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Pancreatic carcinoma

Digestive system Endocrine glands Pancreatic cancer,


CT scan

Pancreas

Biliary
obstruction series

Definition:
Pancreatic carcinoma is a malignancy (cancer) of the pancreas.
Alternative Names:
Pancreatic cancer; Cancer - pancreas
Causes, incidence, and risk factors:
Pancreatic cancer is the 4th leading cause of death from cancer in the U.S. The disease is slightly
more common in men than in women, and risk increases with age.
The cause is unknown, but it is more common in smokers and in obese individuals. Almost 1/3
of cases of pancreatic carcinoma can be attributed to cigarette smoking. There is controversy as
to whether type 2 diabetes is a risk factor for pancreatic cancer. A minority of cases are known to
be related to hereditary syndromes.
Symptoms:
Weight loss

Abdominal pain

Loss of appetite

Jaundice

Nausea and vomiting

Weakness

Fatigue

Diarrhea

Indigestion

Back pain

Clay-colored stools

Paleness

Depression
Signs and tests:
ERCP

Abdominal CT scan

Pancreatic biopsy

Abdominal ultrasound

Abdominal MRI

This disease may also alter the results of the following tests:
Serum bilirubin
Liver function tests
Treatment:
At the time of diagnosis, only about 20% of pancreatic tumors can be removed by surgery. The
standard procedure is called a pancreaticoduodenectomy (Whipple procedure).

This surgery for pancreatic cancer should be done at centers that perform the procedure
frequently. Some studies suggest that surgery is best performed at hospitals that perform at least
9 of these surgeries per year.
When the tumor is confined to the pancreas but cannot be removed, a combination of radiation
therapy and chemotherapy may be recommended. When the tumor has spread (metastasized) to
other organs such as the liver, chemotherapy alone is usually used. The standard chemotherapy
agent is gemcitabine, but other drugs may be used. Gemcitabine provides clinical improvement
in approximately 25% of patients.
For patients who have biliary obstruction (blockage of the vessels that transport bile) and the
tumor cannot be totally removed, the obstruction must be relieved. There are generally two
approaches to this -- surgery and placement of a biliary stent (similar to stents placed in the
arteries of the heart to relieve blockages) during ERCP.
Management of pain and other symptoms is an important part of the treatment of advanced
pancreatic cancer. Hospice can be very helpful to patients for both pain and symptom
management and psychological support for the patient and the family during the course of the
illness.
Support Groups:
The stress of illness can often be eased by joining a support group with members who share
common experiences and problems. See cancer - support group. Also see the discussion of
hospice in the treatment section above.
Expectations (prognosis):
Some patients with pancreatic cancer that is resectable (can be surgically removed) are cured.

However, cure rates are significantly less than 50%.


Chemotherapy and radiation are often given after surgery to attempt to increase the cure rate. For
pancreatic cancer that cannot be removed completely with surgery, or cancer that has spread
beyond the pancreas, cure is not currently possible and the average survival is usually less than 1
year. Such patients might consider enrollment in a clinical trial (a medical research study to
determine the best treatment).
Complications:
Pancreatic cancer may result in weight loss, blood clots, liver dysfunction, infections, pain, and
depression. Symptoms such as pain can usually be controlled with aggressive pain management.
Calling your health care provider:
Call for an appointment with your health care provider if you have persistent abdominal pain,
loss of appetite, fatigue, back pain, or other symptoms suggestive of this disorder.
Prevention:
If you smoke, stop smoking. Eat a diet high in fruits, vegetables, and whole grains, and exercise
regularly.
Review Date: 8/10/2004
Reviewed By: Stephen Grund, M.D., Ph.D., Chief of Hematology & Oncology and Director of
the George Bray Cancer Center at New Britain General Hospital, New Britain, CT. Review
provided by VeriMed Healthcare Network.