Pancreatic

Overview

The pancreas lies behind the stomach and in front of the spine. There are two kinds of cells in the pancreas. Exocrine pancreas cells make enzymes that are released into the small intestine to help the body digest food. Neuroendocrine pancreas cells (such as islet cells) make several hormones, including insulin and glucagon, which help control sugar levels in the blood.

Most pancreatic cancers form in exocrine cells. These tumors do not secrete hormones and do not cause signs or symptoms. This makes it hard to diagnose this type of pancreatic cancer early.

The American Cancer Society estimates that in the United States 53,670 people will develop pancreatic cancer annually, and of those people 43,090 will succumb to the disease. In South Carolina alone, that translates to roughly 1,000 new cases this year.

Most cases of pancreatic cancer occur after the age of 60, and rarely does it occur before the age of 40. The largest risk factors for pancreatic cancer are smoking and a history of chronic pancreatitis, which increase the risk by three times and six times, respectively.

In South Carolina, smoking rates are some of the highest in the nation, as is the use of alcohol, which can lead to chronic pancreatitis. As a consequence of these two factors, pancreatic cancer is a condition that we all should be aware of and watch for warning signs and symptoms.

Screening is not recommended at this time for pancreatic cancer, but given that 5 to 10 percent of pancreatic cancers have an inherited genetic component, there is consensus that patients with a family history (parent, sibling or children) need to be screened. Discuss with your doctor.

Prisma Health–Upstate interventional gastroenterologist Veeral M. Oza, MD, implements a Therapeutic Interventional Endoscopy program, which includes medical, surgical, oncologic and radiologic approaches. Endoscopic ultrasound (EUS) is a powerful tool that, used in conjunction with CT/MRI to closely evaluate and assess pancreatic cysts and other diseases of the pancreas, can aid in early detection.

Risk Factors

Having a risk factor, or even several risk factors, does not mean that you will get the disease. Many people who who develop pancreatic cancer may have few or no known risk factors.

  • Being very overweight
  • Having a personal history of diabetes or chronic pancreatitis
  • Having a family history of pancreatic cancer or pancreatitis
  • Having certain hereditary conditions, such as:
    • Multiple endocrine neoplasia type 1 (MEN1) syndrome
    • Hereditary nonpolyposis colon cancer (HNPCC; Lynch syndrome)
    • von Hippel-Lindau syndrome
    • Peutz-Jeghers syndrome
    • Hereditary breast and ovarian cancer syndrome
    • Familial atypical multiple mole melanoma (FAMMM) syndrome

Symptoms

Early pancreatic cancers often do not cause any signs or symptoms. By the time they do cause symptoms, they have often already grown through the pancreas or spread beyond it.

  • Jaundice
  • Dark urine
  • Light-colored stools
  • Itchy skin
  • Abdominal or back pain
  • Weight loss and poor appetite
  • Digestive problems
  • Gallbladder enlargement
  • Blood clots
  • Fatty tissue abnormalities
  • Diabetes

Diagnosis

Pancreatic cancer is hard to find early. The pancreas is deep inside the body, so early tumors can’t be seen or felt by health care providers during routine physical exams. Patients usually have no symptoms until the cancer has already spread to other organs.

Screening tests or exams are used to look for a disease in people who have no symptoms (and who have not had that disease before). At this time, no major professional groups recommend routine screening for pancreatic cancer in people who are at average risk.

Treatment

After the cancer is found and staged, your cancer care team will discuss treatment options with you. It is important that you take time to think about your choices. You will want to weigh the benefits of each treatment option against the possible risks and side effects. In choosing a treatment plan, two of the main factors to consider are whether or not the cancer can be removed (resected) with surgery and your overall health.

The main types of treatment for pancreatic cancer are:

  • Surgery
  • Ablative techniques
  • Radiation therapy
  • Chemotherapy and other drugs

For pancreatic neuroendocrine tumors (NETs), treatment options might include surgery, ablation or embolization treatments, radiation therapy, or different types of medicines.

How May We Help?

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“They put a plan in place for me.”

Ken talks about how, although a cancer diagnosis can feel like a death sentence, as he says, “There’s a whole community in Greenville to help you get through the death sentence.”