What is pancreatic cancer?
Pancreatic cancer happens when cells that aren't normal grow and start to form tumours in the pancreas, a small organ located deep in the belly, behind your stomach.
The pancreas makes juices that help your body digest food. It also makes insulin and other hormones that help control your blood sugar.
There are two main types of pancreatic tumours: exocrine and endocrine. The type of tumour depends on which type of cells are involved. Exocrine (say "EX-oh-krin") cells make digestive juices. Endocrine (say "EN-doh-krin") cells make insulin. Most people with pancreatic cancer have exocrine tumours, which grow faster than endocrine tumours.
Treatments are more successful when cancer is found early. But in most cases, pancreatic cancer has already spread by the time it is found. Still, treatment may help you feel better, and it helps some people live longer.
What causes pancreatic cancer?
Experts don't know what causes pancreatic cancer. But they do know that changes in the body's DNA play a role in many cancers.
What are the symptoms?
Pancreatic cancer rarely causes symptoms until it has spread. Then, symptoms may include pain in the upper belly or the back, weight loss, extreme tiredness, and jaundice.
How is pancreatic cancer diagnosed?
There are not yet any tests that work well for finding pancreatic cancer in its early stages.
You may also have a biopsy. This means taking a tissue sample from the pancreas and checking it under a microscope.
What increases the risk of pancreatic cancer?
Your risk of getting pancreatic cancer is higher if you:
- Have diabetes.
- Have chronic pancreatitis.
- Have a family history of pancreatic cancer.
- Have certain rare inherited conditions, such as hereditary pancreatitis or Lynch syndrome.
How is it treated?
Surgery, chemotherapy, and radiation are the main treatments for pancreatic cancer. Although treatment doesn't usually cure the cancer, it may help you feel better and live longer.
This cancer is rarely found before it has grown. But when it is found early, treatment can help the person live longer. Statistics show that for every 100 people whose cancer is found early, about 23 will live at least 5 more years.footnote 1
Finding out that you have cancer can change your life. You may feel like your world has turned upside down and you've lost control. Talking with family, friends, and a counsellor can really help. Ask your doctor about support groups. Or call the Canadian Cancer Society (1-888-939-3333) or visit its website at www.cancer.ca.
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Pancreatic cancer usually doesn't cause symptoms at first. It's silent and painless. Symptoms usually don't begin until the cancer has spread. They may include:
- Pain in the upper belly or back.
- Jaundice. This yellowing of the skin and whites of the eyes can happen when the growing tumour presses the bile duct closed.
- Unexpected weight loss.
- Loss of appetite.
- Extreme tiredness.
Of course, there are other conditions that cause these symptoms, so they don't necessarily mean you have cancer. But it's important to talk to your doctor if you have any of these problems.
Examinations and Tests
To look for or diagnose pancreatic cancer, your doctor may use these tests:
- Blood chemistry screen . A sample of your blood is checked to measure levels of bilirubin and other substances.
- Tumour marker tests . These tests look for signs of cancer in samples of urine, blood, or tissue.
- CT scan or MRI . You lie on a table while a large scanner takes images. Dye may be injected in your arm or swallowed to make the images clearer.
- PET scan . A radioactive liquid called a tracer is injected in your arm. When the tracer has had time to reach your pancreas, you lie on a table while a large scanner takes pictures.
- Endoscopic ultrasound . A small tube is inserted through your mouth and down into your digestive system. A camera at the end of the tube takes ultrasound pictures of the pancreas. The doctor can also insert a needle through the tube to collect tissue samples.
- Endoscopic retrograde cholangiopancreatogram . A small tube is inserted through your mouth and down into your digestive system. Dye is injected through the tube, and X-rays are taken.
- Percutaneous transhepatic cholangiogram. Dye is injected through the skin into the bile ducts, and X-rays are taken.
Imaging tests can show evidence of pancreatic cancer. But your doctor may also order a biopsy. This means getting a sample of tissue from the pancreas to see if it contains cancer cells. There are two main kinds:
- Laparoscopy . The doctor makes a small cut in your skin and inserts a small tube with a camera on the end. When the camera reaches the pancreas, the doctor can use the same tube to collect tissue samples.
- Needle biopsy . Tissue samples are collected through a needle. This may be done with a needle inserted through the skin and into the pancreas or as part of an endoscopy.
Staging and grading
An important part of treating most types of cancer is staging and grading. This means looking at tissue samples under a microscope to see whether the cancer cells have spread beyond the pancreas and what kind of cells they are.
For pancreatic cancer, the tissue samples may be collected during a separate biopsy or during an endoscopic ultrasound. Sometimes the biopsy is done at the time of surgery to remove the cancer.
Knowing the stage and grade helps doctors know whether surgery will work to remove the cancer or what kind of treatment will help you feel better.
