Pancreatic Cancer

There are two main types of cells within your pancreas: exocrine cells and endocrine cells. Each cell type can form its own type of cancer with its own risk factors, symptoms, diagnostic methods, treatments and therapies. 
 

Exocrine Pancreatic Cancer

Exocrine cancer forms in the exocrine cells, which is where enzymes that help digest food are made. Exocrine pancreatic cancers make up about 95% of all cancers of the pancreas. There are many types including:  

• Pancreatic adenocarcinoma - represents about 95% of cancers of the exocrine pancreas. These kinds of cancers usually begin to develop in the ducts of the pancreas, but sometimes will occur in the cells that form pancreatic enzymes.
• Acinar cell carcinoma - this kind of rare and malignant tumor represents about 1% of all pancreatic tumors.
• Solid pseudopapillary neoplasm - also known as a Frantz tumor, solid pseudopapillary tumors are more common in women than in men.
• Ampullary cancer -this type of cancer begins in the ampulla of Vater, which is where the pancreatic duct and the bile duct meet. While ampullary cancer isn’t technically considered a type. of pancreatic cancer, it’s generally treated in a similar manner.
• Pancreatoblastoma - this rare type of pancreatic cancer most commonly affects children and is extremely rare in adults.

Endocrine Pancreatic Cancer 

On rare occasions, pancreatic cancer can develop in the endocrine cells, which are responsible for making and releasing hormones into the bloodstream. This type of cancer is known as a pancreatic neuroendocrine tumor or pancreatic NET. Pancreatic NETs are managed differently than exocrine pancreatic cancers. If you develop one of these tumors, your Mercy doctor will discuss your treatment options with you. 

While the exact cause of pancreatic cancer isn’t known, cancers can be caused by DNA changes that turn on and off the genes that help cells grow, divide and stay alive. People can inherit certain gene mutations from their parents which increases their risk of developing pancreatic cancer. 
 

Risk Factors

Age & Gender

Men are slightly more likely to develop pancreatic cancer than women. This may be due to higher tobacco use, which raises their risk. The risk of pancreatic cancer increases as we age. Nearly all patients of pancreatic cancer are older than age 45, and the average age of diagnosis is 70.
 

Tobacco Use

The risk of contracting pancreatic cancer is nearly two times as high among smokers compared to non-smokers. Nearly one-fourth of all pancreatic cancers are thought to be caused by tobacco use.
 

Weight

People who are obese or overweight are thought to be 20% more likely to be diagnosed with pancreatic cancer.
 

Chemical Exposure

Increased exposure to workplace chemicals, specifically used in dry cleaning or metalworking industries, may make a person more susceptible to pancreatic cancer. Gene mutations can develop as a result of exposure to these cancer-causing chemicals, and be passed down from generation to generation.
 

Chronic Pancreatitis

People who have a history of heavy alcohol or tobacco use may develop chronic pancreatitis, long-term inflammation of the pancreas, which carries with it an increased risk of pancreatic cancer.
 

Inherited Gene Mutations

Inherited gene mutations can pass from generation to generation. Some of these mutations cause as many as 10% of pancreatic cancers.

Signs of pancreatic cancer don’t usually develop until cancer has advanced, spreading to other parts of the body. The signs and symptoms of pancreatic cancer can vary depending on the type of pancreatic tumor present. See your Mercy doctor if you are experiencing symptoms that persist or don’t get better over time.
 

Exocrine Pancreatic Symptoms

Exocrine pancreatic symptoms include: 

• Jaundice (yellowing of skin and eyes)
• Dark urine
• Light-colored or greasy stools
• Pain in the abdomen or back
• Unintended weight loss
• Poor appetite
• Nausea and vomiting
• Enlarged gallbladder or liver
• Blood clots (especially in the legs)

Neuroendocrine Tumor Symptoms

Symptoms of pancreatic neuroendocrine tumors (NETs) can vary but may include: 

• Excess stomach acid that leads to stomach ulcers
• Diarrhea
• Unintended weight loss
• Red rash with swelling and blisters
• Low blood sugar
• Abdominal pain
• Nausea and vomiting

Tumors in the pancreas are usually too small for doctors to feel during a physical exam, which means they might not be found until they’ve spread beyond the pancreas. Mercy gastroenterologists, pathologists and radiologists use advanced diagnostic testing methods to help detect pancreatic cancer, evaluate the extent of the disease and develop a treatment plan. 
 

