Pancreatic carcinoma

Pancreatic carcinoma is cancer of the pancreas.

Causes

The pancreas is a large organ located behind the stomach. It makes and releases enzymes into the intestines that help the body absorb foods, especially fats.

Hormones called insulin and glucagon, which help your body control blood sugar levels, are made in special cells in the pancreas called islet cells. Tumors can also occur in these cells, but they are called islet cell tumors.

The exact cause of pancreatic cancer is unknown. It is more common in:

    - People with diabetes
    - People with long-term inflammation of the pancreas (chronic pancreatitis)
    - Smokers

Pancreatic cancer is slightly more common in women than in men. The risk increases with age.

A small number of cases are related to genetic syndromes that are passed down through families.

Symptoms 

A tumor or cancer in the pancreas may grow without any symptoms at first. This means pancreatic cancer is often advanced when it is first found.

Early symptoms of pancreatic cancer include:

    - Dark urine and clay-colored stools
    - Fatigue and weakness
    - Jaundice (a yellow color in the skin, mucus membranes, or eyes)
    - Loss of appetite and weight loss
    - Nausea and vomiting
    - Pain or discomfort in the upper part of the belly or abdomen


Other possible symptoms are:

    - Back pain
    - Blood clots
    - Diarrhea
    - Indigestion

Exams and Tests

    - CT scan of the abdomen
    - Endoscopic retrograde cholangiopancreatography (ERCP)
    - Endoscopic ultrasound
    - MRI of the abdomen
    - Pancreatic biopsy

This disease may also affect the results of the following tests:

    - Complete blood count (CBC)
    - Liver function tests
    - Serum bilirubin

 Treatment

Because pancreatic cancer is often advanced when it is first found, very few pancreatic tumors can be removed by surgery. The standard surgical procedure is called a pancreaticoduodenectomy (Whipple procedure).

This surgery should be done at centers that perform the procedure often. Some studies suggest that surgery is best performed at hospitals that do more than five of these surgeries per year.

When the tumor has not spread out of the pancreas but cannot be removed, radiation therapy and chemotherapy together may be recommended.

When the tumor has spread (metastasized) to other organs such as the liver, chemotherapy alone is usually used. The standard chemotherapy drug is gemcitabine, but other drugs may be used. Gemcitabine can help about 25% of patients.

Patients whose tumor cannot be totally removed, but who have a blockage of the tubes that transport bile (biliary obstruction) must have that blockage relieved. There are two approaches:

    - Surgery
    - Placement of a tiny metal tube (biliary stent) during ERCP

Managing pain and other symptoms is an important part of treating advanced pancreatic cancer. Palliative care tams and hospice can help with pain and symptom management, and provide psychological support for patients and their families during the illness.

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