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 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 behind the stomach and in front of the spine.
Anatomy of the pancreas. 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 produce juices that help digest (break down) food.
To produce 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 produced by exocrine pancreas cells and the hormones are produced by endocrine pancreas cells. About 95% of pancreatic cancers begin in exocrine cells.
This summary provides information on exocrine pancreatic cancer. Refer to the PDQ summary on Islet Cell Tumors (Endocrine Pancreas) Treatment for information on endocrine pancreatic cancer.
Smoking and health history can affect the risk of developing pancreatic cancer.
Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer. People who think they may be at risk should discuss this with their doctor. Risk factors for pancreatic cancer include the following:
Smoking.
Long-standing diabetes.
Chronic pancreatitis.
Certain hereditary conditions, such as hereditary pancreatitis, multiple endocrine neoplasia type 1 syndrome, hereditary nonpolyposis colon cancer (HNPCC; Lynch syndrome), von Hippel-Lindau syndrome, ataxia-telangiectasia, and the familial atypical multiple mole melanoma syndrome (FAMMM).
Possible signs of pancreatic cancer include jaundice, pain, and weight loss.
These and other symptoms may be caused by pancreatic cancer. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems occur:
Jaundice (yellowing of the skin and whites of the eyes).
Pain in the upper or middle abdomen and back.
Unexplained weight loss.
Loss of appetite.
Fatigue.
Pancreatic cancer is difficult to detect (find) and diagnose early.
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 of pancreatic cancer, when present, are like the signs 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 (find), diagnose, and stage pancreatic cancer.
Pancreatic cancer is usually diagnosed with tests and procedures that produce 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:
Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
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.
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.
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. This procedure is also called nuclear magnetic resonance imaging (NMRI).
PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radionuclide 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.
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.
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. Other instruments may be inserted through the same or other incisions to perform procedures such as removing organs or taking tissue samples for biopsy.
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.
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 may be inserted into the pancreas during an x-ray or ultrasound to remove cells. Tissue may also be removed during a laparoscopy (a surgical incision made in the wall of the abdomen).
Certain factors affect prognosis (chance of recovery) and treatment options.
The prognosis (chance of recovery) 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, when it can be 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.
Showing posts with label pancreatic. Show all posts
Showing posts with label pancreatic. Show all posts
pancreatic cancer adenocarcinoma
The most common type of cancer of the pancreas is an adenocarcinoma of the pancreas. 85% of all cancerous tumors of the pancreas are adenocarcinomas. Pancreatic adenocarcinoma is the 4th leading cause of cancer deaths in men and women in the United States. The American Cancer Society estimates that each year 29,000 American are diagnosed with adenocarcinoma of the pancreas and approximately 28,000 die of pancreatic cancer.
About 20-40% of patients with pancreatic cancer appear to have the cancer contained entirely within the pancreas at the time of the diagnosis. Surgical removal of the tumor is recommended in this group of patients and this provides the best option for long term survival. Surgery for pancreatic cancer is a highly specialized operation and therefore the patient should be evaluated by a surgeon who is highly experienced in treating this disorder.
About 60-80% of the patients are found to have a locally advanced cancer because it is invading into the surrounding tissues outside the pancreas or where the cancer has metastasized (spread outside of the pancreas).
Risk factors for cancer of the pancreas:
Some of the risk factors for cancer of the pancreas include:
Cigarette Smoking: Cigarette smoking is the single most risk factor for pancreatic cancer. Approximately 30% of pancreatic cancers are thought to be related to excessive cigarette smoking.
Diet: A diet high in meat and fats increase pancreatic cancer risks while fruits, vegetables and dietary fiber appear to have a protective effect.
Diabetes Mellitus: While it is not clear whether diabetes mellitus is a risk factor for pancreatic cancer often patients develop diabetes few months to two to three years prior to manifestation of their cancer. Development of diabetes in an elderly patient should raise concern for pancreatic cancer and lead to a work up for pancreatic cancer.
Chronic pancreatitis: Chronic pancreatitis is long term inflammation of the pancreas. This condition is associated as an increased risk for pancreatic cancer.
Family History: Cancer of the pancreas seems to run in some families. An inherited tendency to develop this cancer may occur in about 5 to 10% of all cases of pancreatic cancer. Some of the DNA changes that give rise to pancreatic cancer can be recognized by genetic testing.