Even if treatment doesn't usually cure the cancer, it may help you live longer and feel better. The most common treatments include surgery, radiation, and chemotherapy. Targeted therapy may also be used. Often a combination of these treatments is used.
Surgery will be done to remove the tumour if possible. But most of the time the cancer has already spread so far that not all of it can be removed.
If surgery can remove all of the cancer, it can help you live longer. But even with successful surgery, the cancer often comes back.
If you are told that your cancer has spread too much for surgery, you may want to get a second opinion from a pancreatic cancer surgeon.
Surgery for pancreatic cancer includes:
- Whipple procedure . This is the most common surgery for pancreatic cancer. The surgeon may remove part of the pancreas, part of the stomach, part of the small intestine, and the gallbladder and common bile duct.
- Distal pancreatectomy. The surgeon may remove part of the pancreas and the spleen.
- Total pancreatectomy. The surgeon may remove the whole pancreas, part of the stomach, part of the small intestine, the bile duct, gallbladder, spleen and nearby lymph nodes.
You'll be in the hospital for 1 to 2 weeks after the surgery. You will probably be able to return to work or your normal routine in about 1 month. It will probably take about 3 months until your strength is back to normal. You will probably need more treatment for the cancer, such as chemotherapy or radiation.
Depending on how much of your pancreas is removed, you may need to take enzyme supplements (to replace the enzymes the pancreas makes) and anti-ulcer pills from now on. If your entire pancreas is removed, you will need to replace the insulin produced by your pancreas. You may have to check your blood sugar levels and take insulin.
Chemotherapy, sometimes called chemo, uses medicine to destroy cancer cells. The drugs used in this treatment can also affect healthy cells and cause side effects. The most common chemo drugs used for pancreatic cancer are:
- Fluorouracil (5-FU).
Common side effects of these drugs include:
- Nausea, vomiting, and diarrhea.
- Loss of appetite.
- Hair loss.
- Mouth sores.
- Low blood counts, which may increase the risk of infection and bleeding.
Radiation treatment may be used for certain types of pancreatic tumours.
External radiation is the kind of radiation most often used. It may be used along with chemotherapy. It may also be used before or after surgery.
Radiation can have side effects. The most common ones include:
- Extreme tiredness.
- Hair loss near the treated area.
- Skin darkening in the area.
- Loss of appetite.
- Nausea, vomiting, and diarrhea.
- Pain or a feeling of fullness in the belly.
Radiation can also be used to help control pain by shrinking the tumour so that it doesn't press on nerves or other organs.
Targeted therapy with tyrosine kinase inhibitors (TKIs), such as sunitinib, may be used. This medicine is taken by mouth. Targeted therapy can slow the growth of cancer cells.
Your doctor may talk to you about being in a clinical trial. For some people with pancreatic cancer, taking part in a clinical trial may be the best treatment choice.
Among the treatments being looked at by clinical trials for pancreatic cancer is biologic therapy, a treatment that uses your immune system to fight cancer.
Treatment to help you feel better
When pancreatic cancer gets worse or comes back, the goal of treatment in many cases is to help you feel better and live longer. This is called hospice palliative care.
Pain is one of the main concerns of people with pancreatic cancer. But cancer pain can almost always be controlled. You and your doctor have several options to help your pain.
- Nerve blocks are injections of alcohol or another liquid into the area of pain. The liquid numbs the nerves, interrupting the pain signal being sent to your brain. In some cases, the nerves carrying the pain sensation can actually be cut.
- Sometimes radiation or chemotherapy can be used to help ease the pain by shrinking the tumour.
- And there are stronger medicines your doctor can give you to help your pain.
Removing a blockage
Sometimes the tumour presses on and blocks the bile duct where it passes through the pancreas. This can cause digestion problems. There are two ways to fix the blockage and help you feel better.
- Widen the blocked area so that it can drain. This may be done using an endoscope—a long, flexible tube that is inserted through your mouth all the way to the pancreas while you are sedated. Or it may be done by inserting a tube through your skin into the blocked area.
- Divert the flow of bile so that it goes around, instead of through, the pancreas. This requires surgery.
Because the pancreas is next to the stomach, the tumour can sometimes block the flow of food from the stomach to the first part of the small intestine. In that case, your doctor may do a gastric bypass, sewing the stomach directly to a lower part of the small intestine to get around the blocked area.
You can find more information about pancreatic cancer online at the:
- Canadian Cancer Society website at www.cancer.ca.
- U.S. National Cancer Institute website at www.cancer.gov.
Hospice palliative care
Hospice palliative care is a kind of care for people who have diseases that don't go away and that often get worse over time. It's different from care to cure your illness. Its goal is to improve your quality of life—not just in your body but also in your mind and spirit. You can have this care along with treatment to cure your illness.
