Pancreatic cancer: Symptoms, diagnosis, stage, treatment and prevention

Pancreatic cancer is the cancer that develops in your pancreas. Pancreas is an organ located in the left side of the abdomen. Pancreas has two functions, one is secreting fluids that are rich in enzymes, the fluids help break down the ingested food in the small intestines; the other is releasing insulin to the blood to help control the blood sugar. Pancreatic cancer develops as the cells that secrete fluids to your bowels go awry. 

Symptoms

In the early stages of pancreatic cancer, most patients have no noticeable symptom. When the cancer develops to an advanced stage, common symptoms include:

  • Abdominal pain. The pain is predominantly located in the left abdomen. However, it can radiate to your back, causing persistent back pain.
  • Jaundice. Jaundice means yellowing of your skin, eyes and palms. Sometimes, it’s associated with a dark-yellow urine and skin itchiness. Jaundice suggests the tumor may be located in the head of your pancreas so that it obstructs the biliary tract.
  • Loss of appetite or unintentional weight loss.
  • Your stools may be pale or light-colored.

Diagnosis

Doctors make the diagnosis based on the results of lab tests and imaging tests, which include:

  1. Blood tests. The tumor marker CA 19-9 is a biomarker of pancreatic cancer. A significantly elevated value of CA 19-9 suggests you may have pancreatic cancer.
  2. CT scans, particularly contrast-enhanced CT scans. It can be used to evaluate the mass on the pancreas. Other imaging scans, such as magnetic resonance imaging (MRI), MRI with contrast, are also frequently used.
  3. Ultrasound. An ultrasound uses sound wave to provide echoes of the pancreas. The echoes that pancreatic tumors produce are different from those of healthy tissues.
  4. Endoscopic ultrasound & biopsy. In some cases, your doctor may insert a thin tube to your stomach through your mouth, as in a gastroscopy. At the end of the inserted tube, there is a micro-ultrasound that can visualize the pancreatic mass nicely. In addition, doctors will take a sample from your pancreatic or bile ducts with a tiny brush for pathologic examination.
  5. Biopsy. A biopsy is usually done in one of three ways: fine needle aspiration (FNA) biopsy, brush biopsy (endoscopic ultrasound and biopsy), laparoscopy. Once the biopsy is done, a pathologist examines tissue samples under a microscope to check for cancer cells. A biopsy can also reveal the type of the pancreatic cancer you have. It usually takes a few days for the results of your biopsy to come back.

Stage

Stage of cancer is a way to describe the extent of a cancer’s growth. Doctors follow a standard stage system called TNM system, in which:

  • T (tumor): The size of the original tumor and whether or not it has invaded nearby organs.
  • N (node): Whether the lymph nodes in the area of the original tumor have become cancerous.
  • M (metastasis): Whether the cancer has spread to other, distant organs in the body, such as your bones, liver or lungs.

Combining the T, N and M, doctors determine the stage of your cancer by Roman numbers 0 through IV.

The stages of pancreatic cancer are:

  • Stage 0: The tumor is only in the top layer of the pancreatic duct cells and has not invaded deeper. This is usually called pancreatic cancer in situ.
  • Stage IA: Cancer is only found in the pancreas and is no larger than two centimeters across. The cancer has not spread to the lymph nodes or to distant parts of the body.
  • Stage IB: Cancer is only found in the pancreas and is larger than two centimeters across. The cancer has not spread to the lymph nodes or to distant parts of the body.
  • Stage IIA: The cancer has spread to other areas near the pancreas. It has not spread to nearby lymph nodes, to major blood vessels or to distant sites.
  • Stage IIB: The cancer may or may not have spread to nearby areas. It has spread to nearby lymph nodes, but has not spread to nearby major blood vessels or nerves or to distant parts of the body.
  • Stage III: The cancer has spread to nearby major blood vessels or nerves and may have spread to nearby lymph nodes, but it has not spread to distant sites.
  • Stage IV: The cancer has spread to organs further away from the pancreas. This might include the liver, lining of the abdomen (called the peritoneum) or the lungs.

As you can see, the lower the number, the less the cancer has spread.

Treatment

The most effective treatment to date is surgery. Depending upon the type and stage, surgical removal may not work for some patients, then doctors may recommend non-surgical treatment.

The type of surgery depends on the stage of the cancer, the location and size of the tumor and your overall health. Most pancreatic tumors occur in the head of the pancreas, so the Whipple’s procedure, in which your pancreas head, small intestine, the gallbladder, part of the bile duct and nearby lymph nodes are all surgically removed, is most commonly applied. This procedure is technically challenging and patients need a long period of time to recover.

Non-surgical treatment include chemotherapy, radiotherapy, and target therapy. However, the efficacy of chemotherapy and radiation for pancreatic cancer is limited.

In 2005, FDA approved the targeted therapy drug erlotinib (Tarceva®), in combination with the chemotherapy drug gemcitabine (Gemzar®), for use in advanced pancreatic cancer that cannot be removed by surgery. Erlotinib is currently the only FDA approved targeted therapy drug for pancreatic adenocarcinoma, the most common type of pancreatic cancer.

In May 2011, the FDA approved two targeted therapy drugs, sunitinib (Sutent®) and everolimus (Afinitor®), for the treatment of advanced pancreatic neuroendocrine tumors (PNETs). Pancreatic neuroendocrine tumors account for about 6% of all pancreatic tumors.


Outlook

Long-term prognosis for individuals with pancreatic cancer depends on:

  • the size and type of the tumor;
  • whether the lymph nodes become cancerous;
  • metastasis to a distant organ.

The 5-year survival rate is:

  • For local 37 percent;
  • For regional 12 percent;
  • For distant 3 percent;

Prevention

Pancreatic cancer cannot be prevented. However, you can reduce the risks by:

  • Quite smoking (if you smoke).
  • Maintain a healthy weight, because overweight is a risk factor for the development of pancreatic cancer.
  • Limit alcohol use: some studies found that heavy drinking is associated with pancreatic cancer.
* The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.