Imaging Tests

Imaging tests may be done both before and after a pancreatic cancer diagnosis for a number of reasons such as looking for suspicious areas that might be cancer, determining how far cancer might have spread, and looking for signs of cancer returning after treatment. Common imaging procedures include:

• CT/PET scans - CT scans are used to diagnose pancreatic cancer as well as used to determine if surgery is a good treatment option. PET scans are often used in combination with CT scans when diagnosing pancreatic cancer.
• MRIs - special types of MRIs can be used for people with pancreatic cancer or those at high-risk
• Cholaangeiopancreatography - this imaging test looks at pancreatic ducts & bile ducts to see if they are blocked, dilated or narrowed
• Ultrasounds - the two most commonly used ultrasounds for pancreatic cancer are abdominal ultrasounds and endoscopic ultrasounds (EUS)

Blood Tests

There are several blood and laboratory tests that can be used to help diagnose pancreatic cancer as well as help determine the best course of treatment(s) if cancer is found.

• Tumor markers - some of the blood tests can check for tumor-associated antigens, such as elevated CA19-9 levels
• Liver function tests - can look at levels of bilirubin to determine whether a patient's jaundice is caused by liver disease or something else

Biopsy

A biopsy is generally required for a definitive diagnosis of pancreatic cancer. A biopsy is when cells or tissues are removed to be examined by a pathologist for signs of cancer.

At Mercy, we don’t just care for you, we care about you. We’ll do everything we can to help you battle your pancreatic cancer, relieve your symptoms and ease your mind. Your treatment plan will depend on several factors: what stage your cancer is in and whether it’s already spread to other areas of your body. You may need one or more types of treatment, which can include surgery, radiation therapy, chemotherapy, targeted therapy & immunotherapy.
 

Pancreatic Cancer Surgery

In most cases, surgery is the best treatment for pancreatic cancer that hasn’t spread beyond the pancreas. Mercy gastrointestinal surgeons are skilled in using the latest surgical procedures and techniques, such as minimally invasive laparoscopic surgery, robotic surgery and endoscopic surgery. There are many different kinds of pancreatic cancer surgeries, but which kind you need depends on many factors. The types of pancreatic surgery include the following.

Pancreaticoduodenectomy

Also known as a Whipple procedure, this is the most common type of surgery for pancreatic cancer and is used to remove cancer in the head of the pancreas. Most often this surgery is done with an incision down the belly, but it’s sometimes performed laparoscopically.

Distal & Total Pancreatectomy

In a distal pancreatectomy, your Mercy surgeon removes just the tail of your pancreas, and may even remove your spleen as well. If your cancer has spread throughout the pancreas, but can still be removed, your Mercy surgeon may recommend a total pancreatectomy. In this procedure, your entire pancreas is removed, as well as your gallbladder, part of your stomach, intestines and spleen.

Stent Placement

A stent is a small tube made of metal, which is sometimes placed inside a blocked bile duct to keep it open. This is the most common approach to relieving a blocked bile duct and is usually performed during an endoscopy.  

Bypass Surgery

Another option for relieving a blocked bile duct is bypass surgery, which reroutes the flow of bile from the common bile duct into the small intestine. This procedure can be performed laparoscopically or by making a large cut in the abdomen.

Palliative Surgery

Palliative surgery for pancreatic cancer is usually performed if the cancer is too widespread to be removed completely. It can be performed using an operation known as bypass surgery to relieve symptoms or prevent complications.

Radiation Therapy for Pancreatic Cancer

If surgery isn’t an option for you, our radiation oncologists offer advanced radiation therapy treatments to precisely target cancerous tumors. Radiation therapy can be used in all stages of pancreatic cancer, including:
 

• Before surgery (neoadjuvant therapy) to lower the risk of leaving cancer cells behind
• After surgery (adjuvant therapy) to lower the chances of your cancer coming back, which is known as recursion
• As a treatment option for patients whose health makes them unable to undergo complex pancreatic surgery
• In combination with chemotherapy as a way to treat cancers that have spread beyond the pancreas itself

External Beam Radiation

External beam radiation is the most common type of radiation therapy used to treat pancreatic cancer. It focuses radiation from a source outside of the body onto the area of the tumor. In addition to standard external beam radiation, two forms of planning and delivering external beam radiation therapy may be used to treat pancreatic cancer:
 

• Stereotactic body radiation (SBRT)
• Intensity-modulated radiation therapy (IMRT) 

Chemotherapy for Pancreatic Cancer

Chemotherapy (also referred to as “chemo”) uses drugs delivered directly into your veins or given by mouth to reach pancreatic cancer cells throughout the body. Chemo may be an option for some patients before, after or in lieu of surgery. It’s usually given in cycles, with periods of time built into treatment plans that allow for patients to recover fully.