PANCREATIC CANCER

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Definition

Pancreatic carcinoma is cancer of the pancreas.

Alternative Names

Pancreatic cancer; Cancer - pancreas

Causes, incidence, and risk factors

Pancreatic cancer is slightly more common in men than in women. The risk increases with age.

The cause is unknown, but it is more common in smokers and in people who are obese. Almost a third of cases of pancreatic cancer are due to cigarette smoking.

There is controversy as to whether type 2 diabetes is a risk factor for pancreatic cancer. A small number of cases are known to be related to syndromes that are passed down through families.

Symptoms

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

Signs and tests

• Abdominal CT scan
• Abdominal MRI
• Abdominal ultrasound
• Endoscopic retrograde cholangiopancreatography (ERCP)
• Endoscopic ultrasound
• Pancreatic biopsy

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

• Liver function tests
• Serum bilirubin

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 should be done at centers that perform the procedure frequently. Some studies suggest that surgery is best performed at hospitals that do at least nine 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 drug is gemcitabine, but other drugs may be used. Gemcitabine can help approximately 25% of patients.

For patients who have a blockage of the tubes that transport bile (biliary obstruction) and the tumor cannot be totally removed, the blockage must be relieved. There are generally two approaches to this:

• Surgery
• Placement of a tiny metal tube (biliary stent) that is 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 treating advanced pancreatic cancer. Hospice can help with pain and symptom management, and provide psychological support for patients and their families during the illness.

Reviewer Info: Sean O. Stitham, MD, private practice in Internal Medicine, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc., 08/17/2008