According to estimates by the American Cancer Society, in the United States alone in the year 2017:
- Around 53,670 individuals will receive a pancreatic cancer diagnosis.
- Around 43,090 individuals will die from pancreatic cancer.
What Is Pancreatic Cancer?
Pancreatic cancer originates in the organ known as the pancreas. Your pancreas sits in front of your spine and behind your stomach and lies in your abdominal cavity. This glandular organ is part of your endocrine and digestive systems. Your pancreas produces the hormones responsible for controlling your blood sugar levels and the juices that are partly responsible for breaking down food. Pancreatic cancer begins in your cells that make the juices.
While anyone has the potential to develop pancreatic cancer, there are certain risk factors can affect your chances of getting this cancer. These factors include:
- Being extremely overweight
- Having a personal history of chronic pancreatitis or diabetes
- Having a family history of pancreatitis or pancreatic cancer
- Having specific hereditary conditions ( Peutz-Jeghers syndrome, MEN1 syndrome, Hereditary ovarian and breast cancer syndrome)
It’s difficult to catch pancreatic cancer early as symptoms of pancreatic cancer don’t appear right away. Even when they do appear, they’re often so subtle you don’t notice them. During routine exams, doctors can’t always see or feel the tumors since your other organs cover your pancreas.
To diagnose pancreatic cancer, liver and pancreas experts rely on blood tests, a physical exam, a biopsy and imaging tests. Pancreatic cancer can spread quickly. If detected too late, it can make it difficult for doctors to treat.
What Are the Stages of Pancreatic Cancer?
The term “stage” refers to how far the cancer has spread. The stages guide the doctor on what course of treatment to use and how to classify a patient for clinical trials.
Pancreatic cancer stages are:
- Stage 0: The cancer hasn’t spread. It’s limited to one layer of cells in your pancreas. It’s not visible to the naked eye or on imaging tests.
- Stage I: The cancer shows local growth. It’s limited to your pancreas but has grown to less or greater than two centimeters (stage IA and stage IB).
- Stage II: The cancer shows local spreading. It has spread to neighboring lymph nodes or has grown outside your pancreas.
- Stage III: The cancer shows wider spread. Your tumor expands into neighboring nerves or major blood vessels but hasn’t metastasized.
- Stage IV: The cancer shows confirmed spread. It has spread to distant organs.
What Warning Signs Should I Look For?
Having one or a couple of the following symptoms doesn’t necessarily mean you have pancreatic cancer. Other conditions can cause these symptoms as well. Even so, if you notice any of these symptoms, you should see your doctor for an examination.
Some warning signs of pancreatic cancer to watch for include:
Skin or Eye Yellowing
This happens when a small pancreatic tumor begins to develop, blocking the bile duct located in the head of your pancreas and leading to the buildup of bile. When this happens, it results in jaundice.
Itchy Palms, Skin, and Soles of Feet
This is caused by your skin reacts to the bilirubin, which is a brown and yellowish liver chemical that leads to jaundice.
Changes in Taste
Some patients may suddenly lose their taste for wine, coffee, and smoking. They claim to feel disgust for the taste and smell of alcohol and coffee.
Lack of Appetite
Some patients with pancreatic cancer report a sudden lack of appetite or the feeling of becoming full easily, usually around six to eight months before receiving their diagnosis.
Enlarged Gall Bladder
The same bile duct blockage that leads to jaundice may also result in an enlarged gall bladder, since the bile is building up behind the duct. Doctors can spot an enlarged gallbladder on an imaging test. During a physical exam, they may even be able to feel it.
Patients with pancreatic cancer usually feel a gnawing pain instead of an ache or sharp cramp. It tends to radiate towards the back. The pain may lessen when the patient leans forward.
Floating, Pale, and Smelly Stools
If a pancreatic tumor is preventing digestive enzymes from getting to the intestines, this leads to your body not being able to digest fatty foods. Because of this excess fat, your body produces smelly, loose stool that floats. Physicians say this pancreatic tumor symptom is an early clue that is frequently overlooked.
