Pancreatic Cancer Diagnosis

  • Diagnosis

    Pancreatic cancer is a disease in which abnormal cells divide uncontrollably in the pancreas Figure 01.

    Click to enlarge: The pancreas

    Figure 01. The pancreas

    Found behind the stomach, the pancreas is a gland involved in digestion. The pancreas produces digestive juices that enter the small intestine to break down food. In pancreatic cancer, abnormal pancreatic cells grow out of control and damage tissue, impairing the body's ability to digest foods and sugars.

    In some cases, these cells enter the bloodstream to form new tumors in other parts of the body, such as the lymph nodes and the liver. Of all pancreatic cancers, 95% begin in the area of the pancreas that helps produce juices to digest foods, while 5% begin in cells (islet cells) that produce hormones such as insulin, which breaks down sugars.

    Pancreatic cancer is the seventh leading cause of cancer in the U.S., and the fourth leading cause of cancer deaths. The American Cancer Society estimated that 33,730 new cases of pancreatic cancer would have been reported in the U.S. in 2006. Although the rates of pancreatic cancer have declined in men over the past 20 years, the rates in women have remained constant. Nonetheless, pancreatic cancer most commonly affects males, occurring most often in people over the age of 45.

    Islet cell cancer is a type of pancreatic cancer that is rare compared to other pancreatic cancers. The islet cells of the pancreas are small clusters of cells that release hormones such as insulin and glucagon. These hormones are necessary to control the amount of sugar in a person's blood. Most islet cell tumors are not cancerous.

    Although they usually do not provide a cure for people with pancreatic cancer, treatment options are available to extend survival and/or relieve symptoms Table 01. In most cases, traditional treatment options for pancreatic cancer include surgery, radiation therapy, and chemotherapy. Based on the patient's age and fitness, as well as the stage of the disease, the doctor will indicate the appropriate treatment regimen.

    Table 1.  Pancreatic Cancer Treatments

    Treatment Description Side effects
    Surgery Removal of all or part of the pancreas and the affected surrounding tissue Pain, weakness, digestive problems. If the pancreas is removed, the patient will become diabetic
    Radiation Exposing the affected area to high-energy rays to control the growth of cancer cells Tiredness, hair loss, redness, itchiness, and tenderness of skin in treated area; nausea, vomiting, diarrhea, digestive problems
    Chemotherapy Treating the patient with drugs to control tumor growth Depending on the agent used"
    Treatment Description Side effects
    Surgery Removal of all or part of the pancreas and the affected surrounding tissue Pain, weakness, digestive problems. If the pancreas is removed, the patient will become diabetic
    Radiation Exposing the affected area to high-energy rays to control the growth of cancer cells Tiredness, hair loss, redness, itchiness, and tenderness of skin in treated area; nausea, vomiting, diarrhea, digestive problems
    Chemotherapy Treating the patient with drugs to control tumor growth Depending on the agent used: low white blood cell count, infections, bruises or easy bleeding, fatigue, loss of appetite, nausea, vomiting, diarrhea, mouth sores
    Biological Uses the body's natural ability to fight disease (e.g., a vaccine) Flu-like symptoms including chills, fever, muscle aches, weakness, loss of appetite, nausea, vomiting, diarrhea; easy bruising or bleeding, rash, or swelling

    The cause of pancreatic cancer is unknown, although there may be risk factors associated with the disease.

    A person with early-stage pancreatic cancer rarely has symptoms. Pancreatic cancer is also referred to as the “silent disease”, because early detection of symptoms is unusual. In some cases in which the tumor originates in the head of the pancreas and blocks a bile duct, a person may have a yellowing of the skin (jaundice). This symptom allows the doctor to diagnose the disease at an early stage.

    When symptoms develop, they depend on where the lesions or tumors are located. If the cancer spreads to areas outside of the pancreas, pain may develop in the upper abdomen and spread to the back. When the cancer cells invade the pancreatic cells that make insulin or other hormones, a person may become dizzy and have chills, muscle spasms, or diarrhea. As the disease progresses, symptoms may mimic those of other diseases, and may go undetected for some time.

    Some symptoms of pancreatic cancer include:

    • Nausea
    • Appetite loss
    • Involuntary weight loss
    • Pain in the upper or middle abdomen
    • Yellowing of the skin or jaundice
    • Weakness/tiredness
    • Dizziness
    • Chills
    • Muscle spasms
    • Diarrhea
    • Depression
    • Digestive abnormalities and bleeding
    • Gallbladder enlargement
    • Middle back pain

    Islet cell tumors can cause diabetes. Rarely, tumors are present in the islet cells—the part of the pancreas that produces a substance called insulin. Insulin is responsible for breaking down sugars in your body. If this process is blocked by a tumor, insulin decreases, allowing sugar in the blood to accumulate. This might lead to diabetes. On the other hand, if the tumor causes the pancreas to make too much insulin or hormone, you may feel weak or dizzy, and have chills, muscle spasms, and/or loose stools.

    Although the cause of pancreatic cancer is unknown, it is associated with some risk factors, such as smoking, age, obesity and family history. People who have a history of chronic pancreatitis or diabetes may also have a higher risk. Researchers do not know with certainty if excess alcohol consumption and heavy coffee drinking increase the risk of pancreatic cancer.

    • Smoking. Cells in the pancreas may be damaged by heavy cigarette smoking. The damaged cells become abnormal or mutated, predisposing people to pancreatic cancer. In fact, smoking is linked to approximately one-third of pancreatic cancer deaths.
    • Age. The incidence of pancreatic cancer increases significantly after age 45. In fact, most patients affected by the disease are between 60 and 80 years old when diagnosed.
    • Obesity Being obese increases the risk of pancreatic cancer.
    • Family member with the disease. Some people are at an increased risk of developing pancreatic cancer because they have a family history of the condition. In about 5% to 10% of cases, pancreatic cancer is inherited.
    • Gender. Men are 30% more likely than women to get pancreatic cancer.

