Pancreatic Cancer
Symptoms
The symptoms of pancreatic cancer are often vague or not apparent, making the disease difficult to diagnose. Frequently, it reaches an advanced stage before symptoms occur. The most common are:
- Abdominal pain
- Loss of appetite, nausea or weight loss
- Jaundice (a yellowish discoloration of the skin and whites of the eyes)
- Back pain
- Feeling of weakness
An individual's risk of getting pancreatic cancer increases if he or she:
- Uses tobacco
- Eats a high fat diet
- Has chronic pancreatitis
- Has a hereditary form of pancreatitis or pancreatic cancer
- Works with metals or chemicals
- Is African American
The exocrine part of the pancreas (which produces the digestive fluids that help break down fats, proteins and carbohydrates) is where 95% of all pancreatic cancers, or adenocarcinomas, begin. The other five percent grow in the endocrine section, where hormones (like insulin) are made. Identifying the type of tumor is important since they behave, develop and respond to treatment differently.
Pancreatic cancer's symptoms are like those of many other pancreatic conditions. That's why it's important to be seen by an expert, who may use any of the following tests for an accurate diagnosis:
- Basic blood tests and a lab test called CA19-9
- Ultrasound. Though not a definitive test for tumors, it is a good way to find gallstones or cysts in the pancreas.
- Computed tomography (CT) scan. These three-dimensional X-rays are accurate tests for cancer. A CT scan is also used to guide a biopsy needle exactly to the tumor to take a tissue sample for lab analysis.
- Magnetic resonance imaging (MRI). This uses magnetic fields and radio waves to create detailed images of soft tissue. A special type, magnetic resonance cholangiopancreatography (MRCP), can find blockages in the pancreatic and bile ducts.
- Endoscopic retrograde cholangiopancreatography (ERCP). This minimally invasive procedure is considered the gold standard for pancreatic and biliary diagnosis, but there is a two to five percent risk of causing pancreatitis.
Currently, there are no effective screening tests to detect pancreatic cancer. It is often difficult for a doctor to distinguish between pancreatitis (inflammation of the pancreas) and pancreatic cancer. Both conditions present similar symptoms and may look the same on radiology scans. Most patients require exploratory surgery to establish a diagnosis of pancreatic cancer and determine the extent of the disease.
TreatmentTreatment for pancreatic cancer includes surgery, chemotherapy, radiation therapy or a combination, depending on the stage of the disease.
Exploratory surgery is performed through an incision in the abdomen (laparotomy). This allows the surgeon to assess the extent of the disease. If the tumor can be removed, a Whipple procedure (pancreatoduodenectomy) is used, which can be very effective and results in few complications. Only five to 20% of patients have tumors that can be surgically removed.
Laparoscopy, a less invasive procedure, is sometimes done. The surgeon inserts a laparoscope (flexible telescope with a camera attached) into the abdomen to see how far the disease has progressed.
Chemotherapy or radiation may benefit the patient if the tumor cannot be removed. Neither can be done until the patient has sufficiently recovered from the exploratory surgery, which usually takes about six weeks.
USC Ampullary Cancer
Premalignant lesions that may give rise to an ampullary cancer
In patients with an ampullary cancer, a pre-existing benign adenoma (growth of the ampulla Vater) is often found. The incidence of this adenoma is higher in patients who have inflammatory bowel disease. This adenoma, often called a villous adenoma, should be completely excised to prevent future cancerous change in this tumor.
A villous adenoma may be excised by surgical or endoscopic techniques. Small villous adenomas can be snared during endoscopy. It is important though that the gastroenterologist is able to completely excised to tumor. If remnants of the tumor are left behind then these may undergo malignant change in the future.
Surgical resection of the adenoma is required if the tumor is not amenable to removal by endoscopic techniques. At USC we offer a specialized organ preserving procedure in which the tumor is completely excised in the duodenum and the bile and the pancreatic ducts are then reimplanted into the duodenum. As a consequence of this type of surgery, more radical operations such as a Whipple operation is avoided for these benign (non-cancerous) lesions.
Treatment of ampullary cancer
The surgical treatment for ampullary cancer is a pylorus preserving Whipple operation. Ampullary tumors are associated with an excellent prognosis and if the tumor is limited to the duodenal mucosa without any invasion into the adjacent pancreas then the five-year survival may be as high as 90 percent.
At USC we have developed a laparoscopic procedure for the Whipple operation that we offer to selected patients with an ampullary cancer where the cancer is limited to the wall of the intestine without any invasion into the surrounding pancreas. Laparoscopic surgery utilizes minimally invasive techniques and is associated with a much more rapid recovery, diminish requirements for pain medication in the postoperative period and early return to work compared to conventional open surgery.
Because of the excellent prognosis associated with an ampullary cancer, aggressive surgical treatment should be offered to the patient at a center that performs a high volume of pancreatic surgery and the Whipple operation.
Contact information: USC Center for Pancreatic and Biliary Diseases
1510 San Pablo Street, Los Angeles, CA
Phone: 323-4425837
e-mail: PancreasDiseases@surgery.usc.edu
Programs
This web site provides select information about pancreatic and biliary disorders and is updated twice monthly. This information is not intended as a substitute for professional medical consultation with your physician.It is important that you consult with your physician for detailed information about your medical condition and treatment.The center will make every effort to update the site, however, past performance is no guarantee of future medical outcomes.
Copyright © 2002 USC Center for pancreatic and biliary diseases. All rights reserved.
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