Pancreatic Cancer

Pancreatic Cancer Treatment

Pancreatic cancer is cancer of the pancreas. It is not often detectable until its later stages because of a lack of symptoms, so unfortunately the mortality rate is high. It is the fourth-leading cause of cancer death in both men and women, and it’s estimated that 7 percent of the United States population will be diagnosed with pancreatic cancer in their lifetime. Read on to learn about what pancreatic cancer is, its risk factors, the stages of pancreatic cancer, and pancreatic cancer treatment options.

What Is Pancreatic Cancer?

To first understand pancreatic cancer, it’s good to know what the pancreas is and what it does since it’s not the most talked about digestive organs, such as the liver or stomach. The pancreas is shaped like a fish,  and it is a gland located directly behind the stomach. The pancreas creates insulin and glucagon, and in turn, this helps regulate blood sugar levels. The pancreas also aids in the digestion of food.

Pancreatic cancer begins when pancreatic cells mutate and begin to multiply rapidly. These mutations can result in tissue masses. However, some tumors are benign (not cancerous), while others become pancreatic cancer cells.

There are two distinct types of pancreatic cancer: exocrine and neuroendocrine tumors. The most common type is exocrine pancreatic cancer, which is responsible for 93 percent of all pancreatic cancer cases. The type of cancer associated with pancreatic exocrine tumors is adenocarcinoma. This usually begins in the ducts of the pancreas, however, 75 percent of pancreatic cancer is in the head of the pancreas.

Neuroendocrine tumors are associated with islet cell carcinoma. These are much less common than exocrine tumors.

What Are the Signs and Symptoms of Pancreatic Cancer?

Quite often, patients don’t have symptoms of pancreatic cancer until the disease has reached its later stages, which makes pancreatic cancer treatment more difficult. However, there are signs and symptoms associated with pancreatic cancer to be aware of. Symptoms of pancreatic cancer include: 

• Jaundice (yellowing of the skin and eyes)
• Dark-colored urine
• Upper abdominal pain, which also may be felt in the back
• Nausea and vomiting 
• Diabetes
• Fatigue 
• Loss of appetite
• Light-colored bowel movements
• Unintended weight loss
• Itchy skin
• Blood clots

Neuroendocrine pancreatic cancer can have other symptoms due to the overproduction of certain hormones with various metabolic activities.

Some of these symptoms are also shared with other GI disorders. If you consult a gastroenterologist and have these symptoms, they will be especially concerned if you’ve recently had a new case of diabetes or have had pancreatitis, which is inflammation of the pancreas.

How Your Health History Impacts Your Risk of Developing Pancreatic Cancer

Researchers aren’t sure what the cause of pancreatic cancer is, but they have discovered certain risk factors that can contribute to a higher risk of developing cancer. Many of these risk factors are lifestyle-related, so it’s wise to be aware of them and possibly change some habits. Lifestyle-related risk factors for pancreatic cancer include:

• Obesity or carrying too much weight around the waist
• Smoking or using other forms of tobacco
• Having type 2 diabetes, which is also linked to obesity
• Exposure to toxins, such as dry-cleaning chemicals
• Having chronic pancreatitis, which is often associated with tobacco and overuse of alcohol

There are also some risk factors for pancreatic cancer that you can’t change. These include:

• Hereditary syndromes with gene mutations, such as the BRCA gene
• Hereditary chronic pancreatitis
• Being male
• Being of Ashkenazi Jewish descent 
• Being Black
• Being of older age (45 and over)

While men are at a higher risk of developing pancreatic cancer, the symptoms in men and women are the same.

Treating Pancreatic Cancer

If you suspect pancreatic cancer or other GI disorders and see a physician, they will first ask for your comprehensive health history. They will be especially interested in former cases of pancreatitis or a sudden onset of diabetes. It’s difficult to diagnose early-stage pancreatic cancer because the pancreas isn’t felt in a routine exam. Imaging tests or endoscopic procedures can be used for diagnosis.