Staging and treatment of pancreatic cancer:
A simplified staging of pancreatic cancer places patients in the following groups for determining appropriate treatment:
Surgically resectable (removable) pancreatic cancer
Advance cancer that is surgically not removable with no evidence of spread to other organs
Metastatic cancer or cancer that has spread to other organs
Resectable (surgically removable) pancreatic cancer
For patients whose tumors are in the pancreas based on information from preoperative staging removal of the tumor by surgical means is the optimal form of therapy.
The type of the surgery depends on the location of the tumor. For tumors that are located in the first part or the head of the pancreas a whipple operation is the required treatment.
For patients whose tumors are located in the body and tail of the pancreas removal of the bottom half with a distal pancreatectomy together with removal of the spleen is the preferred form of surgical treatment.
All patients who undergo resection (removal) of the pancreas will require chemotherapy and/or radiation therapy after the surgery.
Locally advanced cancer:
Here the cancer has grown outside the pancreas to involve surrounding structures particularly blood vessels that are closely associated with the pancreas such as the superior mesenteric artery and superior mesenteric vein. Invasion of the cancer into these blood vessels precludes surgical removal of the tumor.
A determination of a locally advanced cancer should be made by an experienced surgeon based on careful evaluation of radiological (x-ray) studies such as a high quality CT scan. It is important to note that CT scans that are not done in centers specialized in the treatment of pancreatic cancer may not provide optimal information for staging of patients with pancreatic cancer. Removal of the pancreas for pancreatic cancer is a highly specialized operation and therefore the evaluation of the patient for possible surgery should be by a surgeon who is highly experienced in treating this disorder.
In patients who are determined to have unresectable cancer at a center specialized in the treatment of pancreatic cancer, treatment with chemotherapy and/or radiation therapy is recommended since this treatment has been shown clinical studies to provide improved survival.
Some patients with locally advanced tumor may have excellent response to chemotherapy and/or radiation therapy and shrinkage of the tumor may allow an experienced pancreatic surgeon to remove the cancer.
Metastatic pancreatic cancer:
In patients with metastatic pancreatic cancer the tumor is found to have spread outside of the pancreas. The common sites for spread of the tumor is to the liver and to the lining of the intestines or peritoneal surfaces. In general the prognosis is poor when pancreatic cancer is metastatic and treatment is directed toward relief of symptoms to provide a good quality of life. In some patients chemotherapy may provide an improvement in their symptoms.
About 20-40% of patients with pancreatic cancer appear to have the cancer contained entirely within the pancreas at the time of the diagnosis. Surgical removal of the tumor is recommended in this group of patients and this provides the best option for long term survival. Surgery for pancreatic cancer is a highly specialized operation and therefore the patient should be evaluated by a surgeon who is highly experienced in treating this disorder.
About 60-80% of the patients are found to have a locally advanced cancer because it is invading into the surrounding tissues outside the pancreas or where the cancer has metastasized (spread outside of the pancreas).
Risk factors for cancer of the pancreas:
Some of the risk factors for cancer of the pancreas include:
Cigarette Smoking: Cigarette smoking is the single most risk factor for pancreatic cancer. Approximately 30% of pancreatic cancers are thought to be related to excessive cigarette smoking.
Diet: A diet high in meat and fats increase pancreatic cancer risks while fruits, vegetables and dietary fiber appear to have a protective effect.
Diabetes Mellitus: While it is not clear whether diabetes mellitus is a risk factor for pancreatic cancer often patients develop diabetes few months to two to three years prior to manifestation of their cancer. Development of diabetes in an elderly patient should raise concern for pancreatic cancer and lead to a work up for pancreatic cancer.
Chronic pancreatitis: Chronic pancreatitis is long term inflammation of the pancreas. This condition is associated as an increased risk for pancreatic cancer.
Family History: Cancer of the pancreas seems to run in some families. An inherited tendency to develop this cancer may occur in about 5 to 10% of all cases of pancreatic cancer. Some of the DNA changes that give rise to pancreatic cancer can be recognized by genetic testing.
Staging and treatment of pancreatic cancer:
A simplified staging of pancreatic cancer places patients in the following groups for determining appropriate treatment:
Surgically resectable (removable) pancreatic cancer
Advance cancer that is surgically not removable with no evidence of spread to other organs
Metastatic cancer or cancer that has spread to other organs
Resectable (surgically removable) pancreatic cancer
For patients whose tumors are in the pancreas based on information from preoperative staging removal of the tumor by surgical means is the optimal form of therapy.
The type of the surgery depends on the location of the tumor. For tumors that are located in the first part or the head of the pancreas a whipple operation is the required treatment.
