Pancreatic carcinoma

Alternative names
Pancreatic cancer; Cancer - pancreas

Definition
Pancreatic carcinoma is a malignancy (cancer) of the pancreas.

Causes, incidence, and risk factors

Pancreatic cancer is the 4th leading cause of death from cancer in the U.S. The disease is slightly more common in men than in women, and risk increases with age.

The cause is unknown, but it is more common in smokers and in obese individuals. Almost 1/3 of cases of pancreatic carcinoma can be attributed to cigarette smoking. There is controversy as to whether type 2 diabetes is a risk factor for pancreatic cancer. A minority of cases are known to be related to hereditary syndromes.

Symptoms

     
  • Weight loss  
  • Abdominal pain  
  • Loss of appetite  
  • Jaundice  
  • Nausea and vomiting  
  • Weakness  
  • Fatigue  
  • Diarrhea  
  • Indigestion  
  • Back pain  
  • Clay-colored stools  
  • Paleness  
  • Depression

Signs and tests

     
  • ERCP  
  • Abdominal CT scan  
  • Pancreatic biopsy  
  • Abdominal ultrasound  
  • Abdominal MRI

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

     
  • Serum bilirubin  
  • Liver function tests

Treatment

At the time of diagnosis, only about 20% of pancreatic tumors can be removed by surgery. The standard procedure is called a pancreaticoduodenectomy (Whipple procedure).

This surgery for pancreatic cancer should be done at centers that perform the procedure frequently. Some studies suggest that surgery is best performed at hospitals that perform at least 9 of these surgeries per year.

When the tumor is confined to the pancreas but cannot be removed, a combination of radiation therapy and chemotherapy may be recommended. When the tumor has spread (metastasized) to other organs such as the liver, chemotherapy alone is usually used. The standard chemotherapy agent is gemcitabine, but other drugs may be used. Gemcitabine provides clinical improvement in approximately 25% of patients.

For patients who have biliary obstruction (blockage of the vessels that transport bile) and the tumor cannot be totally removed, the obstruction must be relieved. There are generally two approaches to this - surgery and placement of a biliary stent (similar to stents placed in the arteries of the heart to relieve blockages) during ERCP.

Management of pain and other symptoms is an important part of the treatment of advanced pancreatic cancer. Hospice can be very helpful to patients for both pain and symptom management and psychological support for the patient and the family during the course of the illness.

Support Groups
The stress of illness can often be eased by joining a support group with members who share common experiences and problems. See cancer - support group. Also see the discussion of hospice in the treatment section above.

Expectations (prognosis)

Some patients with pancreatic cancer that is resectable (can be surgically removed) are cured. However, cure rates are significantly less than 50%.

Chemotherapy and radiation are often given after surgery to attempt to increase the cure rate. For pancreatic cancer that cannot be removed completely with surgery, or cancer that has spread beyond the pancreas, cure is not currently possible and the average survival is usually less than 1 year. Such patients might consider enrollment in a clinical trial (a medical research study to determine the best treatment).

Complications

Pancreatic cancer may result in weight loss, blood clots, liver dysfunction, infections, pain, and depression. Symptoms such as pain can usually be controlled with aggressive pain management.

Calling your health care provider
Call for an appointment with your health care provider if you have persistent abdominal pain, loss of appetite, fatigue, back pain, or other symptoms suggestive of this disorder.

Prevention
If you smoke, stop smoking. Eat a diet high in fruits, vegetables, and whole grains, and exercise regularly.

Johns Hopkins patient information

Last revised: December 4, 2012
by Amalia K. Gagarina, M.S., R.D.

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