Risk Factors

Several factors influence the risk of developing pancreatic cancer:

• Age: The likelihood of developing pancreatic cancer increases with age. Most pancreatic cancers occur in people over the age of 60.
• Being African American: African Americans are more likely than Asians, Hispanics, or whites to get pancreatic cancer.
• Being male: More men than women are diagnosed with pancreatic cancer.
• Chronic pancreatitis: Chronic pancreatitis is a painful condition of the pancreas. Some evidence suggests that chronic pancreatitis may increase the risk of pancreatic cancer.
• Diabetes: Pancreatic cancer occurs more often in people who have diabetes than in people who do not. The pancreas makes insulin, which controls the way the body uses sugar. People with diabetes cannot use sugar properly because they have too little insulin in the bloodstream.
• Family history: The risk for developing pancreatic cancer triples if a person's mother, father, sister, or brother had the disease. Also, a family history of colon or ovarian cancer increases the risk of pancreatic cancer. Learn more about hereditary cancer risk from our Family Cancer Assessment Clinic.
• Smoking: Cigarette smokers are two or three times more likely than nonsmokers to develop pancreatic cancer.

Some studies suggest that exposure to certain chemicals in the workplace or a diet high in fat may also increase the chance of getting pancreatic cancer.

Symptoms

Pancreatic cancer is sometimes called a "silent disease" because it often does not cause symptoms. But, as the cancer grows, symptoms may include the following:

• Loss of appetite
• Nausea and vomiting
• Pain in the upper abdomen or upper back
• Weakness
• Weight loss
• Yellow skin and eyes, and dark urine from jaundice

These symptoms can be caused by other conditions. A person with any of these symptoms should see a health care provider so the problem can be diagnosed and treated as early as possible.

Screening and Diagnosis

Currently, there are no screening methods for pancreatic cancer.

If symptoms suggest pancreatic cancer, the doctor may perform a number of procedures, including one or more of the following:

• Physical exam: The doctor examines the skin and eyes for signs of jaundice. The doctor then feels the abdomen to check for changes in the area near the pancreas, liver, and gallbladder. The doctor also checks for abnormal buildup of fluid in the abdomen.
• Lab tests: The doctor may take blood, urine, and stool samples to check for bilirubin and other substances. Bilirubin passes from the liver to the gallbladder to the intestine. If the common bile duct is blocked by a tumor, the bilirubin cannot pass through normally. Blockage may cause the level of bilirubin in the blood, stool, or urine to become very high. High bilirubin levels can result from cancer or from noncancerous conditions.
• CT scan: Doctors often use CT scans to take pictures of tissue inside the abdomen. An x-ray machine linked to a computer takes several pictures. The computer puts the x-rays together to create pictures of the pancreas and other organs and blood vessels in the abdomen.
• Ultrasound: This procedure uses high-energy sound waves bounced off internal tissues or organs in the abdomen to make echoes. The echoes form a picture called a sonogram. The picture can be printed to be looked at later. The ultrasound procedure may use an external or internal device, or both types:
  • Transabdominal ultrasound:To make images of the pancreas, the doctor places the ultrasound device on the abdomen and slowly moves it around.
  • Endoscopic ultrasound (EUS): In this exam, the doctor passes a thin, lighted tube (endoscope) through the patient's mouth and stomach, down into the first part of the small intestine. At the tip of the endoscope is an ultrasound device. The doctor slowly withdraws the endoscope from the intestine toward the stomach to make images of the pancreas and surrounding organs and tissues.
• Endoscopic retrograde cholangiopancreatography (ERCP): In this exam, the doctor passes an endoscope through the patient's mouth and stomach, down into the first part of the small intestine. The doctor slips a smaller tube (catheter) through the endoscope into the bile ducts and pancreatic ducts. After injecting dye through the catheter into the ducts, the doctor takes x-ray pictures. The x-rays can show whether the ducts are narrowed or blocked by a tumor or other condition.
• Percutaneous transhepatic cholangiography (PTC): In this exam, a dye is injected through a thin needle inserted through the skin into the liver. Unless there is a blockage, the dye should move freely through the bile ducts. The dye makes the bile ducts show up on x-ray pictures. From the pictures, the doctor can tell whether there is a blockage from a tumor or other condition.
• Biopsy: The doctor removes tissue to look for cancer cells. A biopsy is the only way to know for sure if cancer is present.

Staging

When pancreatic cancer is detected, the doctor needs to know the stage (extent) of the disease to plan the best treatment. Staging is the process of finding out the size of the tumor in the pancreas, whether the cancer has spread, and if so, to what parts of the body.

The doctor may determine the stage of pancreatic cancer at the time of diagnosis, or the patient may need to have more tests. The results of these tests will help your health care team decide what treatments are best.