For patients whose tumors are located in the body and tail of the pancreas removal of the bottom half with a distal pancreatectomy together with removal of the spleen is the preferred form of surgical treatment.
All patients who undergo resection (removal) of the pancreas will require chemotherapy and/or radiation therapy after the surgery.
Locally advanced cancer:
Here the cancer has grown outside the pancreas to involve surrounding structures particularly blood vessels that are closely associated with the pancreas such as the superior mesenteric artery and superior mesenteric vein. Invasion of the cancer into these blood vessels precludes surgical removal of the tumor.
A determination of a locally advanced cancer should be made by an experienced surgeon based on careful evaluation of radiological (x-ray) studies such as a high quality CT scan. It is important to note that CT scans that are not done in centers specialized in the treatment of pancreatic cancer may not provide optimal information for staging of patients with pancreatic cancer. Removal of the pancreas for pancreatic cancer is a highly specialized operation and therefore the evaluation of the patient for possible surgery should be by a surgeon who is highly experienced in treating this disorder.
In patients who are determined to have unresectable cancer at a center specialized in the treatment of pancreatic cancer, treatment with chemotherapy and/or radiation therapy is recommended since this treatment has been shown clinical studies to provide improved survival.
Some patients with locally advanced tumor may have excellent response to chemotherapy and/or radiation therapy and shrinkage of the tumor may allow an experienced pancreatic surgeon to remove the cancer.
Metastatic pancreatic cancer:
In patients with metastatic pancreatic cancer the tumor is found to have spread outside of the pancreas. The common sites for spread of the tumor is to the liver and to the lining of the intestines or peritoneal surfaces. In general the prognosis is poor when pancreatic cancer is metastatic and treatment is directed toward relief of symptoms to provide a good quality of life. In some patients chemotherapy may provide an improvement in their symptoms.
pancreatic cancer:stages and treatment
If the doctor finds pancreatic cancer, the patient will have more tests to find out if the cancer has spread from the pancreas to the tissues around it or to other parts of the body. This process of testing is called staging, and it helps the doctor plan the patient’s treatment. The following stages are used to describe exocrine cancer of the pancreas:
Stage I: Cancer is found only in the pancreas itself and not in other organs.
Stage II: Cancer has spread to nearby organs, such as the duodenum or bile duct, but has not entered the lymph nodes.
Stage III: Cancer has spread to lymph nodes near the pancreas. The cancer may or may not have spread to nearby organs.
Stage IVA: Cancer has spread to organs, such as the stomach, spleen, and colon, that are near the pancreas, but it has not spread to distant organs, such as the liver or lungs.
Stage IVB: Cancer has spread to organs, such as the stomach, spleen, or colon, that are near the pancreas or to places far away from the pancreas, such as the liver or lungs.
Recurrent: The cancer has come back (recurred) after it has been treated. It may come back in the pancreas or in another part of the body.
Islet cell cancers of the pancreas are usually grouped into three stages: those occurring in one site within the pancreas; those occurring in several sites within the pancreas; and those that have spread to lymph nodes near the pancreas or to distant sites.
Surgery may be used to take out the tumor. A doctor may take out the cancer using one of the following operations:
Whipple Procedure (pancreaticoduodenectomy): In this procedure, the surgeon removes the head of the pancreas, part of the small intestine, and some of the nearby tissues. Enough of the pancreas is left to continue making digestive juices and insulin. This is the most common procedure used for removing cancer of the exocrine pancreas
Pancreatectomy: The surgeon removes the whole pancreas, part of the small intestine, part of the stomach, the bile duct, the gallbladder, the spleen, and most of the lymph nodes in the area.
Distal Pancreatectomy: The body and tail of the pancreas are removed. This procedure is most commonly used for islet cell (endocrine) cancer of the pancreas and is rarely used for cancer of the exocrine pancreas.
If the cancer has spread and it cannot be removed, the doctor may do surgery to relieve symptoms. If the cancer is blocking the small intestine and bile builds up in the gallbladder, the doctor may do surgery to go around (bypass) all or part of the small intestine. During this operation, the doctor will cut the gallbladder or bile duct and sew it to the small intestine. This is called biliary bypass.
Surgery or X-ray procedures may also be done to put in a tube (catheter) to drain bile that has built up in the area. The catheter may drain through a tube to the outside of the body or it may go around the blocked area and drain the bile to the small intestine. In addition, if the cancer 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 uses high-energy X-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes in the area where the cancer cells are found (internal radiation therapy).