Your physician may first order imaging studies like a CT scan or MRI. If suspicion of pancreatic cancer is raised in these studies, then your physician may order an endoscopic ultrasound. Similar to a regular endoscopy, a thin, flexible tube is placed through the mouth and down through the upper GI tract while you are under light sedation. Upper GI endoscopy procedures allow the doctor to see the tract from the throat to the duodenum (upper part of the small intestine). The probe at the end of this endoscope allows for imaging. Your gastroenterologist may also take tissue samples (biopsy) during the procedure.

Your physician may also order an ERCP (endoscopic retrograde cholangiopancreatography) particularly if the cancer is causing a blockage of the main bile duct. The ERCP is another type of upper endoscopic procedure that is used to engage and instrument the bile and pancreatic ducts. Through that procedure, a stent can be placed in the bile duct to relieve a blockage.

Blood tests may also be performed. Your provider will look for carbohydrate antigen (CA) 19-9, which is a type of protein that is much higher in pancreatic cancer patients.

If pancreatic cancer is discovered, you and your provider will have to discuss cancer care and cancer treatment options. Treatment for pancreatic cancer depends on the type, location, stage, and if it’s metastatic pancreatic cancer (cancer has spread to nearby lymph nodes and potentially, organs).

There are several treatment options used. In late-stage cancer patients where treatment is likely not viable, then different types of treatments are used to improve quality of life and relieve symptoms. Pancreatic cancer treatment includes:

• Surgical removal. This may include removing the cancerous part of the pancreas, which is called a distal pancreatectomy. If the tumor is in the head of the pancreas, your provider may recommend the Whipple procedure. This is a surgical procedure that removes the head of the pancreas, the duodenum, nearby lymph nodes, bile ducts, and the gallbladder.
• Targeted therapy. Instead of chemotherapy or radiation, this therapy targets the genes that promote cancer growth. Not everyone is a good candidate for targeted therapy, and genetic testing may be needed.
• Clinical trials. Depending on your stage, your doctor may recommend clinical trials in cancer research. You may be able to try an experimental treatment.

Other ways to treat pancreatic cancer include:

• Chemotherapy
• Radiation
• Immunotherapy

If you are receiving chemotherapy or radiation, you’ll want to speak to your physician about ways to ward off the uncomfortable side effects that appear with these treatments. Your physician may also use palliative care to help reduce pancreatic cancer symptoms if the case is severe. Some things you can discuss with your provider include:

• Nausea and vomiting treatment during chemotherapy or radiation
• Pain management 
• Diabetes control
• Finding emotional support
• Jaundice treatment 
• Reducing intestinal blockage (if one is present)

Treatment is largely decided on what stage the cancer is in. There are five stages of pancreatic cancer, Stages 0 through 4.

Stage 0 Pancreatic Cancer

Stage 0 marks when abnormal cells begin to form in the lining of the pancreas. This is also known as carcinoma in situ—cancer could form and begin to spread.

Stage 1 Pancreatic Cancer

Stage 1 is another early stage of pancreatic cancer, where a cancerous tumor has formed in the pancreas but has not begun to spread.

Stage 2 Pancreatic Cancer

In stage 2, the cancer has begun to spread to nearby lymph nodes.

Stage 3 Pancreatic Cancer

In stage 3, pancreatic cancer spreads to nearby blood vessels as well. It will also continue to affect lymph nodes and spread.

Stage 4 Pancreatic Cancer

Stage 4 pancreatic cancer is the most serious and most difficult for pancreatic cancer treatment. In stage 4, it has spread to more distant areas and organs in the body, such as the liver, abdominal cavity, or lungs.

If you are diagnosed with pancreatic cancer, be sure you understand the diagnosis and stage fully. While your gastroenterologist can make treatment suggestions, making treatment decisions is a joint effort. Understanding your diagnosis can help you make a more informed decision.

After one year, the survival rate for pancreatic cancer is 20 percent. Overall, the five-year survival rate is 6 percent. Those with stage 4 pancreatic cancer have a five-year survival rate of 1 percent. Even if surgery is successful and part of the pancreas is removed, a person often only has a life expectancy of 18 to 20 months. This is why seeing your gastroenterologist is so important if you have sudden symptoms or suspect pancreatic cancer. Genetic testing can also help you determine if you have a predisposition to the disease.