    Your doctor will take a complete medical history when trying to diagnose your condition. If your doctor suspects that you may have pancreatic cancer, he or she will ask questions about your family’s health, as pancreatic cancer is inherited in 10% of all cases. Your doctor will also ask about your ability to digest foods, since abnormalities in the pancreatic cells may hinder digestion. Oftentimes, people with pancreatic cancer experience symptoms such as unexpected weight loss, loss of appetite, nausea, diarrhea, weakness/tiredness, bleeding, abdominal pain, and gallbladder enlargement associated with digestive problems.

    Your doctor may also want to find out if you are diabetic. This is because people with diabetes possibly have an increased risk of developing pancreatic cancer. Tumors found in the pancreas may block production of insulin, which is necessary to break down sugars. As a result, sugar accumulates in the blood, leading to diabetes. On the other hand, the abnormal cells may, in very rare cases, cause too much insulin to be produced, and you may become dizzy, and experience chills and muscle spasms.

    If you are suspected of having pancreatic cancer, the doctor will run tests to determine the extent to which the pancreas and other tissues of the body are involved.

    • Ultrasound. This test uses sound waves to create an image of the internal organs. During this procedure, you will lie on a table, and a technician will rub gel on your abdomen. Then, he or she will run the ultrasound instrument over the gel. Sound waves will be emitted from the instrument that create a picture of the internal organs.
    • CT (Computed Tomography). This test takes x-ray scans of various cross-sections of the body, called “slices”.During this test, a patient will lie on a platform around which a machine moves, taking many x-ray pictures. A computer compiles these x-rays to produce a detailed picture of the internal organs.
    • MRI (Magnetic Resonance Imaging). This test is similar to a CT, except that it uses a magnetic field to create images of the inside of the body. For this test, a patient will lie very still on a platform that moves into a cylindrical machine. The machine will make tapping or banging noises while it is creating the images. During the procedure, the MRI technician will supervise from an adjacent room.
    • ERCP (Endoscopic Retrograde Cholangiopancretography). An endoscope is a long, flexible tube that the doctor passes down the patient's throat, through the stomach, and into the small intestine. The doctor injects dye into the common bile and pancreatic ducts and takes x-rays to see if any ducts are blocked. During ERCP, a doctor may surgically remove a sample (biopsy) of the pancreas.
    • PTC (Percutaneous Transhepatic Cholangiogram). For this procedure, the doctor will place a thin needle through the skin on the right side of the patient's abdomen and into the liver. Upon inserting the needle into the liver, the doctor will inject a dye into the bile ducts, and then x-ray the area to see if any ducts are blocked.
    • Blood tests can detect abnormal organ function (e.g., liver function) and presence of abnormal proteins produced by tumors called “tumor markers”.

    There are four stages of pancreatic cancer. In 70% to 80% of cases, advanced stages of pancreatic cancer affecting the cells in the ducts are present at diagnosis.

    • Stage I. Cancer cells are limited to the pancreas with no nodal or other organ involvement.
    • Stage II. Cancer cells spread to other organs (e.g., small intestine) in the digestive system with no nodal or distant organ (e.g., liver, brain, lungs) involvement.
    • Stage III. Stage I or II; however, the lymph nodes are also involved
    • Stage IVA. Cancer cells spread beyond the pancreas and other nearby organs to the stomach, spleen, colon, or blood vessels. Lymph nodes are also affected.
    • Stage IVB. Lymph nodes and distant organs are affected.

    If you are suspected of having pancreatic cancer, a tissue biopsy is the only reliable way to confirm a diagnosis. In a tissue biopsy, a doctor takes a small tissue sample and gives it to a laboratory for examination. Personnel in the laboratory examine the tissue sample under the microscope to detect cancer cells. In most cases, the patient doesn’t require general anesthesia.

    Physicians have little information on how to prevent pancreatic cancer. Avoid smoking. Don't start smoking. If you smoke, take steps to quit.

    The NCI American Cancer Society Guidelines on Diet and Nutrition recommends adhering to the following guidelines to reduce the risk for all cancers:

    • Maintain a desirable body weight
    • Eat a variety of foods daily, including fruits and vegetables
    • Eat more high-fiber foods such as whole grain cereals, legumes, vegetables, and fruits
    • Reduce the amount of dietary fat you consume
    • Cut down on the amount of alcohol you drink, if you drink at all
    • Reduce the amount of food you eat that is salt-cured, smoked, or nitrite-preserved

    Those with a family history of pancreatic cancer may benefit from imaging studies for early detection of the disease. Genetic testing is not currently offered for those with a family history of pancreatic cancer.

  • Prevention and Screening

    Physicians have little information on how to prevent pancreatic cancer. Avoid smoking. Don't start smoking. If you smoke, take steps to quit.

    The NCI American Cancer Society Guidelines on Diet and Nutrition recommends adhering to the following guidelines to reduce the risk for all cancers:

    • Maintain a desirable body weight
    • Eat a variety of foods daily, including fruits and vegetables
    • Eat more high-fiber foods such as whole grain cereals, legumes, vegetables, and fruits
    • Reduce the amount of dietary fat you consume
    • Cut down on the amount of alcohol you drink, if you drink at all
    • Reduce the amount of food you eat that is salt-cured, smoked, or nitrite-preserved

    Those with a family history of pancreatic cancer may benefit from imaging studies for early detection of the disease. Genetic testing is not currently offered for those with a family history of pancreatic cancer.

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