Chemotherapy is the use of drugs to kill cancer cells. Most anticancer drugs are injected into a vein (IV) or a muscle; some are given by mouth. Chemotherapy is a systemic treatment, meaning that the drugs flow through the bloodstream to nearly every part of the body to kill cancerous cells. It is generally given in cycles: A treatment period is followed by a recovery period, then another treatment period, and so on.
The use of biological therapy (using the body’s immune system to fight cancer) is being tested for pancreatic cancer. Biological therapy searches for ways that the cancer tissue is different from normal pancreas tissue, and tries to get the body to fight the cancer. It uses materials made by the body or made in a laboratory to boost, direct, or restore the body’s natural defenses against disease. Biological therapies are sometimes called biological response modifier (BRM) therapy or immunotherapy
Stage I: Cancer is found only in the pancreas itself and not in other organs.
Stage II: Cancer has spread to nearby organs, such as the duodenum or bile duct, but has not entered the lymph nodes.
Stage III: Cancer has spread to lymph nodes near the pancreas. The cancer may or may not have spread to nearby organs.
Stage IVA: Cancer has spread to organs, such as the stomach, spleen, and colon, that are near the pancreas, but it has not spread to distant organs, such as the liver or lungs.
Stage IVB: Cancer has spread to organs, such as the stomach, spleen, or colon, that are near the pancreas or to places far away from the pancreas, such as the liver or lungs.
Recurrent: The cancer has come back (recurred) after it has been treated. It may come back in the pancreas or in another part of the body.
Islet cell cancers of the pancreas are usually grouped into three stages: those occurring in one site within the pancreas; those occurring in several sites within the pancreas; and those that have spread to lymph nodes near the pancreas or to distant sites.
Surgery may be used to take out the tumor. A doctor may take out the cancer using one of the following operations:
Whipple Procedure (pancreaticoduodenectomy): In this procedure, the surgeon removes the head of the pancreas, part of the small intestine, and some of the nearby tissues. Enough of the pancreas is left to continue making digestive juices and insulin. This is the most common procedure used for removing cancer of the exocrine pancreas
Pancreatectomy: The surgeon removes the whole pancreas, part of the small intestine, part of the stomach, the bile duct, the gallbladder, the spleen, and most of the lymph nodes in the area.
Distal Pancreatectomy: The body and tail of the pancreas are removed. This procedure is most commonly used for islet cell (endocrine) cancer of the pancreas and is rarely used for cancer of the exocrine pancreas.
If the cancer has spread and it cannot be removed, the doctor may do surgery to relieve symptoms. If the cancer is blocking the small intestine and bile builds up in the gallbladder, the doctor may do surgery to go around (bypass) all or part of the small intestine. During this operation, the doctor will cut the gallbladder or bile duct and sew it to the small intestine. This is called biliary bypass.
Surgery or X-ray procedures may also be done to put in a tube (catheter) to drain bile that has built up in the area. The catheter may drain through a tube to the outside of the body or it may go around the blocked area and drain the bile to the small intestine. In addition, if the cancer 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 uses high-energy X-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes in the area where the cancer cells are found (internal radiation therapy).
Chemotherapy is the use of drugs to kill cancer cells. Most anticancer drugs are injected into a vein (IV) or a muscle; some are given by mouth. Chemotherapy is a systemic treatment, meaning that the drugs flow through the bloodstream to nearly every part of the body to kill cancerous cells. It is generally given in cycles: A treatment period is followed by a recovery period, then another treatment period, and so on.
The use of biological therapy (using the body’s immune system to fight cancer) is being tested for pancreatic cancer. Biological therapy searches for ways that the cancer tissue is different from normal pancreas tissue, and tries to get the body to fight the cancer. It uses materials made by the body or made in a laboratory to boost, direct, or restore the body’s natural defenses against disease. Biological therapies are sometimes called biological response modifier (BRM) therapy or immunotherapy
pancreatic cancer:
Pancreatic cancer is a malignant neoplasm of the pancreas. Each year in the United States, about 42,470 individuals are diagnosed with this condition and 35,240 die from the disease. The prognosis is generally poor; less than 5 percent of those diagnosed are still alive five years after diagnosis. Complete remission is still extremely rare. About 95% of exocrine pancreatic cancers are adenocarcinomas (M8140/3). The remaining 5% include adenosquamous carcinomas, signet ring cell carcinomas, hepatoid carcinomas, colloid carcinomas, undifferentiated carcinomas, and undifferentiated carcinomas with osteoclast-like giant cells. Exocrine pancreatic cancers are far more common than endocrine pancreatic cancers (also known as islet cell carcinomas), which make up about 1% of total cases.