• Blood tests: Doctors check for specific substances in the blood that indicate cancer is present.
• CT scan: Doctors often use CT scans to take pictures of tissue inside the abdomen. An x-ray machine linked to a computer takes several pictures. The pictures may show a tumor, abnormal fluid, swollen lymph nodes, or if the cancer has spread to other parts of the body.
• Ultrasound: This procedure uses high-energy sound waves bounced off internal tissues or organs in the abdomen to make echoes. The echoes form a picture called a sonogram. The picture can be printed to be looked at later.
• Laparoscopy: Doctors use a thin, tube-like instrument to look at the pancreas and surrounding tissues inside the abdomen. A laparoscope has a light and a lens for viewing and may have a tool to remove tissue.

Stages of Pancreatic Cancer

Stage 0: Cancer is found only in the lining of the pancreas. These abnormal cells may become cancer and spread into nearby normal tissue.

Stage I: Cancer is found in the pancreas, but it has not spread to lymph nodes or nearby tissue and organs.

Stage II: Cancer may have spread to nearby tissue and organs, and may have spread to lymph nodes near the pancreas.

Stage III: Cancer has spread to the major blood vessels near the pancreas and may have spread to nearby lymph nodes.

Stage IV: Cancer may be of any size and has spread to distant organs such as the liver, lung, and peritoneal cavity. It may have also spread to organs and tissues near the pancreas or to lymph nodes.

Recurrent pancreatic cancer: Cancer that has come back after it has been treated. The cancer may come back in the pancreas or in other parts of the body.

Treatment

At Huntsman Cancer Institute, pancreatic cancer is treated by a team of specialists, including gastroenterologists (doctors who specialize in diseases of the digestive system), surgeons, medical oncologists, radiation oncologists, nurses, social workers, dietitians, and other professionals.

Pancreatic cancer treatment options include the following:

• Surgery
• Chemotherapy
• Radiation therapy
• Clinical trials

A patient may receive more than one type of treatment. The treatment that's right for each patient depends on the stage of the cancer and a patient's overall health before diagnosis.

Surgery

This treatment removes all or part of the pancreas. The extent of surgery depends on the location and size of the tumor, the stage of the disease, and the patient's general health. Types of surgery include the following:

• Whipple procedure: If the tumor is in the head (the widest part) of the pancreas, the surgeon removes the head of the pancreas and part of the small intestine, bile duct, and stomach. The surgeon may also remove other nearby tissues.
• Distal pancreatectomy: The surgeon removes the body and tail of the pancreas if the tumor is in either of these parts. The surgeon also removes the spleen.
• Total pancreatectomy: The surgeon removes the entire pancreas, part of the small intestine, a portion of the stomach, the common bile duct, the gallbladder, the spleen, and nearby lymph nodes.

Sometimes the cancer cannot be completely removed. But if the tumor is blocking the common bile duct or duodenum, the surgeon can create a bypass. A bypass allows fluids to flow through the digestive tract. It can help relieve jaundice and pain resulting from a blockage.

The doctor sometimes can relieve blockage without doing bypass surgery. The doctor uses an endoscope to place a stent in the blocked area. A stent is a tiny plastic or metal mesh tube that helps keep the duct or duodenum open.

Chemotherapy

This treatment uses drugs to destroy or control cancer throughout the body. Learn more about this treatment in our introduction to chemotherapy video.

Radiation therapy

This treatment uses high-energy rays to kill cancer cells. Radiation therapy may be given alone, or with surgery, chemotherapy, or both. Doctors may use radiation to destroy cancer cells that remain in the area after surgery. They also use radiation to relieve pain and other problems caused by the cancer.

Clinical trials

These studies discover and evaluate new and improved cancer treatments. Patients are encouraged to talk with their doctors about participating in a clinical trial or to ask any questions regarding research studies. For more information, also visit HCI's clinical trials website.

Support

When you or someone you love is diagnosed with cancer, concerns about treatments and managing side effects, hospital stays, and medical bills are common. You may also worry about caring for your family, employment, or how to continue normal daily activities.

Here's where you can go for support:

• Your health care team can answer your questions and talk to you about your concerns. They can help you with any side effects and keep you informed of all your treatments, test results, and future doctor visits.
• The Cancer Learning Center has hundreds of free brochures and more than 3,000 books, DVDs, and CDs available for checkout. You can browse the library, perform Internet research, or talk with a cancer information specialist. Call 801-581-6365 or toll free 1-888-424-2100, or e-mail This e-mail address is being protected from spambots. You need JavaScript enabled to view it .
• Our Patient and Family Support Services professionals offer HCI patients and their families emotional support and resources for coping with cancer and its impact on daily life.
• The Linda B. and Robert B. Wiggins Wellness-Survivorship Center offers support groups, classes, and activities aimed to increase the quality of life and well-being of HCI patients and their families.