Pancreatic cancer is diagnosed in over 43,000 Americans each year, according to the National Cancer Institute. It is the number-four cause of cancer deaths and most often affects individuals over the age of 65.
Symptoms & Causes
The pancreas is a small organ situated behind the stomach that helps food digestion and metabolism.
There are two types of cancer that affect the pancreas: adenocarcinoma and endocrine cancer. Adeonocarcinomas grow in ducts where digestive juices are made. Most pancreatic cancers are of this type. Endocrine cancers develop in pancreatic cells that release hormones, such as insulin.
Symptoms of pancreatic cancer often remain absent until the disease has progressed to an advanced stage. At that time, individuals may notice a condition called jaundice in which the skin yellows. Also, appetite may decrease, and there may be pain in the abdomen and back. Depression may occur.
Both types of pancreatic cancer develop as a result of genetic mutations. Family history, as well as acquired or inherited genetic mutations such as a mutation in a gene called BRCA2 (also a risk factor for breast cancer), can increase the risk of developing pancreatic cancer. Old age, obesity, diabetes and smoking are also risk factors.
Diagnosis & Tests
Often pancreatic cancer is not diagnosed until it has spread beyond the pancreas. Still, early diagnosis does not necessarily improve prognosis since pancreatic cancer grows very quickly.
Several tests exist to diagnose and ‘stage’ pancreatic cancer. Ultrasound, computerized tomography (CT) scan and magnetic resonance imaging (MRI) allow a physician to visualize the location and size of a tumor.
Endoscopic procedures may be employed to see inside the pancreas. These include endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS). In ERCP, a physician inserts an endoscope—a bendable tube with a camera attached at the end—and pushes it down the throat into the small intestine. Next, a catheter is inserted into the endoscope and passed down into the small intestine. The physician then releases dye from the catheter that will illuminate the pancreatic ducts in an X-ray.
In an endoscopic ultrasound, the physician uses an endoscope to move an ultrasound device into the stomach where it creates images.
A biopsy, in which tissue from the tumor is removed for testing in the lab, is typically required to confirm diagnosis. A biopsy may be performed with a needle or through an endoscopic ultrasound.
Finally, blood tests can help physicians determine how far along the cancer has progressed.
Pancreatic cancer may exist in one of four stages. In Stage I, the cancer is still limited to the area of the pancreas. In Stage II, the cancer can be found just outside the pancreas. By Stage III, cancer cells have metastasized to blood vessels and lymph nodes, and in Stage IV it has moved to other organs.
Treatment & Medications
Treatment options depend on the stage of the cancer. According to the National Cancer Institute, pancreatic cancer is only potentially curable if it is diagnosed before it has spread beyond the organ. At that stage, it is possible that surgery can remove the entire tumor.
Radiation and chemotherapy are commonly given following—and sometimes before—surgery to ensure that any remaining cancer cells are destroyed. If surgery is not an option, radiation and chemotherapy may be given as the sole treatment.
Chemotherapy drugs for pancreatic cancer are administered through an I.V. Although they can be effective at killing cancer cells, they also destroy some healthy cells, which can cause side effects such as hair loss and nausea.
Often, drugs aimed at particular aspects of cancer cells may be included in the treatment regimen. Called “targeted therapy”, these drugs include growth factor inhibitors such as erlotinib and anti-angiogenesis factors. Anti-angiogenesis factors prevent the tumor from forming blood vessels that are required for the tumor to grow. These drugs are still in clinical trials for use in pancreatic cancer.
Alternative therapies may help individuals cope with a cancer diagnosis, as well as the stress of the treatment process. Types of alternative treatments include art and music therapy, meditation and exercise such as yoga.
Imaging and genetic tests may be used to screen people that have a family history of the disease. For example, there is a genetic test that looks for alterations in a gene called K-ras that is related to cell growth. According to the American Cancer Society, however, these tests are only currently recommended for high-risk people.
As researchers begin to better understand the process from genetic mutation to cancer development, it may one day be possible to develop better screening methods that are available to the general population, and can diagnose pancreatic cancer earlier.