Saanichton, BC

Dr. Miguel A. Lipka

Pancreatic Cancer

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Pancreatic cancer is the fourth most common cause of cancer death in North America. Symptoms are typically vague, making it difficult to diagnose early. Because these cancers are often caught at a late stage, they have been hard to treat in the past.

The pancreas is an oblong organ, about six inches long, located in the upper abdomen. It has two major functions:

  • The first is to produce digestive enzymes — proteins that help digest food into the small intestine. Cells that perform this function make up the exocrine pancreas.
  • The second major function is to produce hormones that are secreted into the blood. These cells make up the endocrine pancreas.

Endocrine Pancreas

The endocrine pancreas is made up of specialized cells, referred to as islets of Langerhans, that produce hormones. The most important hormone produced is insulin that helps control sugar in the blood. Cancers that begin in islet cells are called islet cell tumors or pancreatic neuroendocrine tumors. These tumors are rare and may produce hormones that cause very low or very high blood sugars or symptoms such as stomach pain and severe diarrhea.

Exocrine Pancreas

The exocrine pancreas is made up of ducts and acini, which are small pockets at the end of the ducts. Cells lining the ducts are the most likely to develop cancer, called ductal adenocarcinomas, the most common type of pancreatic cancer.

These two types of tumors are treated very differently.

Common symptoms may include:

  • Jaundice — If the tumor blocks the bile duct so bile can't flow into the intestines, jaundice may occur, causing the skin and whites of the eyes to turn yellow, the urine to become dark and the stool to turn clay-colored.
  • Pain — As the cancer grows and spreads, pain often develops in the upper abdomen and the back. The pain may increase after a person eats or lies down.
  • Weight Loss — Cancer of the pancreas can also cause unintentional weight loss. This is often due to an inadequate intake of calories because of nausea, vomiting and loss of appetite.
  • Digestive Problems — Digestive problems may occur if the cancer blocks the pancreatic juices from flowing into the intestines, which help the body break down dietary fats, proteins and carbohydrates. Stools may be different than usual and appear pale, bulky or greasy, float in the toilet, or be particularly foul-smelling.

Although the cause of pancreatic cancer is unknown, risk factors have been identified that increase a person's chance of developing the disease. These include:

  • Smoking — People who smoke cigarettes are two to three times more likely to develop pancreatic cancer than non-smokers.
  • Age — The risk of pancreatic cancer increases with age. People over the age of 60 are more commonly diagnosed with the disease.
  • Race — African Americans are more likely than Asians, Hispanics and whites to develop pancreatic cancer.
  • Chronic Pancreatitis — A history of chronic pancreatitis may increase the likelihood of developing pancreatic cancer.
  • Diabetes — Some people with diabetes are more commonly affected by pancreatic cancer. Diabetes may also be a complication or an early sign of pancreatic cancer.
  • Diet — A diet high in fats, especially processed red meats, may increase the chance of developing pancreatic cancer.
  • Weight — Overweight people are more likely than others to develop pancreatic cancer.

While most cases of pancreatic cancer don't run in families, inherited conditions may increase the chance of developing pancreatic cancer.

About 5 percent to 10 percent of pancreatic cancers are considered hereditary, or related to a specific genetic mutation. Pancreatic cancer is considered to run in a family when two or more first-degree relatives — such as parents, siblings or children — have the condition. This is sometimes referred to as familial pancreatic cancer (FPC). If a person has a first-degree relative with pancreatic cancer, his or her risk is significantly greater than the average person's.

An increased risk also has been associated with a number of genetic syndromes including hereditary breast, ovarian and colon cancer and a serious type of skin cancer called familial atypical multiple mole syndrome (FAMMM).

Treatment of pancreatic cancer depends on the stage of the cancer. Surgery is a common treatment. The addition of chemotherapy post-surgery has been shown to significantly increase the 5-year survival rate from approximately 10 to 20%.

In patients not suitable for surgery with curative intent, palliative chemotherapy may be used to improve quality of life and gain a modest survival benefit.