At UofL Health – Brown Cancer Center you are the focus of personalized care that brings together the most advanced techniques and technologies and top pancreatic cancer professionals.
Your personal team of experts from our Multidisciplinary Gastrointestinal Cancer Clinic, which includes oncologists, surgeons, radiologists, gastroenterologists and a specially trained support staff communicates closely about your care for pancreatic cancer. You are involved in every decision.
As an active research center, we are able to offer a variety of innovative treatments, including targeted therapies that help your body fight pancreatic cancer. We are also able to offer a wide range of clinical trials for new treatment.
Facts
Pancreatic cancer is a disease in which malignant (cancer) cells form in the tissues of the pancreas.
The pancreas is a gland about six inches long that is shaped like a thin pear lying on its side. The wider end of the pancreas is called the head, the middle section is called the body and the narrow end is called the tail. The pancreas lies between the stomach and the spine.
The pancreas has three areas: head, body, and tail. It is found in the abdomen near the stomach, intestines and other organs.
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.
The digestive juices are made by exocrine pancreas cells and the hormones are made by endocrine pancreas cells. About 95 percent of pancreatic cancers begin in exocrine cells.
Smoking and health history can affect the risk of pancreatic cancer.
Risk factors
- 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, such as:
- Multiple endocrine neoplasia type 1 (MEN1) syndrome
- Hereditary nonpolyposis colon cancer (HNPCC; Lynch syndrome)
- Von Hippel-Lindau syndrome
- Peutz-Jeghers syndrome
- Hereditary breast and ovarian cancer syndrome
- Familial atypical multiple mole melanoma (FAMMM) syndrome
Symptoms
Signs and symptoms of pancreatic cancer include jaundice, pain and weight loss.
Pancreatic cancer may not cause early signs or symptoms. Signs and symptoms may be caused by pancreatic cancer or by other conditions. Check with your doctor if you have any of the following:
- 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
Diagnosis
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 that examine the pancreas are used to detect, diagnose and stage pancreatic cancer.
Pancreatic cancer is usually diagnosed with tests and procedures that make pictures of the pancreas and the area around it. The process used to find out if cancer cells have spread within and around the pancreas is called staging. Tests and procedures to detect, diagnose and stage pancreatic cancer are usually done at the same time. In order to plan treatment, it is important to know the stage of the disease and whether or not the pancreatic cancer can be removed by surgery.
The following tests and procedures may be used:
- Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
- Blood chemistry studies: A procedure in which a blood sample is checked to measure the amounts of certain substances, such as bilirubin, released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease.
- Tumor marker test: A procedure in which a sample of blood, urine or tissue is checked to measure the amounts of certain substances, such as CA 19-9, and carcinoembryonic antigen (CEA), made by organs, tissues or tumor cells in the body. Certain substances are 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. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography or computerized axial tomography. A spiral or helical CT scan makes a series of very detailed pictures of areas inside the body using an X-ray machine that scans the body in a spiral path.
- 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. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. 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 is used to take pictures of the inside of the abdomen. The ultrasound transducer is pressed against the skin of the abdomen and directs high-energy sound waves (ultrasound) into the abdomen. The sound waves bounce off the internal tissues and organs and make echoes. The transducer receives the echoes and sends them to a computer, which uses the echoes to make pictures called sonograms. The picture can be printed to be looked at later.
- Endoscopic ultrasound (EUS): A procedure in which an endoscope is inserted into the body, usually through the mouth or rectum. 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 echoes. The echoes form a picture of body tissues called a sonogram. This procedure is also called endosonography.
- Endoscopic retrograde cholangiopancreatography (ERCP): A procedure used to X-ray the ducts (tubes) that carry bile from the liver to the gallbladder and from the gallbladder to the small intestine. Sometimes pancreatic cancer causes these ducts to narrow and block or slow the flow of bile, causing jaundice. 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.
- Percutaneous transhepatic cholangiography (PTC): A procedure used to X-ray the liver and bile ducts. A thin needle is inserted through the skin below the ribs and into the liver. Dye is injected into the liver or bile ducts and an X-ray is taken. If a blockage is found, a thin, flexible tube called a stent is sometimes left in the liver to drain bile into the small intestine or a collection bag outside the body. This test is done only if ERCP cannot be done.
- Laparoscopy: A surgical procedure to look at the organs inside the abdomen to check for signs of disease. Small incisions (cuts) are made in the wall of the abdomen and a laparoscope (a thin, lighted tube) is inserted into one of the incisions. The laparoscope may have an ultrasound probe at the end in order to bounce high-energy sound waves off internal organs, such as the pancreas. This is called laparoscopic ultrasound. Other instruments may be inserted through the same or other incisions to perform procedures such as taking tissue samples from the pancreas or a sample of fluid from the abdomen to check for cancer.
- Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. There are several ways to do a biopsy for pancreatic cancer. A fine needle or a core needle may be inserted into the pancreas during an X-ray or ultrasound to remove cells. Tissue may also be removed during a laparoscopy.