For some people who have advanced cancer, a time comes when treatment to cure cancer no longer seems like a good choice. This can be because the side effects, time, and costs of treatment are greater than the promise of cure or relief. But this isn't the end of treatment. Hospice palliative care providers will work to help manage pain and other symptoms or side effects. They may help you decide what treatment you want or don't want. And they can help your loved ones understand how to support you.
It can be hard to decide when to stop treatment aimed at prolonging your life and shift the focus to end-of-life care. You and your doctor can decide when you may be ready for hospice palliative care.
For more information, see the topics:
People sometimes use complementary therapies along with medical treatment to help relieve symptoms and side effects of cancer treatments. Some of the complementary therapies that may be helpful include:
- Acupuncture to relieve pain.
- Meditation or yoga to relieve stress.
- Massage or biofeedback to reduce pain and ease tension.
- Breathing exercises for relaxation.
These mind-body treatments may help you feel better. They can make it easier to cope with treatment. They also may reduce chronic low back pain, joint pain, headaches, and pain from treatments.
Before you try a complementary therapy, talk to your doctor about the possible value and potential side effects. Let your doctor know if you are already using any such therapies. They aren't meant to take the place of standard medical treatment.
Managing side effects
The side effects of treatment can be serious. Healthy habits such as eating a balanced diet and getting enough sleep and exercise may help control your symptoms. Your doctor may also give you medicines to help you with certain side effects, such as medicines to control and prevent nausea and vomiting.
- Home treatment for fatigue includes tips on how to manage tiredness that doesn't go away with rest or sleep. For example, if taking a shower is a priority, and if mornings are when you have the most energy, take your shower in the morning.
- Home treatment for nausea or vomiting includes watching for and treating early signs of dehydration, such as having a dry mouth or feeling light-headed when you stand up. Eating smaller meals may help. So can a little bit of ginger candy or ginger tea.
- Home treatment for diarrhea includes resting your stomach and being alert for signs of dehydration. Check with your doctor before using any non-prescription medicines for your diarrhea. Be sure to drink enough fluids.
- Home treatment for constipation includes making sure that you drink enough fluids and eat fruits, vegetables, and fibre in your diet each day. Don't use a laxative without first talking to your doctor.
- Home treatment for mouth sores includes watching what you eat and drink and rinsing regularly with mouthwash or an antacid.
Other symptoms that can be treated at home include:
- Sleep problems. If you have trouble sleeping, some tips for managing sleep problems may help.
- Hair loss may be unavoidable. But you can decrease irritation of your scalp by using mild shampoos and avoiding hair products that damage hair.
- Pain. There are many home treatments that can help when you have pain, such as over-the-counter pain relievers, heat packs, or cold packs.
Pancreatic cancer and its treatments can cause you to lose your appetite. And the cancer can make it harder for your body to get what it needs from food. This can make you lose weight and grow weak. So it's important to pay attention to what you eat.
A dietitian can help you plan meals that will give you the most energy. You may also need to take supplements.
Having cancer and being treated for it can be very stressful. There are steps you can take to reduce your stress. Some people find that it helps to talk about their feelings with family and friends. Others find that spending time alone is what they need.
If your emotional reaction to cancer gets in the way of your ability to make decisions about your health, it's important to talk with your doctor. Your cancer treatment centre may offer psychological or financial services. And a local chapter of the Canadian Cancer Society can help you find a support group.
Having cancer can change your life in many ways. For support in managing these changes, see the topic: Getting Support When You Have Cancer.
- American Cancer Society (2011). Cancer Facts and Figures 2011. Atlanta: American Cancer Society. Available online: http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-029771.pdf.
Other Works Consulted
- American Cancer Society (2011). Treating pancreatic cancer. Detailed Guide: Pancreatic Cancer. Available online: http://www.cancer.org/Cancer/PancreaticCancer/DetailedGuide/index.
- National Cancer Institute (2010). Pancreatic Cancer Treatment PDQ—Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/pancreatic/HealthProfessional.
- National Cancer Institute (2010). Pancreatic Cancer Treatment PDQ—Patient Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/pancreatic/Patient.
- Winter JM, et al. (2015). Cancer of the pancreas. In VT DeVita Jr et al., eds., DeVita, Hellman, and Rosenberg's Cancer Principles and Practices of Oncology, 10th ed., pp. 657–684. Philadelphia: Walters Kluwer.
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Kathleen Romito, MD - Family Medicine
Adam Husney, MD - Family Medicine
Joseph F. O'Donnell, MD - Hematology, Oncology
Douglas A. Stewart, MD, FRCPC - Medical Oncology
Current as ofMarch 28, 2018
Current as of: March 28, 2018