Contents:
1 Signs and symptoms
1.1 Presentation
1.2 Predisposing factors
1.2.1 Alcohol
2 Diagnosis
3 Treatment
3.1 Surgery
3.2 Chemotherapy
4 Prognosis
5 Prevention
6 See also
7 References
8 External links
Signs and symptoms;
Presentation:
Pancreatic cancer is sometimes called a "silent killer" because early pancreatic cancer often does not cause symptoms and the later symptoms are usually non-specific and varied.Therefore, pancreatic cancer is often not diagnosed until it is advanced.
Common symptoms include:
Pain in the upper abdomen that typically radiates to the back (seen in carcinoma of the body or tail of the pancreas)
Loss of appetite (anorexia), and/or nausea and vomiting
Significant weight loss
Painless jaundice (yellow skin/eyes, dark urine) when a cancer of the head of the pancreas (about 60% of cases) obstructs the common bile duct as it runs through the pancreas. This may also cause pale-colored stool and steatorrhea.
Trousseau sign, in which blood clots form spontaneously in the portal blood vessels, the deep veins of the extremities, or the superficial veins anywhere on the body, is sometimes associated with pancreatic cancer.
Diabetes mellitus, or elevated blood sugar levels. Many patients with pancreatic cancer develop diabetes months to even years before they are diagnosed with pancreatic cancer, suggestion that new onset diabetes in an elderly individual may be an early warning sign of pancreatic cancer.
Clinical depression has been reported in association with pancreatic cancer, sometimes presenting before the cancer is diagnosed. However, the mechanism for this association is not known.
Predisposing factors:
Risk factors for pancreatic cancer include:
Age (particularly over 60)
Male gender
African-American ethnicity
Smoking. Cigarette smoking has a risk ratio of 1.74 with regard to pancreatic cancer; a decade of non-smoking after heavy smoking is associated with a risk ratio of 1.2.
Diets low in vegetables and fruitsDiets high in red meat
Obesity
Diabetes mellitus is both risk factor for pancreatic cancer, and, as noted earlier, new onset diabetes can be an early sign of the disease.
Chronic pancreatitis has been linked, but is not known to be causal. The risk of pancreatic cancer in individuals with familial pancreatitis is particularly high.
Helicobacter pylori infection
Family history, 5–10% of pancreatic cancer patients have a family history of pancreatic cancer. The genes responsible for most of this clustering in families have yet to be identified. Pancreatic cancer has been associated with the following syndromes; autosomal recessive ataxia-telangiectasia and autosomal dominantly inherited mutations in the BRCA2 gene and PALB2 gene, Peutz-Jeghers syndrome due to mutations in the STK11 tumor suppressor gene, hereditary non-polyposis colon cancer (Lynch syndrome), familial adenomatous polyposis, and the familial atypical multiple mole melanoma-pancreatic cancer syndrome (FAMMM-PC) due to mutations in the CDKN2A tumor suppressor gene.Gingivitis or periodontal disease
Alcohol:
It is controversial whether alcohol consumption is a risk factor for pancreatic cancer. Drinking alcohol excessively is a major cause of chronic pancreatitis, which in turn predisposes to pancreatic cancer, but "chronic pancreatitis that is due to alcohol doesn't increase risk as much as other types of chronic pancreatitis."[clarification needed)Overall, the association is consistently weak and the majority of studies have found no association.
Some studies suggest a relationship, with risk increasing with increasing amount of alcohol intake.Risk is greatest in heavy drinkers mostly on the order of four or more drinks per day. But there appears to be no increased risk for people consuming up to 30g of alcohol a day so most of the U.S. consumes alcohol at a level that "is probably not a risk factor for pancreatic cancer.
Several studies caution that their findings could be due to confounding factors.Even if a link exists, it "could be due to the contents of some alcoholic beverages' other than the alcohol itself. One Dutch study even found that drinkers of white wine had lower risk.A pooled analysis concluded, "Our findings are consistent with a modest increase in risk of pancreatic cancer with consumption of 30 or more grams of alcohol per day.
Diagnosis:
Most patients with pancreatic cancer experience pain, weight loss, or jaundice.
