can easily find this cancer early in people without symptoms. Levels of tumor markers such as CA 19-9 and CEA may be higher than normal in people with pancreatic cancer, but the cancer is usually advanced by the time the levels become high.

Tests for certain genes in people with a family history of the disease can help tell if they are at higher risk for cancer. But there is concern that people with results showing they may be at higher risk would not be able to get health insurance or that it would cost more. These tests are not used to screen the general public.

There are some new tests for finding pancreatic cancer early in people with a strong family history of the disease. But these tests are complicated and expensive.

The following can be symptoms of pancreatic cancer:

Jaundice: A yellow color of the eyes and skin is called jaundice. It is caused by a buildup of a substance (bilirubin) that is made in the liver. At least half of all people with pancreatic cancer have jaundice. While jaundice can be a sign of cancer, more often it is caused by something else.

Pain: Pain in the belly area (abdomen) or in the middle of the back is a very common sign of advanced pancreatic cancer. Again, such pain is often caused by something other than cancer.

Weight loss: Losing weight (without trying) over a number of months is very common in patients with this cancer. They may also feel very tired and have a loss of appetite.

Digestive problems: If the cancer blocks the release of the pancreatic juice into the intestine, problems such as trouble breaking down fat can result. Stools might be pale, bulky, greasy, and float in the toilet. Other problems may include nausea, vomiting, and pain that tends to be worse after eating.

Swollen gallbladder: The doctor may find that the gallbladder is enlarged.

Blood clots: Rarely, substances released by cancer cells can cause blood clots to form in the veins or cause problems with fatty tissue under the skin. Clots can sometimes travel to the lungs and cause trouble with breathing.

Diabetes: This cancer can cause problems with blood sugar. Sometimes (though rarely) it can cause diabetes.

If the doctor has any reason to suspect pancreatic cancer, certain tests will be done to see if the disease is really present. First the doctor will ask questions about your health and do a physical exam. The exam will focus mostly on the abdominal area. Sometimes this type of cancer spreads to the lymph nodes or the liver so the doctor will check these for swelling. The skin and the white part of the eyes will be checked for jaundice.

Certain other tests that provide pictures of the inside of the body might also be done. These are called imaging tests.

Imaging Tests
CT scan (computed tomography): This is a special type of x-ray that creates detailed pictures of the inside of the body. CT scans are useful in finding cancer and in seeing how far it has spread. CT scans can also be used to help guide a biopsy needle into the precise area that might be cancer (see below for more about biopsy).

CT scans take longer than regular x-rays, but they are getting faster. You need to lie still on a table while they are being done.

PET scan (positron emission tomography): PET scans use a form of sugar that contains a radioactive atom. Cancer cells absorb large amounts of this sugar. A special camera can show where these cells are. This test is useful to see whether the cancer has spread to the lymph nodes or other places.

PET/CT scan: This new test combines the 2 types of scans to even better pinpoint the tumor. This test may be especially useful for spotting cancer that has spread beyond the pancreas and can’t be removed by surgery. It may be useful for staging the caner. And it may even be able to spot early cancer. Because the test is so new, it is still being studied.

Ultrasound: This test uses sound waves to produce pictures of the inside of the body. The pictures are combined by a computer to give a detailed image. This test can help tell what kind of a tumor is in the pancreas. Endoscopic ultrasound is done with a probe placed through the mouth or nose into the stomach. The probe can be pointed toward the pancreas. This gives a very good picture and is better than CT scans for spotting small tumors. Patients are sedated for this type of ultrasound.

MRI (magnetic resonance imaging): This test uses radio waves and strong magnets instead of x-rays to create cross-sectional pictures of the body. MRI scans are helpful in looking at the brain and spinal cord. MRI scans take longer than CT scans—often up to an hour. Also, you have to lie inside a narrow tube, which can be upsetting for some people. The machine makes a thumping noise. Some places will give you headphones with music to block out the noise.

ERCP (endoscopic retrograde cholangiopancreatography): In this test, a flexible tube is passed down the throat, all the way into the small intestine. The doctor can see through the end of the tube and find where the common bile duct opens into the small intestine. A small amount of harmless dye is then injected through the tube into the ducts. This dye helps outline the ducts on x-rays. The pictures can show narrowed or blocked ducts that might be caused by a cancer of the pancreas. The doctor doing this test can also put a small brush through the tube to get cells to look at under a microscope to see whether they appear to be cancer.