Treatment
Certain factors affect prognosis (chance of recovery) and treatment options. The prognosis and treatment options depend on the following:
- Whether or not the tumor can be removed by surgery
- The stage of the cancer (the size of the tumor and whether the cancer has spread outside the pancreas to nearby tissues or lymph nodes or to other places in the body)
- The patient’s general health
- Whether the cancer has just been diagnosed or has recurred (come back)
Pancreatic cancer can be controlled only if it is found before it has spread, or when it can be completely removed by surgery. If the cancer has spread, palliative treatment can improve the patient's quality of life by controlling the symptoms and complications of this disease.
Treatment options
There are different types of treatment for patients with pancreatic cancer. Five types of standard treatment are used:
- Surgery
- Radiation therapy
- Chemotherapy
- Chemoradiation therapy
- Targeted therapy
There are treatments for pain caused by pancreatic cancer. Patients with pancreatic cancer have special nutritional needs. New types of treatment are being tested in clinical trials.
Biologic therapy
Patients may want to think about taking part in a clinical trial. Patients can enter clinical trials before, during or after starting their cancer treatment. Follow-up tests may be needed.
There are different types of treatment for patients with pancreatic cancer.
Five types of standard treatment are used:
Surgery
One of the following types of surgery may be used to take out the tumor:
- Whipple procedure: A surgical procedure in which the head of the pancreas, the gallbladder, part of the stomach, part of the small intestine and the bile duct are removed. Enough of the pancreas is left to produce digestive juices and insulin.
- Total pancreatectomy: This operation removes the whole pancreas, part of the stomach, part of the small intestine, the common bile duct, the gallbladder, the spleen and nearby lymph nodes.
- Distal pancreatectomy: The body and the tail of the pancreas and usually the spleen are removed.
- Irreversible Electroporation: UofL Physicians - Surgical Oncology was the first to perform Irreversible Electroporation (IRE) with the Nanoknife System to treat locally advanced pancreatic cancer in the Southeastern United States. A locally advanced pancreatic cancer has grown beyond the confines of the pancreas to invade surrounding vital areas. Patients with locally advanced pancreatic cancer have limited treatment options. The current standard of care is chemotherapy with radiation therapy. Only 5% to 8% percent of patients respond to that type of treatment, and the results are not long-lasting. While using ablation to treat these types of cancers has been used, it can cause major complications to the area. IRE is a non-thermal ablation technology that has been shown to be safe near vital parts of the body. UofL Physicians - Surgical Oncology is trying to determine if the Nanoknife could be used to safely and effectively treat locally advanced pancreatic cancer.
If the cancer has spread and cannot be removed, the following types of palliative surgery may be done to relieve symptoms and improve quality of life:
- Surgical biliary bypass: If cancer is blocking the small intestine and bile is building up in the gallbladder, a biliary bypass may be done. During this operation, the doctor will cut the gallbladder or bile duct and sew it to the small intestine to create a new pathway around the blocked area.
- Endoscopic stent placement: If the tumor is blocking the bile duct, surgery may be done to put in a stent (a thin tube) to drain bile that has built up in the area. The doctor may place the stent through a catheter that drains to the outside of the body or the stent may go around the blocked area and drain the bile into the small intestine.
- Gastric bypass: If the tumor is blocking the flow of food from the stomach, the stomach may be sewn directly to the small intestine so the patient can continue to eat normally.
Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy X-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy:
- External radiation therapy uses a machine outside the body to send radiation toward the cancer.
- Cyberknife radiosurgery, which is not really surgery. The CyberKnife’s robotic arm will position itself around your body, delivering radiation with pinpoint precision.
- Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires or catheters that are placed directly into or near the cancer.
The way the radiation therapy is given depends on the type and stage of the cancer being treated. External radiation therapy is used to treat pancreatic cancer.
Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Combination chemotherapy is treatment using more than one anticancer drug. The way the chemotherapy is given depends on the type and stage of the cancer being treated.
Chemoradiation therapy
Chemoradiation therapy combines chemotherapy and radiation therapy to increase the effects of both.
Targeted therapy
Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. Tyrosine kinase inhibitors (TKIs) are targeted therapy drugs that block signals needed for tumors to grow. Erlotinib is a type of TKI used to treat pancreatic cancer.
Treatments for pain caused by pancreatic cancer
Pain can occur when the tumor presses on nerves or other organs near the pancreas. When pain medicine is not enough, there are treatments that act on nerves in the abdomen to relieve the pain. The doctor may inject medicine into the area around affected nerves or may cut the nerves to block the feeling of pain. Radiation therapy with or without chemotherapy can also help relieve pain by shrinking the tumor.
Patients with pancreatic cancer have special nutritional needs.
Surgery to remove the pancreas may affect its ability to make pancreatic enzymes that help to digest food. As a result, patients may have problems digesting food and absorbing nutrients into the body. To prevent malnutrition, the doctor may prescribe medicines that replace these enzymes.
