Alternate Names: Pancreatic cancer; Cancer - pancreas

Causes and Risks: Pancreatic cancer is the 4th leading cause of death from cancer in the U.S. The disease is slightly more common in men than women and increases with age. The cause is unknown, but the incidence is greater in smokers and almost one third of cases can be attributed to cigarette smoking. A small minority of cases are related to hereditary syndromes.

Prevention: If you smoke, stop smoking. If your diet is high in fat, dietary adjustments may help reduce the risk.

Symptoms:

• weight loss
• abdominal pain
• loss of appetite
• jaundice
• nausea
• weakness
• fatigue
• vomiting
• diarrhea
• indigestion
• back pain
• stools, clay colored
• paleness
• depression

Signs and Tests:

• ERCP
• abdominal CT scan
• pancreatic biopsy
• abdominal ultrasound
• abdominal MRI

• 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 used is called a pancreaticoduodenectomy (Whipple procedure). This surgery for pancreatic cancer should be done at centers that perform this procedure frequently. Some studies suggest that surgery is best performed at hospitals that perform at least 9 pancreatic resections per year.

When the tumor is confined to the area of the pancreas but cannot be removed, a combination of radiation therapy and chemotherapy may be recommended. When the tumor has spread to other organs (metastasized) such as the liver, chemotherapy alone is usually used. The standard chemotherapy agent used is gemcitabine, but other drugs may be active. Gemcitabine provides clinical improvement in approximately 50% of patients.

For patients in whom there is biliary obstruction and in whom the tumor cannot be totally removed, relief of biliary obstruction is needed. 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 their illness.

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

Prognosis:

For patients with pancreatic cancer that can be surgically removed (resectable), some patients are cured but cure rates are significantly less than 50%. Chemotherapy and radiation are often given after surgery to attempt to increase the cure rate. Patients with resectable pancreatic cancer should consider enrollment on clinical trials.

For patients with unresectable pancreatic cancer or cancer that has spread beyond the pancreas, cure is not currently possible. Average (median) survival is generally less than one year, though some patients will live longer than a year.

Complications:

Pancreatic cancer can result in weight loss, liver dysfunction, infections and pain. Most patients die from disease. However symptoms such as pain can usually be controlled with aggressive pain management.

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