Angiography: This is a type of x-ray for looking at blood vessels. This test can show whether blood flow in an area is blocked or slowed by a tumor. It can also show if there are any abnormal blood vessels. The results help the doctor decide whether the cancer can be removed and to plan the surgery.

There are several other tests, including blood tests, the doctor might conduct to learn more about a tumor. But the only way to know for sure if cancer is really present is with a biopsy.

During a biopsy a sample of tissue from the tumor is removed and looked at under a microscope to see if there are cancer cells. There are several types of biopsies that might be done. In the past, a biopsy was often done as part of surgery. Now, however, the FNA (fine needle aspiration) biopsy is the more usual method. For this test, the doctor inserts a thin needle through the skin and into the pancreas to remove small pieces of tissue. Ultrasound might also be used to place the needle through the wall of the intestine into the tumor. This test can be done with the patient awake. It rarely causes side effects.

Another approach is “keyhole surgery” (laparoscopy). The patient is sedated, and the surgeon inserts a small, thin instrument into the abdomen. It may be connected to a video display. The surgeon can look at the abdomen and see how big the tumor is and whether it has spread.

Most doctors who treat people with pancreatic cancer try to avoid surgery unless it looks like an operation might be able to remove all the cancer. Even so, there are times when the doctor starts an operation only to find that the cancer has spread too far to be completely removed. In these cases, the doctor just takes a sample of the tumor and the rest of the operation is stopped.

How Is Pancreatic Cancer Treated?
There are 3 main types of treatment for cancer of the pancreas: surgery, radiation therapy, and chemotherapy. Depending on the stage of the cancer, 2 or even all of these types of treatment could be combined.

Surgery
There are 2 types of surgery for pancreatic cancer, depending on the goal of the treatment. If the tumor is small enough so there's a chance it can all be removed, then the goal of the surgery is to try to cure the cancer. If the cancer is too widespread to be completely removed, then the goal might be to relieve symptoms or to prevent other future problems. This type of surgery is known as palliative, since its main goal is to promote comfort.

The type of surgery most often done if it looks like the cancer can be cured is called the Whipple procedure. In this surgery, the head of the pancreas (and sometimes the body) are removed along with parts of the stomach and small intestine, the gallbladder, part of the common bile duct, and some nearby lymph nodes. This is a very complex operation. It is best done by a surgeon who has done it many times in a hospital that has had much experience with this kind of surgery. This is a major operation that carries a relatively high risk of complications that may even be fatal.

Only a small fraction (10%) of cancers of the pancreas appear to be contained entirely within the pancreas when they are found. But even when it looks like the cancer hasn’t spread, a small number of cancer cells may already have spread to other parts of the body. For patients who have surgery to try to completely remove cancer of the exocrine pancreas, the 5-year survival rate is about 20%.

Palliative surgery might be done to prevent or relieve symptoms if the cancer has spread too far to be cured. For example, surgery can be used to relieve blockage of the bile duct. When this duct is blocked, the result can be pain and problems with digestion.

There are 2 options for relieving a bile duct blockage. One is to re-route the flow of bile from the common bile duct into the small intestine. This approach requires an incision and it may take weeks for the patient to recover. An advantage is that during the surgery, the doctor may be able to cut the nerves leading to the pancreas. This will reduce or get rid of any pain for the patient. Also, the doctor might re-route the stomach connection to the small intestine with the goal of preventing problems in the future.

Because this type of cancer can progress so quickly, most doctors don’t recommend palliative surgery by itself. What often happens is that surgery is begun in hopes of curing the cancer. If it becomes clear that the cancer is too advanced, the doctor may switch to the palliative approach to prevent symptoms.

A second approach to bile duct blockage is to use tubes called stents to keep the bile duct open. The doctor inserts the stents through an endoscope. After several months the stents may become clogged and need to be replaced. Newer stents may be used to keep the small intestine open as well.

Radiation Therapy
Radiation therapy is treatment with high energy rays (such as x-rays) to kill or shrink cancer cells. The radiation is given much like a regular x-ray although it takes longer. Treatment is usually given 5 times a week for several weeks or months. Sometimes the radiation is given before surgery, sometimes after. Radiation (often combined with chemotherapy) can also be used for patients whose tumors are too widespread to be removed by surgery.

One new way to give radiation therapy is being studied at some cancer centers. It consists of giving radiation directly into the tumor during an operation. In this way the doctor can move other organs out of the way and aim the radiation right at the tumor. But so far this approach hasn’t been shown to help patients live longer than regular radiation treatment.

