Pancreatic Cancer

The pancreas is a gland in the abdomen between the stomach and the spine. The pancreas makes hormones that control blood sugar and helps the body use and store energy that comes from food. The pancreas also makes enzymes that help digest food. Pancreatic cancer is when there is a tumor in the pancreas that is cancerous (malignant).

There are two types of pancreatic cancer:

• Exocrine. This is the most common type.
• Endocrine. This is also called islet cell cancer.

Pancreatic cancer can spread (metastasize) to other parts of the body.

What are the causes?

The exact cause of this condition is not known.

What increases the risk?

The following factors may make you more likely to develop this condition:

• Being over 65 years old.
• Smoking cigarettes.
• Having a family history of cancer of the pancreas, colon, or ovaries.
• Having diabetes.
• Having long-term inflammation of the pancreas (chronic pancreatitis).
• Being exposed to certain chemicals.
• Being obese and having a decreased level of physical activity.
• Eating a diet that is high in fat and red meat.
• Having certain hereditary conditions.

What are the signs or symptoms?

In the early stages, there are often no symptoms of this condition. As the cancer gets worse, symptoms may vary depending on the type of pancreatic cancer you have. Common symptoms include:

• Nausea and vomiting.
• Loss of appetite and unintended weight loss.
• Pain in the upper abdomen or upper back.
• Skin or the white parts of the eyes turning yellow (jaundice).
• Fatigue.

Other symptoms include:

• Itchy skin.
• Dark urine.
• Stools that are light-colored and greasy-looking, or stools that are black and tarry-looking.
• A lump under the rib cage on the right side.
• High blood sugar (hyperglycemia). This may cause increased thirst and frequent urination.
• Low blood sugar (hypoglycemia). This may cause confusion, sweating, and a fast heartbeat.
• Depression.

How is this diagnosed?

This condition may be diagnosed based on your medical history and a physical exam. Your health care provider may check your:

• Skin and eyes for signs of jaundice.
• Abdomen for any changes in the areas near the pancreas. Your health care provider may also check for excess fluid in the abdomen.

You may also have other tests, including:

• Blood and urine tests.
• Genetic testing.
• Ultrasound.
• CT scan.
• MRI.
• A biopsy. A sample of pancreatic tissue would be removed and looked at under a microscope.

If pancreatic cancer is diagnosed, it will be staged to determine its severity and extent. Staging is an assessment of:

• The size of the tumor.
• If the cancer has spread.
• Where the cancer has spread.

How is this treated?

Depending on the type and stage of your pancreatic cancer, treatment may include:

• Surgery to remove all or part of the pancreas, or to remove the tumor.
• Chemotherapy. This uses medicine to destroy the cancer cells.
• Radiation therapy. This uses high-energy beams to kill cancer cells.
• Medicine to attack a tumor's genes and proteins (targeted therapy). These medicines attack the genes and proteins that allow a tumor to grow while limiting damage to healthy cells.
• Participating in clinical trials to see if new (experimental) treatments are effective.
• Medicines to help manage pain and other symptoms.

Your health care provider may recommend a combination of surgery, radiation therapy, and chemotherapy. You may be referred to a health care provider who specializes in cancer (oncologist).

Follow these instructions at home:

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Ask your health care provider about changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
• Do not take dietary supplements or herbal medicines unless your health care provider tells you to take them. Some supplements can interfere with how well the treatment works.
• Ask your health care provider if the medicine prescribed to you:
  • Requires you to avoid driving or using heavy machinery.
  • Can cause constipation. You may need to take these actions to prevent or treat constipation:
    • Drink enough fluid to keep your urine pale yellow.
    • Take over-the-counter or prescription medicines.
    • Eat foods that are high in fiber, such as beans, whole grains, and fresh fruits and vegetables.
    • Limit foods that are high in fat and processed sugars, such as fried or sweet foods.

Lifestyle

• Get enough sleep on a regular basis. Most adults need 6–8 hours of sleep each night. During treatment, you may need more sleep.
• Rest as told by your health care provider.
• Consider joining a cancer support group. Ask your health care provider for more information about local and online support groups. This may help you learn to cope with the stress of having pancreatic cancer.
• Do not use any products that contain nicotine or tobacco, such as cigarettes, e-cigarettes, and chewing tobacco. If you need help quitting, ask your health care provider.

Eating and drinking

• Try to eat regular, healthy meals. Some of your treatments might affect your appetite. If you are having problems eating or with your appetite, ask to meet with a food and nutrition specialist (dietitian).
• Do not drink alcohol.

General instructions

• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Work with your health care provider to manage any side effects of your treatment.
• Keep all follow-up visits as told by your health care provider. This is important.

Where to find more information

• American Cancer Society: https://www.cancer.org
• National Cancer Institute (NCI): https://www.cancer.gov

Contact a health care provider if:

• You have unexplained weight loss.

Get help right away if:

• Your pain suddenly gets worse.
• Your skin or eyes turn more yellow.
• You cannot eat or drink without vomiting.
• You have:
  • Trouble breathing.
  • Chest pain or an irregular heartbeat.
  • Blood in your vomit or dark, tarry stools.
  • New fatigue or weakness.
  • Abdominal bloating or pain.

These symptoms may represent a serious problem that is an emergency. Do not wait to see if the symptoms will go away. Get medical help right away. Call your local emergency services (911 in the U.S.). Do not drive yourself to the hospital.

Summary

• Pancreatic cancer is a tumor in the pancreas that is cancerous (malignant).
• Risk factors include having a family history of cancer of the pancreas, colon, or ovaries. Risk factors also include having long-term inflammation of the pancreas (chronic pancreatitis) and diabetes.
• Treatment may include a combination of surgery, medicine to destroy cancer cells (chemotherapy), and high-energy beams to kill cancer cells (radiation therapy).
• Consider joining a cancer support group. This may help you learn to cope with the stress of having pancreatic cancer.
• Keep all follow-up visits as told by your health care provider. This is important.