Pancreas

This information should not be used for self-diagnosis or in place of a qualified physician’s care.

Reviewed June 2016

The basics

Guidelines for treating this cancer have been developed by the Gastrointestinal (GI) Tumour Group.
For health professional information on treating this cancer, please see our Cancer Management Guidelines.
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.

What causes it and who gets it?

Listed below are some of the known causes of this cancer. Not all of the risk factors below may cause this cancer, but they may be contributing factors.

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

Can I help to prevent it?

To reduce your risk, don’t smoke, and avoid exposure to tobacco and cigarette smoke. Even if you have been using tobacco for many years, quitting will reduce your cancer risk. Support is available to help you successfully quit. Visit the BC Cancer Agency’s Prevention page on Tobacco for information and resources.
Eating healthy, nutritious foods can reduce your cancer risk. Follow the recommendations in Canada's Food Guide. In particular, eating a low-fat diet with plenty of fruits and vegetables can reduce your risk for this cancer.
Healthy eating and regular physical activity are the best ways to maintain a healthy body weight. Visit the BC Cancer Agency’s Prevention pages on Nutrition and on Physical Activity for information and resources.

Screening for this cancer

No effective screening program exists for this cancer yet. Some people are considered a higher risk for pancreatic cancer. They may be eligible for certain screening tests, such as MRI or an endoscopic ultrasound. These people can include close relatives of people with pancreatic cancer, carriers of the BRCA2 gene mutations, people with p16 mutations, patients with Lynch Syndrome with affected first degree relatives and people who have Peutz-Jeghers Syndrome. Please discuss this information with your physician if you fit this description.

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 & staging

Diagnosis

These are tests that may be used to diagnose this type of 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 (EUS). 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.

For more information on tests used to diagnose cancer, see our Recommended Websites, Diagnostic Tests section.

Types and Stages

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

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)

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 is offered after surgery.
Chemotherapy may be offered in cases where surgery is not possible.

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.

Follow-up after Treatment

Guidelines for follow-up after treatment are covered on our website.
You will be returned to the care of your family doctor or specialist for regular follow-up. If you do not have a family physician, please discuss this with your BC Cancer oncologist or nurse.
Follow-up testing is based on your type of cancer and your individual circumstances.
Life after Cancer focuses on the issues that cancer survivors can face.

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