Stools Are Tarry and Dark
Upper intestinal bleeding can cause this symptom.
Unexplained, Sudden Weight Loss
Many people believe weight loss is a sign of cancer that has spread to the liver. However, this isn’t always the case. It may also occur due to a lack of pancreatic enzymes that are forcing fat to pass undigested through your body.
Diabetes is a common warning sign, particularly if you experience a sudden onset of the disease. However, since the disease is so widespread, many diabetes cases aren’t caused by pancreatic cancer. Physicians are developing screening tools that will help tell the difference.
As for now, doctors say an important clue is your family history. If you don’t have a family history of diabetes, but the disease comes on suddenly, you’ll want to request screening for pancreatic cancer.
What Treatment Options Are Available?
When it comes to cancer care, physicians and other healthcare professionals often work as a multidisciplinary team to derive an overall treatment plan for your pancreatic cancer. Patients who visit The University of Maryland St. Joseph Medical Center Liver and Pancreas Center work with Dr. Fraiman’s multidisciplinary team of experts.
Your treatment plan will likely combine several types of treatments. Therefore, your treatment will require various specialists such as:
Several factors determine the recommendations and treatment options you receive. These factors may include:
- The stage your cancer
- Your overall health
- Possible side effects
- Your personal preference
It’s vital that you sit down with your liver and pancreas doctor and learn about each treatment option. You should get your questions answered about anything you’re unclear about. You’ll want to also talk with your doctor about the goals of your treatment. Find out what you can expect during and after your treatment.
During the treatment plan decision-making process, you might be encouraged to consider participating in clinical trials. Clinical trials are studies that test new treatments and approaches. Studies can evaluate a revised dose of a current treatment, a different combination of treatments or a new drug altogether.
When the doctor detects pancreatic cancer at an early stage, there’s a higher chance of the treatment being successful. But even if you’re at an advanced stage of the cancer, there are still treatments that can help relieve your symptoms, control the disease, and even extend your life.
Treatment options will depend on the type and stage of your pancreatic cancer. Treatments may include:
The liver and pancreas surgeon may decide between two types of pancreatic cancer surgery. These include:
- Potentially Curative Surgery: Used when exam and test results suggest the surgeon may be able to resect (remove) all your cancer. Potentially curative surgeries include the Whipple procedure (pancreaticoduodenectomy), Distal pancreatectomy and total pancreatectomy.
- Palliative Surgery: Used when your imaging tests show the surgeon won’t be able to remove all your cancer because it’s too widespread. Your doctor may use this surgery to prevent certain complications such as a blocked intestine or bile duct or to relieve symptoms. Palliative surgery might also include bypass surgery and stent placement.
Your liver and pancreas surgeon assesses the stage of your cancer to determine which type of surgery is best. He may have to perform a laparoscopy procedure to make this decision since imaging tests alone aren’t an entirely accurate way of determining the stage of pancreatic cancer.
Side Effects of Surgery. Many patients, even under the best circumstances, can have complications from pancreatic surgery such as:
- Leaking from different organ connections the surgeon needs to make
- Difficulty digesting some foods
- Difficulty emptying stomach after eating
- Changes in bowel habits
- Weight loss
Ablation or Embolization Treatments
Physicians use these types of treatments to destroy tumors as an alternative to your surgeon performing surgery to remove them. Your surgeon may also use them to help treat pancreatic cancer that has spread to your liver and other organs. They help relieve or prevent certain symptoms, although they won’t cure your cancer. The surgeon may use these treatments in conjunction with others.
During this treatment, the surgeon uses extreme cold or heat to destroy your tumor. There are a few types of ablative treatments:
- Microwave thermotherapy
- Radiofrequency ablation (RFA)
Your doctor will discuss all three options with you.
Side effects of Ablation Treatments. You may experience certain side effects after this procedure including infection, abdominal pain, and bleeding inside your body.
