Pancreatic cancer is a disease in which malignant (cancer) cells form in the tissues of the pancreas. The two types of pancreatic glands — exocrine and endocrine — form different types of tumors.
These are by far the most common type of pancreatic cancer. About 95% of them are adenocarcinomas, which usually begin in the ducts (tubular canals) of the pancreas, but sometimes form in the cells that make the pancreatic enzymes. Treatment of exocrine tumors depends on the stage, or extent, of the cancer. Many adenocarcinomas are not discovered until a late stage, because symptoms rarely appear early.
Less common exocrine tumors include adenosquamous carcinoma, sqamous cell carcinomas, signet ring cell carcinomas, and undifferentiatied carcinomas. Another type of exocrine tumor, which can cause early symptoms such as jaundice, is ampullary cancer, which develops where the bile duct and pancreatic duct come together and empty into the duodenum.
Known as neuroendocrine tumors or islet cell tumors, these are much less common, but often have a better prognosis. These can arise in the cells that make insulin or glucagon, as well as cells that make the hormones gastrin and somatostatin, or in vasoactive intenstinal peptides.
Another type of tumor involving the pancreas is called an intraductal papillary mucinous neoplasm (IPMN). These are often pre-malignant, and therefore have a higher cure rate than the previously mentioned types of pancreatic cancer. Imaging studies can usually determine if you have IPMN.
Because it does not cause symptoms early on, and because of the lack of routine pancreas screening (due to location of the pancreas behind other organs), the serious forms of pancreatic cancer may grow for some time before they show symptoms such as:
- Jaundice, a yellowish appearance of the skin and whites of the eyes
- Pain in the upper abdomen or back
- Pressure in the abdomen
- Loss of appetite
- Long-standing diabetes
- Chronic pancreatitis
- Certain hereditary conditions
- Diet high in fat
Pancreatic cancer is usually diagnosed with tests and procedures that produce pictures of the pancreas and the area around it. The two most common procedures are an endoscopic ultrasound and a CT scan. A biopsy (the removal of a small sample of the tumor with a fine needle) may also be taken during an imaging exams. If pancreatic cancer is diagnosed, the information gathered will pinpoint the location, size and stage of the cancer. This information will help your medical team design your specific treatment plan.
In this procedure, you will receive intravenous sedation so that an endoscope (a thin, lighted tube) can be inserted into the abdominal area, next to the pancreas. The endoscope has a special miniaturized ultrasound built onto the tip, so that physicians can detect even the smallest of growths. This procedure also differentiates between a tumor and a non-cancerous stone that might be blocking the bile duct. If the physician sees a pancreatic mass, a needle can be inserted into the mass to take a biopsy, which is immediately evaluated by a pathologist. UC San Diego physicians are regional experts in endoscopic ultrasound.
CT (Computed Tomography) scan
During a CT scan, a series of detailed pictures are taken of areas inside the body, from different angles. UC San Diego’s high-quality, multidetector CT scanners are able to obtain detailed images of the pancreas and adjacent organs and vessels. You will receive an intravenous (IV) contrast injected into your vein, allowing radiologists to precisely determine the extent of the cancer and any involvement of adjacent organs.
MRI (Magnetic Resonance Imaging)
In selected patients, an MRI scan may be performed instead of or along with a CT scan. UC San Diego is a leader in MRI, with multiple scanners available to provide high-resolution imaging of the pancreas. An MRI provides detailed information about all parts of the pancreas, including areas that are hard to see on a CT scan, such as pancreatic ducts and channels. As with a CT scan, you will receive an intravenous (IV) contrast injected into your vein.
In order to plan treatment, it is best to know the size, location and stage of the cancer. The American Cancer Society recommends the American Joint Committee on Cancer (AJCC) TNM system of staging:
- T describes the size of the primary tumor, measured in centimeters
- N describes the spread to nearby lymph nodes
- M indicates whether the cancer has metastasized (spread) to other organs.
The numbers and/or letters after TNM provide more detail about each of these factors. According to the National Cancer Institute, these numbers are:
- Stage 0 – the cancer is found only in the lining of the pancreas
- Stage I – the cancer is only in the pancreas, if IA the tumor is 2 centimeters or smaller, IB if larger than 2 centimeters
- Stage II – in IIA, the cancer may have spread to nearby tissue and organs; in IIB, it has also spread to nearby lymph nodes
- Stage III – the cancer has spread to major blood vessels near the pancreas and may have spread to nearby lymph nodes
- State IV – the cancer may be of any size and has spread to distant organs, such as the liver, lung and peritoneal cavity
After your diagnosis, your physician will discuss your treatment options, which may include:
Your treatment will be customized to your condition. If at all possible, your doctor will recommend surgery to remove the tumor. (However, only about 20% of pancreatic cancers can be removed by surgery, due to the aggressiveness of this type of cancer and the stage at which it is often discovered. See Surgical Treatment of Pancreatic Cancer for more information about Whipple and other procedures. If your tumor can be removed by surgery, you may also receive chemotherapy and/or radiation therapy.
Unfortunately, many cases are not discovered until the cancer has spread. In advanced cancers of the pancreas that have grown too far to be completely removed by surgery, the standard treatments are chemotherapy with the drug Gemcitabine and Erlotinib or the combination of radiation therapy and chemotherapy with Gemcitabine or 5-Fluorouracil (5-FU). In some cases of widespread, metastatic cancer of the pancreas, additional medications may be considered, as well.
Another treatment option your physician may discuss with you is participation in one of our clinical trials. This is your access to the most promising new therapies being tested. The decision to enter a clinical trial is always up to you.
Palliative care is designed to relieve suffering and improve the quality of your life by treating physical and emotional symptoms caused by your cancer or its treatment. Palliative care is not reserved for end-of-life care. We encourage patients with survivable cancers to seek palliative care, and to seek care early in cancer treatment. Learn more about Palliative Care at UC San Diego.