Condition Basics

What is pancreatic cancer?

Pancreatic cancer is the growth of abnormal cells in the pancreas. The pancreas is 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 it?

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?

Symptoms usually don't begin until the cancer has spread. Then, symptoms may include pain in the upper belly or the back, unexpected weight loss, loss of appetite, extreme tiredness, or jaundice.

How is it diagnosed?

If your doctor suspects pancreatic cancer, you may have some tests. These may include lab tests, such as blood tests, or an imaging test, such as a CT scan or MRI. You may also have a biopsy. This means taking a tissue sample from the pancreas to see if it has cancer cells.

How is pancreatic cancer treated?

Treatment for pancreatic cancer is based on the stage of the cancer and other things, such as your overall health. Surgery is done if all of the cancer can be removed. Other treatments include radiation therapy, chemotherapy, and targeted therapy. Chemotherapy and radiation may be given together. (This is called chemoradiation.)

What Increases Your Risk

Your risk of getting pancreatic cancer is higher if you:

• Smoke.
• Are very overweight or not active.
• Have abnormal glucose metabolism or insulin resistance.
• Have chronic pancreatitis.
• Have a family history of pancreatic cancer.
• Have certain rare inherited conditions, such as hereditary pancreatitis or Lynch syndrome.

Symptoms

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.

What Happens

Pancreatic cancer happens when abnormal cells grow in the pancreas. It's usually found after it has spread from the pancreas to other parts of the body. You may need medicines to control pain, help you digest food, and manage your blood sugar. Surgery, radiation therapy, and other treatments are often needed.

Examinations and Tests

To look for or diagnose pancreatic cancer, your doctor will ask you about your medical history and your family history. You will get a physical exam. Some of these tests will also be done:

• Lab tests. These include blood tests to measure levels of bilirubin and other substances.
• Imaging tests. They include:
  • CT scan or MRI.
  • PET scan.
  • Endoscopic ultrasound (EUS).
  • X-rays. This includes endoscopic retrograde cholangiopancreatogram (ERCP).
• Tumour marker tests. These tests look for signs of cancer in samples of blood or tissue.

Your doctor may also order a biopsy. This means getting a sample of tissue from the pancreas to see if it contains cancer cells. Types of biopsies include:

• Needle biopsy. Tissue samples are collected through a needle. Imaging, like ultrasound, may be used to guide the needle.
• Laparoscopy. The doctor makes a small cut in your belly and uses a thin, lighted tool called a laparoscope to collect tissue samples.

Tests to stage pancreatic cancer

Your doctor uses different tests to stage pancreatic cancer. Staging is a way to describe how far the cancer has spread.

You may have one or more of these imaging tests:

• A CT scan, MRI, or PET-CT scan.
• An endoscopic ultrasound.

These tests can show how big the tumour is, where it's located, and if it's spread to other parts of the body.

Your doctor may do a procedure called a staging laparoscopy to see if the cancer has spread outside of the pancreas. Through a small cut in your belly, your doctor uses a thin, lighted tool to look at the pancreas. Your doctor may also take a tissue sample (biopsy) to look for signs of cancer and tumour markers.

Knowing the stage of the cancer can help guide your treatment.

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Treatment Overview

Treatment for pancreatic cancer is based on the stage of the cancer and other things, such as your overall health. Surgery is done if all of the cancer can be removed. Other treatments include radiation, chemotherapy, and targeted therapy. Sometimes a clinical trial may be a good choice.

Your doctor will talk with you about your options and then make a treatment plan.

Surgery

Surgery may be an option. But in most cases, the cancer has already spread so far that not all of it can be removed. If all of the cancer can't be removed, other treatments are used. These may include radiation therapy or medicines.

The types of surgery include:

Whipple procedure.

This is the most common type of surgery for pancreatic cancer. It removes the thick end (head) of the pancreas, part of the small intestine, and other nearby tissues. The doctor may also remove part of the stomach.

Distal pancreatectomy.

This removes the narrow end (tail) and the body of the pancreas. The doctor may also remove the spleen.

Total pancreatectomy.

This removes the whole pancreas. The doctor will also remove part of the small intestine, part of the stomach, the spleen, the gallbladder, and the common bile duct.

During surgery, the doctor may also take out nearby lymph nodes to check them for cancer.

Radiation therapy

This uses high-dose X-rays to destroy cancer cells and shrink tumours. It may be used before or after surgery.

Radiation may be given by using a machine outside the body (external radiation). Or it may be given by placing substances inside the body (internal radiation). External radiation is most often used for pancreatic cancer.

Medicines

Medicines may be used to control the growth of cancer cells and to relieve symptoms. Medicines for pancreatic cancer include:

Chemotherapy.

These medicines kill fast-growing cells, including cancer cells and some normal cells. Chemotherapy and radiation may be given together. This is called chemoradiation.