Pain is present in 80 to 85 percent of patients with locally advanced or advanced metastic disease. The pain is usually felt in the upper abdomen as a dull ache that radiates straight through to the back. It may be intermittent and made worse by eating. Weight loss can be profound; it can be associated with anorexia, early satiety, diarrhea, or steatorrhea. Jaundice is often accompanied by pruritus and dark urine. Painful jaundice is present in approximately one-half of patients with locally unresectable disease, while painless jaundice is present in approximately one-half of patients with a potentially resectable and curable lesion.
The initial presentation varies according to location of the cancer. Malignancies in the pancreatic body or tail usually present with pain and weight loss, while those in the head of the gland typically present with steatorrhea, weight loss, and jaundice. The recent onset of atypical diabetes mellitus, a history of recent but unexplained thrombophlebitis (Trousseau sign), or a previous attack of pancreatitis are sometimes noted.
Courvoisier sign defines the presence of jaundice and a painlessly distended gallbladder as strongly indicative of pancreatic cancer, and may be used to distinguish pancreatic cancer from gallstones.
Tiredness, irritability and difficulty eating due to pain also exist. Pancreatic cancer is usually discovered during the course of the evaluation of aforementioned symptoms.
Liver function tests can show a combination of results indicative of bile duct obstruction (raised conjugated bilirubin, γ-glutamyl transpeptidase and alkaline phosphatase levels). CA19-9 (carbohydrate antigen 19.9) is a tumor marker that is frequently elevated in pancreatic cancer. However, it lacks sensitivity and specificity. When a cutoff above 37 U/mL is used, this marker has a sensitivity of 77% and specificity of 87% in discerning benign from malignant disease. CA 19-9 might be normal early in the course, and could be elevated due to benign causes of biliary obstruction.Imaging studies, such as computed tomography (CT scan) can be used to identify the location of the cancer. Endoscopic ultrasound (EUS) is another procedure that can help visualize the location and can serve to guide a percutaneous needle biopsy, which is necessary to establish a definitive diagnosis.
Treatment:
surgery:Treatment of pancreatic cancer depends on the stage of the cancer.[35] The Whipple procedure is the most common surgical treatment for cancers involving the head of the pancreas. It can only be performed if the patient is likely to survive major surgery and if the cancer is localized without invading local structures or metastasizing. It can therefore only be performed in the minority of cases.
Spleen-preserving distal pancreatectomy can also be used as a method to remove a cancer running through centre of pancreas; this is invasive surgery, resulting in loss of body and tail. Cancers of the tail of the pancreas can be resected using a procedure known as a distal pancreatectomy.[35] Recently, localized cancers of the pancreas have been resected using minimally invasive (laparoscopic) approaches.
After surgery, adjuvant chemotherapy with gemcitabine has in several large randomized studies been shown to significantly increase the 5-year survival.
Surgery can be performed for palliation, if the malignancy is invading or compressing the duodenum or colon. In that case, bypass surgery might overcome the obstruction and improve quality of life, but it is not intended as a cure.
Chemotherapy:
In patients not suitable for resection with curative intent, palliative chemotherapy may be used to improve quality of life and gain a modest survival benefit. Gemcitabine was approved by the United States Food and Drug Administration in 1998 after a clinical trial reported improvements in quality of life in patients with advanced pancreatic cancer. This marked the first FDA approval of a chemotherapy drug for a non-survival clinical trial endpoint.
Prognosis:
Patients diagnosed with pancreatic cancer typically have a poor prognosis partly because the cancer usually causes no symptoms early on, leading to locally advanced or metastatic disease at time of diagnosis. Median survival from diagnosis is around 3 to 6 months; 5-year survival is less than 5%.With 37,170 cases diagnosed in the United States in 2007, and 33,700 deaths, pancreatic cancer has one of the highest fatality rates of all cancers and is the fourth highest cancer killer in the United States among both men and women. Although it accounts for only 2.5% of new cases, pancreatic cancer is responsible for 6% of cancer deaths each year.
Pancreatic cancer may occasionally result in diabetes. Insulin production is hampered and it has been suggested that the cancer can also prompt the onset of diabetes and vice versa. Thus diabetes is both a risk factor for the development of pancreatic cancer and diabetes can be an early sign of the disease in the elderly.
Prevention:
According to the American Cancer Society, there are no established guidelines for preventing pancreatic cancer, although cigarette smoking has been reported as responsible for 20–30% of pancreatic cancers.
