General Information About Pancreatic Cancer

• Pancreatic cancer is a disease in which malignant (cancer) cells form in the tissues of the pancreas.
• The pancreas is a gland about 6 inches long that is shaped like a thin pear lying on its side. The pancreas lies between the stomach and the spine.
• The pancreas has two main jobs in the body:
  • To make juices that help digest (break down) food.
  • To make hormones, such as insulin and glucagon, that help control blood sugar levels. Both of these hormones help the body use and store the energy it gets from food.
• Smoking and health history can affect the risk of pancreatic cancer.
• Signs and symptoms of pancreatic cancer include jaundice, pain, and weight loss.
• Pancreatic cancer is difficult to diagnose early.

Risk factors for pancreatic cancer include the following:

• Smoking.
• Being very overweight.
• Having a personal history of diabetes or chronic pancreatitis.
• Having a family history of pancreatic cancer or pancreatitis.
• Having certain hereditary conditions

Signs and symptoms of pancreatic cancer:

• Jaundice (yellowing of the skin and whites of the eyes).
• Light-colored stools.
• Dark urine.
• Pain in the upper or middle abdomen and back.
• Weight loss for no known reason.
• Loss of appetite.
• Feeling very tired.

Pancreatic cancer is difficult to detect and diagnose for the following reasons:

• There aren’t any noticeable signs or symptoms in the early stages of pancreatic cancer.
• The signs and symptoms of pancreatic cancer, when present, are like the signs and symptoms of many other illnesses.
• The pancreas is hidden behind other organs such as the stomach, small intestine, liver, gallbladder, spleen, and bile ducts.

Tests for diagnosis and staging of pancreatic cancer:

• Physical exam and health history
• Blood chemistry studies
• Tumor marker test: Blood test to measure the amounts of certain substances, such as CA 19-9, and carcinoembryonic antigen (CEA). These have been linked to specific types of cancer when found in increased levels in the body. These are called tumor markers.
• MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body.
• CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine.
• PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do. A PET scan and CT scan may be done at the same time. This is called a PET-CT.
• Abdominal ultrasound: An ultrasound exam used to make pictures of the inside of the abdomen.
• Endoscopic ultrasound (EUS): A procedure in which an endoscope is inserted into the body, usually through the mouth. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. A probe at the end of the endoscope is used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make pictures.
• Endoscopic retrograde cholangiopancreatography (ERCP): An endoscope (a thin, lighted tube) is passed through the mouth, esophagus, and stomach into the first part of the small intestine. A catheter (a smaller tube) is then inserted through the endoscope into the pancreatic ducts. A dye is injected through the catheter into the ducts and an x-ray is taken. If the ducts are blocked by a tumor, a fine tube may be inserted into the duct to unblock it. This tube (or stent) may be left in place to keep the duct open. Tissue samples may also be taken.

Stages of Pancreatic Cancer

Tests and procedures to stage pancreatic cancer are usually done at the same time as diagnosis.

There are three ways that cancer spreads: direct spread to neighboring tissue, through blood stream and through lymph channels.

The following stages are used for pancreatic cancer:

• Stage 0 (Carcinoma in Situ)
• Stage I
• Stage II
• Stage III
• Stage IV

Stage 0 (Carcinoma in Situ): In stage 0, abnormal cells are found in the lining of the pancreas. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.

Stage I: In stage I, cancer has formed and is found in the pancreas only.

Stage IA: The tumor is 2 centimeters or smaller.

Stage IB: The tumor is larger than 2 centimeters but not larger than 4 centimeters.

Stage II: Stage II is divided into stages IIA and IIB, depending on the size of the tumor and where the cancer has spread.

Stage IIA: The tumor is larger than 4 centimeters.

Stage IIB: The tumor is any size and cancer has spread to 1 to 3 nearby lymph nodes.

Stage III: In stage III, the tumor is any size and cancer has spread to:

four or more nearby lymph nodes; or

the major blood vessels near the pancreas.

Stage IV: tumor is any size and cancer has spread to other parts of the body, such as the liver, lung, or peritoneal cavity (the body cavity that contains most of the organs in the abdomen).

Pancreatic Cancer groups used to plan treatment:

Resectable pancreatic cancer: Resectable pancreatic cancer can be removed by surgery because it has not grown into important blood vessels near the tumor.

Borderline resectable pancreatic cancer: Borderline resectable pancreatic cancer has grown into a major blood vessel or nearby tissue or organs. It may be possible to remove the tumor, but there is a high risk that all of the cancer will not be removed.

Locally advanced pancreatic cancer: Locally advanced pancreatic cancer has grown into or close to nearby lymph nodes or blood vessels, so surgery cannot completely remove the cancer.

Metastatic pancreatic cancer: Metastatic pancreatic cancer has spread to other organs, so surgery cannot completely remove the cancer.

Recurrent pancreatic cancer: Recurrent pancreatic cancer has recurred (come back) after it has been treated. The cancer may come back in the pancreas or in other parts of the body.