Targeted therapy.

These medicines target cancer cells and may cause less harm to normal cells. They help keep cancer from growing or spreading.

These medicines may be given in different ways. For example, they may be taken as a pill or injected into a vein (I.V.).

Clinical trials

Clinical trials are research studies that test new treatments to find out how well they work. One treatment is immunotherapy. It is a being studied to see if it helps the immune system fight cancer. Your medical team can tell you if there's a clinical trial that might be right for you.

Treating pain and digestive problems

Pain

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 manage your pain.

• Prescription pain medicines. These are medicines your doctor prescribes when over-the-counter medicines don't work well enough to relieve 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 are cut in surgery.
• Sometimes radiation or chemotherapy can be used to help ease the pain by shrinking the tumour.

Digestive problems

Sometimes the tumour presses on and blocks the bile duct or upper intestine. This can cause jaundice and problems digesting food. A hollow tube called a stent may be placed to keep the bile duct open. Or a surgical bypass may be done to create a pathway around the blocked area.

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Supportive Care

Palliative and end-of-life care is a continuum of care from the time of diagnosis of a life-limiting illness through to the time of death and into bereavement. The palliative approach to care can occur simultaneously with a curative approach or during treatment.

• Palliative care aims to improve the quality of life for patients and families facing the problems associated with a life-limiting illness through the prevention and relief of suffering by means of early identification, comprehensive interdisciplinary assessments and appropriate interventions.
• End-of-life-care is care provided to patients and their families when they are approaching a period of time closer to death, which may be exemplified by an intensification of inter-disciplinary services and assessments such as anticipatory grief support, and pain and symptom management.

Self-Care

• Take your medicines exactly as prescribed. Call your doctor or nurse advice line if you think you are having a problem with your medicine.
• Eat healthy food. If you do not feel like eating, try to eat food that has protein and extra calories to keep up your strength and prevent weight loss. Drink liquid meal replacements for extra calories and protein. Try to eat your main meal early in the day.
• Get some physical activity every day, but do not get too tired. Keep doing the things you enjoy as your energy allows.
• Take steps to manage your stress, such as learning relaxation techniques. To also help reduce stress, get enough sleep, eat a healthy diet, and take time to do things you enjoy.
• Think about joining a support group. Or discuss your concerns with your doctor or a counsellor.
• If you are vomiting or have diarrhea:
  • Drink plenty of fluids to prevent dehydration. Choose water and other clear liquids. If you have kidney, heart, or liver disease and have to limit fluids, talk with your doctor before you increase the amount of fluids you drink.
  • When you are able to eat, try clear soups, mild foods, and liquids until all symptoms are gone for 12 to 48 hours. Other good choices include dry toast, crackers, cooked cereal, and gelatin dessert, such as Jell-O.
• If you have not already done so, prepare an advance care plan. An advance care plan provides instructions to your doctor and family members about what kind of care you want if you become unable to speak or express yourself.

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Complementary Treatments

Some people use complementary therapies along with medical treatment. They may help relieve the symptoms and stress of cancer or the side effects of cancer treatment. Therapies that may be helpful include:

• Acupuncture to relieve pain and other symptoms.
• Meditation or yoga to relieve stress.
• Massage and biofeedback to reduce pain and tension.
• Breathing exercises to help you relax.

Talk with your doctor about any of these options you would like to try. And let your doctor know if you are already using any complementary therapies. They are not meant to take the place of standard medical treatment. But they may help you feel better and cope better with treatment.

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Getting Support

Relationships take on new importance when you're faced with cancer. Your family and friends can help support you. You may also want to look beyond those who are close to you.

• Reach out to your family and friends.

  Remember that the people around you want to support you, and asking for help isn't a sign of weakness.

• Tell them how they can help.

  Your friends and family want to help, but some of them may not know what to do. It may help to make a list. For example, you might ask them to:

  • Run errands or pick up kids.
  • Deliver meals or groceries to your home.
  • Drive you to appointments.
  • Go to doctor visits with you and take notes.
• Look for help from other sources.

  Places to turn for support include:

  Counselling.

  Counselling can help you cope with cancer and the effect cancer is having on your life. Different types of counselling include family therapy, couples therapy, group counselling, and individual counselling.

  Your health care team.

  Your team should be supportive. Be open and honest about your fears and concerns. Your doctor can help you get the right medical treatments, including counselling.

  Spiritual or religious groups.

  These groups can provide comfort and may be able to help you find counselling or other social support services.

  Social groups.

  Social groups can help you meet new people and get involved in activities you enjoy. Focus on activities that bring you comfort, such as spending time outdoors or being with children.

  A cancer support group.

  Cancer support groups offer support and practical advice. You can hear others talk about:

  • What it's like to live with cancer.
  • Practical ways to manage your cancer treatment and its side effects.
  • Ways to cope with your illness.

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