The ACS recommends keeping a healthy weight, and increasing consumption of fruits, vegetables, and whole grains while decreasing red meat intake, although there is no consistent evidence that this will prevent or reduce pancreatic cancer specifically.
Contents:
1 Signs and symptoms
1.1 Presentation
1.2 Predisposing factors
1.2.1 Alcohol
2 Diagnosis
3 Treatment
3.1 Surgery
3.2 Chemotherapy
4 Prognosis
5 Prevention
6 See also
7 References
8 External links
Signs and symptoms;
Presentation:
Pancreatic cancer is sometimes called a "silent killer" because early pancreatic cancer often does not cause symptoms and the later symptoms are usually non-specific and varied.Therefore, pancreatic cancer is often not diagnosed until it is advanced.
Common symptoms include:
Pain in the upper abdomen that typically radiates to the back (seen in carcinoma of the body or tail of the pancreas)
Loss of appetite (anorexia), and/or nausea and vomiting
Significant weight loss
Painless jaundice (yellow skin/eyes, dark urine) when a cancer of the head of the pancreas (about 60% of cases) obstructs the common bile duct as it runs through the pancreas. This may also cause pale-colored stool and steatorrhea.
Trousseau sign, in which blood clots form spontaneously in the portal blood vessels, the deep veins of the extremities, or the superficial veins anywhere on the body, is sometimes associated with pancreatic cancer.
Diabetes mellitus, or elevated blood sugar levels. Many patients with pancreatic cancer develop diabetes months to even years before they are diagnosed with pancreatic cancer, suggestion that new onset diabetes in an elderly individual may be an early warning sign of pancreatic cancer.
Clinical depression has been reported in association with pancreatic cancer, sometimes presenting before the cancer is diagnosed. However, the mechanism for this association is not known.
Predisposing factors:
Risk factors for pancreatic cancer include:
Age (particularly over 60)
Male gender
African-American ethnicity
Smoking. Cigarette smoking has a risk ratio of 1.74 with regard to pancreatic cancer; a decade of non-smoking after heavy smoking is associated with a risk ratio of 1.2.
Diets low in vegetables and fruitsDiets high in red meat
Obesity
Diabetes mellitus is both risk factor for pancreatic cancer, and, as noted earlier, new onset diabetes can be an early sign of the disease.
Chronic pancreatitis has been linked, but is not known to be causal. The risk of pancreatic cancer in individuals with familial pancreatitis is particularly high.
Helicobacter pylori infection
Family history, 5–10% of pancreatic cancer patients have a family history of pancreatic cancer. The genes responsible for most of this clustering in families have yet to be identified. Pancreatic cancer has been associated with the following syndromes; autosomal recessive ataxia-telangiectasia and autosomal dominantly inherited mutations in the BRCA2 gene and PALB2 gene, Peutz-Jeghers syndrome due to mutations in the STK11 tumor suppressor gene, hereditary non-polyposis colon cancer (Lynch syndrome), familial adenomatous polyposis, and the familial atypical multiple mole melanoma-pancreatic cancer syndrome (FAMMM-PC) due to mutations in the CDKN2A tumor suppressor gene.Gingivitis or periodontal disease
Alcohol:
It is controversial whether alcohol consumption is a risk factor for pancreatic cancer. Drinking alcohol excessively is a major cause of chronic pancreatitis, which in turn predisposes to pancreatic cancer, but "chronic pancreatitis that is due to alcohol doesn't increase risk as much as other types of chronic pancreatitis."[clarification needed)Overall, the association is consistently weak and the majority of studies have found no association.
Some studies suggest a relationship, with risk increasing with increasing amount of alcohol intake.Risk is greatest in heavy drinkers mostly on the order of four or more drinks per day. But there appears to be no increased risk for people consuming up to 30g of alcohol a day so most of the U.S. consumes alcohol at a level that "is probably not a risk factor for pancreatic cancer.
Several studies caution that their findings could be due to confounding factors.Even if a link exists, it "could be due to the contents of some alcoholic beverages' other than the alcohol itself. One Dutch study even found that drinkers of white wine had lower risk.A pooled analysis concluded, "Our findings are consistent with a modest increase in risk of pancreatic cancer with consumption of 30 or more grams of alcohol per day.
Diagnosis:
Most patients with pancreatic cancer experience pain, weight loss, or jaundice.