Side effects of radiation therapy could include mild skin changes that look like sunburn or suntan, upset stomach, loose bowels, or tiredness. Often these go away after a short while. Talk with your doctor if you have side effects since there are ways to relieve them.

Chemotherapy
Chemotherapy refers to the use of drugs to kill cancer cells. Usually the drugs are given into a vein or are taken as a pill. Once the drugs enter the bloodstream, they reach throughout the body, making this treatment useful for cancer that has spread beyond the place where it started.

A drug called gemcitabine is the drug most often used to treat pancreatic cancer that has spread. Studies are going on to see if it can be used (either alone or with other drugs) to treat cancers found at an earlier stage.

Chemotherapy can have some side effects. These side effects will depend on the type of drugs given, the amount taken, and how long treatment lasts. Temporary side effects might include nausea and vomiting, loss of appetite, hair loss, and mouth sores. Low blood cell counts from treatment can cause an increased risk of infection, bleeding or bruising after minor cuts, and fatigue. Most side effects stop once treatment is over. Anyone who has problems with side effects should talk with their doctor or nurse, as there are often ways to help.

Targeted therapy: A drug called erlotinib (Tarceva) has helped some patients with advanced pancreatic cancer. When combined with other chemotherapy it prolonged the life of patients by about 12 days. Although this seems like a tiny benefit, it just represents the average. A few patients probably received a few months of extra life, but most were not helped at all.

Managing Problems
Treatment of bile duct blockage was mentioned earlier. Other common problems for people with cancer of the pancreas are loss of appetite, weight loss, and weakness. These problems are caused in part by the side effects of treatments and by the effects of the cancer itself. High-energy liquid food supplements may be helpful. In some cases, a temporary feeding tube into the stomach can improve the person’s nutrition and boost energy levels.

Pain can be a real problem for patients with this cancer. But it is possible to relieve the pain with medicines or by other means. Patients should tell their doctor or nurse about any pain they are having. They should not be afraid to make use of the pain relief treatments offered. For pain treatment to work right, the medicine needs to be taken on a regular schedule, not just when the pain becomes severe. There are long-acting forms of morphine and other drugs that only need to be taken once or twice a day.

Survival Rates for Pancreatic Cancer
Overall, about 5% of patients with cancer of the exocrine pancreas will be alive 5 years after the cancer is found. Even for those with local disease (it has not spread to other organs) the 5-year relative survival rate is only 16%.

For those who have regional disease (the cancer has spread to nearby organs and tissues but not farther away), the 5-year relative survival rate is 7%. If there is spread to distant organs or tissues, the 5-year relative survival rate is 2%.

Five-year relative survival rates don’t count people who died of other diseases. Of course, patients might live more than 5 years after diagnosis.

These numbers provide an overall picture, but keep in mind that every person’s situation is unique and the statistics can’t predict exactly what will happen in your case. Talk with your cancer care team if you have questions about your personal chances of a cure, or how long you might survive your cancer. They know your situation best.

Clinical Trials
Studies of promising new treatments are known as clinical trials. A clinical trial is done only when there is some reason to believe that the new treatment may be of value to the patient. Clinical trials are needed in order to find new and better ways to treat cancer. Treatments used in clinical trials are often found to have real benefits. The main questions the researchers want to answer are:

• Is this treatment helpful?
• Does it work better than the one we're now using?
• What side effects does it cause?
• Do the benefits outweigh the side effects?
• Which patients are most likely to find this treatment helpful?

Clinical trials are carried out in steps called phases. Each phase is designed to answer certain questions

Phase I clinical trials look at the best way to give a new treatment and how much of it can be given safely. The main purpose of a phase I study is to test the safety of the new drug.

Phase II clinical trials are designed to see if the drug works. Patients are given the highest dose that doesn't cause serious side effects and then watched closely to see if there is an effect on the cancer.

Phase III clinical trials compare the new treatment with standard treatment. Large numbers of patients are divided into two groups. The control group receives standard treatment and the other group receives the new treatment. Everyone is closely watched to see which treatment is more effective. The study is stopped if the side effects are too severe or if one group has much better results than the other.

If you are in a clinical trial, you will have a team of experts watching your progress very carefully. However, there are some risks. No one knows in advance if the treatment will work or exactly what side effects will occur. That is what the study is designed to find out. Keep in mind, though, that even standard treatments have side effects.

Taking part in a clinical trial is completely up to you. Even after joining a clinical trial, you are free to drop out of the study at any time, for any reason. Taking part in the study will not prevent you from getting other medical care you may need.

Courtesy: www.cancer.org, Please visit the website for further information