In this procedure, the physician injects substances into your artery, trying to kill cancer cells by blocking the blood flow to them. If the doctor can’t use the ablation procedure because your tumor in your liver is too big, he’ll likely use embolization. There are a few forms of embolization:
- Arterial Embolization
Side Effects of Embolization. Discuss these potential side effects of embolization with your doctor.
- Abdominal pain
- Blood clots in neighboring blood vessels
With this procedure, the doctor kills cancer cells using high-energy x-rays. Radiation therapy is often helpful in treating exocrine pancreatic cancer. It’s also helpful in certain situations such as:
- After surgery, to help lower the likelihood of your cancer coming back. It’s usually combined with chemotherapy and is known as chemoradiotherapy when the two are given together.
- With borderline resectable tumors, combined with chemotherapy before surgery to shrink your tumor and make it easier to remove.
- As part of your primary treatment when your cancer has spread beyond your pancreas and the doctor can’t remove it.
- With advanced cancer, to help relieve pain and other symptoms or if you’re not healthy enough for surgery or other treatments.
A common type of radiation used for treating this type of cancer is external beam radiation therapy. It targets the radiation from an element outside the body on your cancer.
Before your treatment, your doctor and staff of your radiation team will make precise calculations to find the most accurate angles for the radiation. They’ll decide on the right dose of radiation as well. This simulation (planning session) typically includes MRI or CT scans and other imaging tests.
Radiation treatment is painless. However, there are side effects. It’s similar to getting an x-ray, just with stronger radiation. Each of your radiation treatments will only last a few minutes. Most radiation treatments run several weeks, five days a week.
Side Effects of Radiation Treatment. In addition to potentially lowering your blood counts and increasing your risk of severe infection, radiation side effects include:
- Nausea and vomiting
- Skin changes like peeling, redness or blistering in the radiation area
- Loss of appetite
- Weight loss
Chemotherapy and Other Drugs
With this treatment, the doctor injects anti-cancer drugs into your veins or administers them orally. Once in your bloodstream, the drugs can reach all body areas. This is why chemo is useful as a treatment if your cancer has spread to other organs.
Doctors typically use chemotherapy for treating exocrine pancreatic cancer. Other medications treat pancreatic neuroendocrine tumors (NETs).
Chemotherapy can treat any stage of your cancer. For instance, you may be given chemotherapy:
- Before surgery to shrink your tumor (sometimes combined with radiation).
- After surgery to kill leftover cancer cells and lower the chance of your cancer coming back later.
- During advanced cancer stages where the doctor can’t completely eradicate your cancer during surgery.
There are a variety of chemotherapy medications the doctor may use to treat pancreatic cancer which includes:
- 5-FU (5-fluorouracil)
- Gemzar (Gemcitabine)
- Eloxatin (Oxaliplatin)
- Camptosar (Irinotecan)
- Taxotere (Docetaxel)
- Taxol (Paclitaxel)
- Abraxane (Albumin-bound paclitaxel)
- Onivyde (Irinotecan liposome)
If you’re healthy enough, the doctor may give you two or more of these drugs together. If you’re not healthy enough, you may receive a single drug, typically 5-FU, gemcitabine or capecitabine.
Doctors give chemotherapy in cycles, with a rest period after each treatment to allow your body to recover. Your chemotherapy cycles will likely last several weeks.
Side Effects of Chemo Drugs. Some chemotherapy drugs may cause long-term effects such as fertility problems, nerve damage, or heart damage, in addition to the following side effects
- Loss of appetite
- Nausea and vomiting
- Mouth sores
- Hair loss
- Constipation or Diarrhea
- Bruising or bleeding from minor injuries or cuts
- Increased risk of infection
- Shortness of breath and fatigue
Not every pancreatic cancer patient experiences pain. However, if you do experience pain, your doctor can prescribe certain medications or treatments that may help ease it.
Opioids are narcotics. Opioids treat moderate to severe pain. Sometimes doctors combine them with non-opioids. Opioids work similarly to endorphins (natural substances in your body) that control pain.
