• Pancreatic cancers are treated by members of the BC Cancer Agency’s Gastrointestinal (GI) Tumour Group.
• Other names for pancreas cancer include: pancreatic cancer, pancreatic carcinoma, pancreatic neoplasm, cancer of the pancreas.
• The pancreas is a gland that is about 6 inches long and lies deep in the upper abdomen behind the stomach.
• It is a very important gland that helps with the digestion of food and the regulation of blood sugar levels in the body.

• The exact causes of pancreatic cancer are not known.
• This cancer occurs mostly in people between the ages of 60 and 80 years.
• Black people and people with Ashkenazi Jewish heritage are more vulnerable to pancreatic cancer.
• Tobacco smoking is thought to contribute to 20% - 30% of pancreatic cancers.
• A high-fat diet and obesity are risk factors.
• Diabetes is a risk factor for pancreatic cancer. Pancreatic cancer may also cause diabetes.
• Chronic inflammation of the pancreas (pancreatitis), cirrhosis, and prior removal of the gallbladder (cholecystectomy) are also risk factors.
• About 5% - 10% of cases of pancreatic cancer are thought to be hereditary.
• Alcohol intake, coffee drinking and acute pancreatitis have been studied, but no clear link to pancreatic cancer has been found.
• Statistics:
• Pancreatic cancer accounts for approximately 2% of all cancers.
• BC
• Canada  

• Stop your use of and exposure to tobacco and cigarette smoke.
• Eat a low-fat diet with plenty of fruit and vegetables and maintain a healthy weight.

• No valid screening test or process is currently available for pancreatic cancer.

Signs and Symptoms

• Pancreatic cancer is difficult to diagnose at an early stage because there are often no definitive symptoms until the cancer has advanced. One or more of the symptoms below may be present:
• Jaundice (yellowing of the skin and the whites of the eyes, dark urine).
• Pain in the upper abdomen and/or upper back.
• Loss of appetite.
• Unexplained weight-loss.
• Weakness.
• Diarrhea or constipation.
• Nausea and vomiting.
• Pale, greasy stools that may float in the toilet.
• Onset of Type II diabetes.

Diagnosis
This is a list of some or all of the tests used to diagnose this type of cancer. We have more information on other diagnostic tests for cancer. 

• Physical examination.
• Stool examination to look for hidden blood.
• Blood tests to evaluate liver function. Sometimes pancreatic cancer can affect the liver and this can be detected on blood tests.
• Abdominal ultrasound uses sound waves to produce a picture of the organ which can locate a tumour.
• CT scan can show a cross section view of the organ. It can pinpoint the size and location of the tumour.
• MRI.
• Biopsy.  A small amount of tissue is removed for examination under a microscope.
• Fine needle aspiration.  A type of biopsy using a small needle inserted into a mass to withdraw tissue.
• Laparoscopy.  A thin instrument is inserted into the abdomen to view the pancreas; used to biopsy and stage the cancer.
• Endoscopic ultrasound.  An ultrasound probe is inserted via your mouth under sedation and sound waves are used to see the tumor and take a biopsy.
• Endoscopic retrograde cholangiopancreatography (ERCP)  A small camera is inserted via your mouth.  This test is done while you are sedated. Images of of the pancreatic duct and bile ducts are taken.  This is not routinely used for diagnosis, but is often used to help with an obstruction which causes jaundice.

Types & Stages
Staging describes the extent of a cancer. The TNM classification system is used as the standard around the world. In general a lower number in each category means a better prognosis. The stage of the cancer is used to plan the treatment.

• T describes the site and size of the main tumour (primary);
• N describes involvement of lymph nodes;
• M relates to whether the cancer has spread (presence or absence of distant metastases).

Types

• Pancreatic tumours can be of exocrine or endocrine origin.
• Exocrine tumours are the most common type of pancreatic cancer.
• Most (90%) of exocrine pancreatic cancers are adenocarcinomas.
• Adenosquamous, undifferentiated small cell carcinomas, cystadenocarcinomas and lymphomas are rare types of exocrine pancreatic cancer.
• Cystadenomas are a rare type of tumour of the exocrine pancreas; most are benign.
• Islet cell tumours or insulin secreting tumours are pancreatic cancers of endocrine origin. They are uncommon and can be less aggressive than exocrine tumours.

Stages

• In pancreatic cancer, staging has limited impact on survival.

Stage IA	Limited to the pancreas, 2 cm or smaller in size.
Stage IB	Limited to the pancreas, bigger than 2 cm in size.
Stage IIA	Has spread outside the pancreas, but not into large blood vessels, lymph nodes or other parts of the body.
Stage IIB	May have spread outside the pancreas but not into nearby large blood vessels. It has spread to nearby lymph nodes, but not to other parts of the body.
Stage III	Has spread into nearby large blood vessels, may or may not have spread to nearby lymph nodes, has not spread to other parts of the body.
Stage IV	Has spread to other parts of the body.

Treatment
Cancer therapies can be highly individualized – your treatment may differ from what is described below.

Surgery

• Surgery offers the only chance to cure pancreatic cancer, if the cancer has not spread to other organs.
• Pancreatic tumours are often inoperable, but if the tumour is found to be small and it has not spread, complete surgical removal (resection) can be done.
• Small ductal adenocarcinoma tumours, cystic tumours, giant cell tumours, osteoclastic tumours, intraductal papillary tumours and islet cell tumours may do well with resection.
• Carcinoma of the ampulla of Vater, the distal common bile duct and the duodenum can be treated with surgery.
• In resectable cancers, the 5-year survival rate is 15%-20%.
• In inoperable cancers, surgery may still be done to bypass an obstruction of the bile duct or intestine.

Chemotherapy

• Sometimes adjuvant therapy using gemcitabine or fluorouracil is offered after surgery.
• Chemotherapy may be offered in cases where surgery is not possible. Gemcitabine is the drug of choice in these cases.

Radiation Therapy

• For patients with cancer that is confined to the pancreas, radiation therapy can be considered in special cases.
• Radiation may be used when surgery is not possible.

Followup after Treatment

• Guidelines for followup after treatment has ended have been developed by the BC Cancer Agency and are listed on our website.
• You will be returned to the care of your family doctor for regular followup.
• Followup testing is based on your type of cancer and your individual circumstances.

Coping with Cancer

• BC Cancer Agency staff can help with quality of life issues for those living with or affected by cancer. This includes the physical, emotional, psychological and practical aspects of care. Each cancer experience is different, but in one way or another, many cancer patients share the same needs.
• The effects of cancer and its treatment can present unique challenges: from practical concerns like money and housing, to emotional concerns like anxiety and grief. If you need support with the practical and emotional impacts of cancer, or in managing symptoms and side effects you can use the information in Coping with Cancer to connect to these resources.

Search our library catalogue

• Automatically get a bibliography of books, videos and other items available through our library.

Recommended websites
The following websites have been chosen and evaluated by the BC Cancer Agency.

1. NCI http://www.cancer.gov/
2. CCS http://www.cancer.ca/
3. ASCO http://www.cancer.net/
4. BC Cancer Agency Recommended Websites http://www.bccancer.bc.ca/PPI/RecommendedLinks/typesofcancer/pancreas.htm

Can I help with research at BCCA?
BCCA cancer patients are very helpful when it comes to the fight against cancer. Here are a few ways that you can help.

• Clinical Trials – join our treatment-based research. Ask your oncologist if you qualify for a clinical trial.
• What are the pros and cons of joining a clinical trial?
• Tumour Tissue Bank – support our research by donating some of your cancer tissue.
• BC Cancer Foundation – support our research with a donation of money

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