Pancreatic cancer

Pancreatic cancer is the growth of abnormal cells in the pancreas. The pancreas is a small organ located deep in the belly, behind your stomach.

The pancreas makes juices that help your body digest food. It also makes insulin and other hormones that help control your blood sugar.

There are two main types of pancreatic tumors: exocrine and endocrine. The type of tumor depends on which type of cells are involved. Exocrine (say "EX-oh-krin") cells make digestive juices. Endocrine (say "EN-doh-krin") cells make insulin. Most people with pancreatic cancer have exocrine tumors, which grow faster than endocrine tumors.

Treatments are more successful when cancer is found early. But in most cases, pancreatic cancer has already spread by the time it is found. Still, treatment may help you feel better, and it helps some people live longer.

Pancreatic cancer usually doesn't cause symptoms at first. It's silent and painless. Symptoms usually don't begin until the cancer has spread. They may include:

• Pain in the upper belly or back.
• Jaundice. This yellowing of the skin and whites of the eyes can happen when the growing tumor presses the bile duct closed.
• Unexpected weight loss.
• Loss of appetite.
• Extreme tiredness.

Of course, there are other conditions that cause these symptoms, so they don't necessarily mean you have cancer. But it's important to talk to your doctor if you have any of these problems.

To look for or diagnose pancreatic cancer, your doctor will ask you about your medical history and your family history. You will get a physical exam. Some of these tests will also be done:

• Lab tests. These include blood tests to measure levels of bilirubin and other substances.
• Imaging tests. They include:
  • CT scan or MRI.
  • PET scan.
  • Endoscopic ultrasound (EUS).
  • X-rays. This includes endoscopic retrograde cholangiopancreatogram (ERCP).
• Tumor marker tests. These tests look for signs of cancer in samples of blood or tissue.

Your doctor may also order a biopsy. This means getting a sample of tissue from the pancreas to see if it contains cancer cells. Types of biopsies include:

• Needle biopsy. Tissue samples are collected through a needle. Imaging, like ultrasound, may be used to guide the needle.
• Laparoscopy. The doctor makes a small cut in your belly and uses a thin, lighted tool called a laparoscope to collect tissue samples.

Treatment for pancreatic cancer is based on the stage of the cancer and other things, such as your overall health. The main treatments include:

Surgery.

Surgery is done if all of the cancer can be removed. If all the cancer can’t be removed, other treatments are used.

The most common surgery removes part of the pancreas along with parts of nearby organs, like the small intestine. Nearby lymph nodes may also be removed and checked for cancer.

Radiation.

This uses high-dose X-rays to destroy cancer cells and shrink tumors.

Chemotherapy.

These medicines kill fast-growing cells, including cancer cells and some normal cells. Chemotherapy and radiation may be given together (chemoradiation).

Other options may include immunotherapy or targeted therapy. Your doctor may suggest a clinical trial.

Your doctor will talk with you about your options and then make a treatment plan.

• Take your medicines exactly as prescribed. Call your doctor if you think you are having a problem with your medicine.
• Eat healthy food. If you do not feel like eating, try to eat food that has protein and extra calories to keep up your strength and prevent weight loss. Drink liquid meal replacements for extra calories and protein. Try to eat your main meal early in the day.
• Get some physical activity every day, but do not get too tired. Keep doing the things you enjoy as your energy allows.
• Take steps to manage your stress, such as learning relaxation techniques. To also help reduce stress, get enough sleep, eat a healthy diet, and take time to do things you enjoy.
• Think about joining a support group. Or discuss your concerns with your doctor or a counselor.
• If you are vomiting or have diarrhea:
  • Drink plenty of fluids to prevent dehydration. Choose water and other clear liquids. If you have kidney, heart, or liver disease and have to limit fluids, talk with your doctor before you increase the amount of fluids you drink.
  • When you are able to eat, try clear soups, mild foods, and liquids until all symptoms are gone for 12 to 48 hours. Other good choices include dry toast, crackers, cooked cereal, and gelatin dessert, such as Jell-O.
• If you have not already done so, prepare a list of advance directives. Advance directives are instructions to your doctor and family members about what kind of care you want if you become unable to speak or express yourself.