Pain is present in 80 to 85 percent of patients with locally advanced or advanced metastic disease. The pain is usually felt in the upper abdomen as a dull ache that radiates straight through to the back. It may be intermittent and made worse by eating. Weight loss can be profound; it can be associated with anorexia, early satiety, diarrhea, or steatorrhea. Jaundice is often accompanied by pruritus and dark urine. Painful jaundice is present in approximately one-half of patients with locally unresectable disease, while painless jaundice is present in approximately one-half of patients with a potentially resectable and curable lesion.
The initial presentation varies according to location of the cancer. Malignancies in the pancreatic body or tail usually present with pain and weight loss, while those in the head of the gland typically present with steatorrhea, weight loss, and jaundice. The recent onset of atypical diabetes mellitus, a history of recent but unexplained thrombophlebitis (Trousseau sign), or a previous attack of pancreatitis are sometimes noted.
Courvoisier sign defines the presence of jaundice and a painlessly distended gallbladder as strongly indicative of pancreatic cancer, and may be used to distinguish pancreatic cancer from gallstones.
Tiredness, irritability and difficulty eating due to pain also exist. Pancreatic cancer is usually discovered during the course of the evaluation of aforementioned symptoms.
Liver function tests can show a combination of results indicative of bile duct obstruction (raised conjugated bilirubin, γ-glutamyl transpeptidase and alkaline phosphatase levels). CA19-9 (carbohydrate antigen 19.9) is a tumor marker that is frequently elevated in pancreatic cancer. However, it lacks sensitivity and specificity. When a cutoff above 37 U/mL is used, this marker has a sensitivity of 77% and specificity of 87% in discerning benign from malignant disease. CA 19-9 might be normal early in the course, and could be elevated due to benign causes of biliary obstruction.Imaging studies, such as computed tomography (CT scan) can be used to identify the location of the cancer. Endoscopic ultrasound (EUS) is another procedure that can help visualize the location and can serve to guide a percutaneous needle biopsy, which is necessary to establish a definitive diagnosis.
Treatment:
surgery:Treatment of pancreatic cancer depends on the stage of the cancer.[35] The Whipple procedure is the most common surgical treatment for cancers involving the head of the pancreas. It can only be performed if the patient is likely to survive major surgery and if the cancer is localized without invading local structures or metastasizing. It can therefore only be performed in the minority of cases.
Spleen-preserving distal pancreatectomy can also be used as a method to remove a cancer running through centre of pancreas; this is invasive surgery, resulting in loss of body and tail. Cancers of the tail of the pancreas can be resected using a procedure known as a distal pancreatectomy.[35] Recently, localized cancers of the pancreas have been resected using minimally invasive (laparoscopic) approaches.
After surgery, adjuvant chemotherapy with gemcitabine has in several large randomized studies been shown to significantly increase the 5-year survival.
Surgery can be performed for palliation, if the malignancy is invading or compressing the duodenum or colon. In that case, bypass surgery might overcome the obstruction and improve quality of life, but it is not intended as a cure.
Chemotherapy:
In patients not suitable for resection with curative intent, palliative chemotherapy may be used to improve quality of life and gain a modest survival benefit. Gemcitabine was approved by the United States Food and Drug Administration in 1998 after a clinical trial reported improvements in quality of life in patients with advanced pancreatic cancer. This marked the first FDA approval of a chemotherapy drug for a non-survival clinical trial endpoint.
Prognosis:
Patients diagnosed with pancreatic cancer typically have a poor prognosis partly because the cancer usually causes no symptoms early on, leading to locally advanced or metastatic disease at time of diagnosis. Median survival from diagnosis is around 3 to 6 months; 5-year survival is less than 5%.With 37,170 cases diagnosed in the United States in 2007, and 33,700 deaths, pancreatic cancer has one of the highest fatality rates of all cancers and is the fourth highest cancer killer in the United States among both men and women. Although it accounts for only 2.5% of new cases, pancreatic cancer is responsible for 6% of cancer deaths each year.
Pancreatic cancer may occasionally result in diabetes. Insulin production is hampered and it has been suggested that the cancer can also prompt the onset of diabetes and vice versa. Thus diabetes is both a risk factor for the development of pancreatic cancer and diabetes can be an early sign of the disease in the elderly.
Prevention:
According to the American Cancer Society, there are no established guidelines for preventing pancreatic cancer, although cigarette smoking has been reported as responsible for 20–30% of pancreatic cancers.
The ACS recommends keeping a healthy weight, and increasing consumption of fruits, vegetables, and whole grains while decreasing red meat intake, although there is no consistent evidence that this will prevent or reduce pancreatic cancer specifically.
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