What is pancreatic cancer?

Cancer of the pancreas is an unchecked growth of abnormal cells in the pancreas. The pancreas, a large, long organ located behind the stomach, makes both insulin and enzymes needed for digestion.

In the U.S., pancreatic cancer is the fourth most common cancer in men and the fifth most common in women. Approximately 80% of cases of pancreatic cancer occur in people older than 50. This cancer usually cannot be detected early, unlike other cancers such as breast and colon cancer.

How does it occur?

Pancreatic cancer may be related to exposure to cancer- causing agents called carcinogens. Some factors that increase the risk of this disease are:

• cigarette smoking (cancer of the pancreas is three to four times more common in smokers than in nonsmokers)
• a diet high in fat and low in fiber
• use of food additives
• possibly chemicals in the petroleum and dry-cleaning industries.

What are the symptoms?

The pancreas lies behind the stomach, the "head" to the right, the "tail" to the left.

Symptoms of cancer of the head of the pancreas are:

• dull, continuous pain in the abdomen that moves up (you may feel less pain when you lean forward and more pain when you lie down)
• midback pain
• yellowish skin and whites of the eyes (jaundice)
• weight loss, possibly rapid and severe
• nausea and diarrhea
• weakness
• swollen liver and gallbladder, with other symptoms associated with these organs
• itching
• slow digestion
• light-colored bowel movements.

Symptoms of cancer of the tail of the pancreas include:

• pain in the abdomen that is usually worst about 3 or 4 hours after eating
• pain that moves to your back (you may feel less pain when you lean forward and more pain when you lie down)
• blood clots in your legs
• loss of appetite, causing weight loss and weakness.

How is it diagnosed?

Pancreatic cancer can be difficult to diagnose. The doctor will take a history of recent symptoms, especially those relating to pain, appetite, diet, and weight change. A physical exam with special attention to the abdomen will be performed. Sometimes the pancreatic cancer can be felt as a hard, firm lump or mass in the abdomen. Special x-ray studies are most helpful to determine where the cancer is.

Blood studies are done to look for effects of the possible cancer (for example, anemia). In the case of pancreatic cancer, if the pancreas stops making insulin, the blood tests may show a high blood sugar level as a result.

A procedure called ERCP (endoscopic retrograde cholangiopancreatography) may be necessary to look at the bile ducts and help make the diagnosis of pancreatic cancer. If the disease is advanced, ERCP may make major surgery unnecessary. For an ERCP, you will be sedated and the gastroenterologist will pass a slim, flexible tube (an endoscope) through your mouth, esophagus, and stomach into the upper small intestine. From this point the gastroenterologist can pass the tube into the bile ducts of the gallbladder or the ducts connecting the small intestine with the pancreas. The tumor can be biopsied with tiny tools passed through the endoscope.

How is it treated?

Symptoms of pancreatic cancer usually are not recognized until late in the course of the disease, when surgical cure is not possible. However, some patients develop signs and symptoms of pancreatic cancer early in the disease and may be cured with surgery. The most common operation for pancreatic cancer is a Whipple operation, which involves removing parts of the pancreas, duodenum, and bile duct.

If you cannot have a Whipple procedure, surgery may be helpful to relieve obstruction of the bile duct and stomach.

If you have surgery for pancreatic cancer, your doctor may recommend chemotherapy and radiation therapy after you heal from your operation.

How can I take care of myself?

In general, focus on controlling your symptoms. The following may be helpful:

• Follow the doctor's dietary recommendations.
• Eat small, frequent meals instead of large meals.
• Get enough rest.
• Take any pain medications as the doctor has prescribed when you need them. Do not avoid taking prescribed drugs or delay taking pain medications.
• Drugs may make you drowsy. Don't drive or perform tasks that require you to be alert if you are drowsy.
• Discuss your symptoms and concerns openly with your doctor.
• Ask your doctor to recommend a counselor to help deal with your concerns and feelings.

How can I prevent pancreatic cancer?

Since the causes of pancreatic cancer are unknown, there is no reliable way to prevent it. General cancer prevention guidelines include eating a high-fiber, low-fat diet; exercising; maintaining normal weight; and avoiding smoking.