Some types of opioids that doctors often use in cancer care include:
- Dilaudid (Hydromorphone)
- OxyContin (Oxycodone)
- Levo-Dromoran (Levorphanol)
- Opana (Oxymorphone
- Methadose (Methadone)
Any opioid drug that has an “ER” behind the name stands for extended release. It treats chronic pain. You take it following a routine schedule. An “IR” behind the name stands for immediate release and means the drug works fast and for a short time.
Side effects of opioids. When you take opioids, you risk becoming addicted. Other side effects include opioid-induced constipation, nausea, vomiting, dizziness, and respiratory depression.
Non-opioid Pain Medicines
Non-narcotics or non-opioids such as non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen control pain that’s mild to moderate. Most don’t require a prescription. Some examples of non-opioid pain medications include:
- Non-steroidal anti-inflammatory drugs
Side effects of non-opioid pain medicines. Be careful when taking NSAIDs if you drink alcohol. The combination can raise your risk of stomach bleeding and can cause an upset stomach. NSAIDs also raise your risk of stroke or heart attack, particularly if you take them for an extended period. If you take acetaminophen beyond the recommended maximum dose, you risk fatally damaging your liver.
How Can I Change My Lifestyle to Prevent Pancreatic Cancer?
There’s no real way to prevent pancreatic cancer. You can’t control certain risk factors like gender, race, age and family history. The best thing you can do is make certain lifestyle changes to help lower your risk.
Smoking is a risk factor for pancreatic cancer that’s one of the easiest to avoid. Just by quitting smoking, you dramatically lower your risk of pancreatic cancer. Talk to Your healthcare provider about ways they can help you quit smoking.
Maintain a Healthy Weight
Maintaining a healthy weight can also help you lower your risk of pancreatic cancer. Although the effects of eating well and getting physical activity on pancreatic cancer aren’t totally clear, both can keep you at a healthy weight.
Keep in mind that your healthy weight is unique to you and depends on factors like your height and body weight. Your healthcare provider can calculate your BMI (Body Mass Index) using your height and weight. Typically, the higher your BMI, the more body fat you have.
Doctors often use your BMI as a screening tool to determine if your weight is increasing your risk for health issues like diabetes, heart disease and cancer.
According to the American Cancer Society, you should choose foods and drinks in an amount that allows you to enjoy a healthy weight and maintain it. You should always eat plenty of fruits and vegetables. Try to consume pasta, bread, and cereals made with whole-grain instead of refined grains. Avoid red meat and processed meat and stick with poultry, fish, or beans.
You can lower your calorie intake by eating smaller food portions and limiting your snacks between meals. You should also try to limit your intake of drinks and food that are high in calories or added sugars.
Be Physically Active
As an adult, you should get a minimum of 150 minutes of moderate intensity activity each week and 75 minutes of vigorous intensity activity. Combine them if you wish, but spread the minutes out throughout the week.
Limit sedentary behaviors like lying down, sitting, watching television, using the computer and other screen-based entertainment activities.
Adding intentional activities with your usual activities can benefit your health. For instance, ride your bike to work instead of taking the bus or driving your car.
Examples of moderate and vigorous activities include:
- Running or jogging
- Aerobic dance
- Jumping rope
- Roller skating
- Circuit weight training
If you’re not active or you’re just getting started with a physical activity routine, start slowly and work your way up to higher intensity gradually. Even if you have to start with activity levels that are lower than recommended levels, this will still benefit your health. Always consult with your doctor before starting any exercise program.
Talk to a Doctor Today
Pancreatic cancer is a serious condition. It’s important to follow all instructions your doctor gives you. Instructions can be anything from taking certain medications, making lifestyle changes and attending all of your follow-up appointments.
For more information about pancreatic cancer treatment or to schedule a consultation Dr. Fraiman’s multidisciplinary team at the University of Maryland St. Joseph Medical Center Liver and Pancreas Center, please complete our contact form or call us at 410-427-2024.