Pancreatic cancer

Pancreatic cancer starts in the lining of the pancreas, a gland that aids digestion and controls blood sugar. At Atrium Health Floyd and Harbin Clinic, our cancer specialists offer the latest pancreatic cancer treatments.

What is pancreatic cancer?

Pancreatic cancer occurs when cells in the lining of your pancreas change and grow uncontrollably. Your pancreas is a gland that plays important roles in your digestive and endocrine systems. It makes enzymes that aid digestion and hormones that help control blood sugar (glucose).

Your pancreas is located toward the back of your abdomen between your spine and stomach. It has these sections:

• Head: The wider end of your pancreas is near the first part of the small intestine (duodenum).
• Neck: This short part extends from the pancreas head.
• Body: The middle section of the pancreas is between the head and tail.
• Tail: The body of your pancreas tapers into a thin tail near your spleen.

Causes of pancreatic cancer

Pancreatic cancer occurs when cells in the pancreas mutate, or change. These cells quickly multiply and form cancerous tumors in your pancreas. As with many cancers, experts aren’t sure why some people develop pancreatic cancer.

In some people, a gene mutation causes pancreatic cancer. You may inherit this changed gene from a parent, or it may occur for no known reason.

Pancreatic cancer symptoms

Early-stage pancreatic cancer rarely causes symptoms. Symptoms become noticeable as the cancer grows larger or spreads outside the pancreas. Common signs of pancreatic cancer include:

• Abdominal or back pain
• Dark urine
• Itchy skin
• Loss of appetite
• Nausea and vomiting
• Pale or greasy stools
• Unintended weight loss
• Unusual fatigue or weakness
• Yellowing of your skin and the white parts of your eyes (jaundice)

Pancreatic cancer types

The cells where cancer starts determine the type of pancreatic cancer. Types include:

• Pancreatic exocrine tumors: Cancer starts in exocrine cells that make digestive enzymes. Pancreatic adenocarcinoma is the most common form, accounting for almost all pancreatic cancers.
• Pancreatic neuroendocrine tumors (PNETs): Cancer starts in islet cells, a type of endocrine system cell that makes hormones to control blood sugar.

Pancreatic cancer diagnosis

Pancreatic cancer can be challenging to diagnose because symptoms don't appear until the disease progresses. Your health care provider may notice a tumor in your pancreas when you get imaging tests to check for problems that result from the cancer, like a swollen liver or gallbladder.

To make an accurate diagnosis, your doctor may order one or more of these tests:

• Blood tests to check liver function and blood sugar levels, as well as look for tumor markers unique to pancreatic cancer
• Genetic testing to look for gene changes and inherited conditions that can cause pancreatic cancer
• Imaging tests, such as MRI, ultrasound or CT scan, to view the pancreas and look for tumors
• Cholangiopancreatography, using an endoscope or special MRI machine to look for blockages in pancreatic ducts and bile ducts

Pancreatic cancer staging

After a pancreatic cancer diagnosis, doctors determine whether the cancer has spread outside the organ. This process, called cancer staging, helps guide treatment decisions.

There are several stages of pancreatic cancer. Stages one through three have distinct substages. The main stages of pancreatic cancer include:

• Stage 1: Cancer is only in the pancreas and hasn't spread. The tumor is smaller than 1.6 inches (4 centimeters).
• Stage 2: Cancer has spread to nearby lymph nodes, blood vessels or both. It hasn't spread to other organs.
• Stage 3: Cancer has spread to major nearby arteries and may be in lymph nodes. It hasn't spread to other organs.
• Stage 4: Cancer has spread to the liver, lungs, abdominal wall or distant lymph nodes or organs.

Pancreatic cancer risk factors

Certain factors may increase your risk of developing pancreatic cancer, including:

• Addiction to nicotine
• Chronic inflammation of your pancreas (pancreatitis)
• Exposure to chemicals, such as pesticides
• Family history of pancreatitis or pancreatic cancer
• Inherited gene changes and hereditary conditions
• Obesity
• Type 2 diabetes

Pancreatic cancer prevention

Often, there is nothing you can do to prevent pancreatic cancer. But these actions may help lower your risk:

• Being physically active and maintaining a healthy weight
• Limiting alcohol to no more than one drink per day for females or two drinks per day for males
• Minimizing your exposure to cancer-causing chemicals
• Seeking help to quit using tobacco products

Pancreatic cancer treatments

Pancreatic cancer treatments depend on the type, cancer stage, tumor location and other factors. Surgery can cure pancreatic cancer, but it’s an option only if the surgeon feels confident they can remove all of the cancer.

Surgeries for pancreatic cancer include:

• Whipple procedure to remove cancer in the pancreas head
• Distal pancreatectomy to remove cancer in the pancreas tail or the tail and part of the body
• Total pancreatectomy to remove the pancreas, gallbladder, common bile duct, spleen and part of the stomach and small intestine

Other pancreatic cancer treatments include:

• Ablation to destroy cancerous tumors using extreme heat or cold
• Chemotherapy and/or radiation therapy to destroy cancer cells
• Embolization to inject chemicals into a blood vessel that stops blood flow to a tumor, causing it to die
• Immunotherapy to help your immune system find and destroy cancer cells
• Targeted therapy to target certain proteins in genes that spur the growth of cancer cells