Pancreatic cancer is a malignancy that develops in the pancreas. The pancreas is an organ deep within the abdomen and is located between the abdominal wall, spine, spleen, and the first portion of the small intestine.  In the United States, there are approximately 27,000 new cases of pancreatic carcinoma each year with about 26,000 people dying during that time period.  Pancreatic carcinoma is the fifth deadliest form of cancer in the United States.  There is accumulating evidence that alcohol consumption and cigarette smoking increases the risks of developing pancreatic carcinoma.  In addition, there may be a genetic component in some families with a history of pancreatic carcinoma.  Current research is attempting to identify specific genes associated with pancreatic cancer.

In-depth Information

     Generally, there are no early symptoms in pancreatic carcinoma.  Later in the course of the disease, the most common presentation is painless jaundice (yellowing of the skin and the whites of the eyes).  Other possible symptoms are nausea, vomiting, itching, dark urine, light colored stools and weight loss.  In addition, there has been an association between depression and pancreatic carcinoma.  

     If you or your doctor suspects that you might have pancreatic carcinoma, the workup includes a careful physical examination evaluating the presence or absence of a palpable abdominal mass.  Tests can include a CT scan of the abdomen to evaluate the presence of a mass in the pancreas and also whether the ducts going of the pancreas and liver are dilated.  Other tests include an ERCP (endoscopic retrograde cholangio- pancreatography) a test where a light is placed through the mouth, esophagus, stomach, small intestine and the bile ducts in order to visualize the head of the pancreas.  Further tests include a needle biopsy (placing a needle through the skin under guidance of a CT scan to get a tissue diagnosis).  In order to further assess whether the tumor is resectable, other tests could include an arteriogram (x-rays of the vascular structures around the pancreas) or a spiral CT scan (a high resolution CT scan that yields better visualization of the blood vessels). Further blood work should include liver function tests and a CA 19-9 level.

     Staging describes how advanced the cancer is.  Staging of pancreatic carcinoma is based on the size of the tumor, proximity to certain important structures, and involvement of lymph nodes. 

• Stage IA: The tumor is limited to the pancreas and is less than or equal to 2.0 cm in greatest dimension.
• Stage IB: The tumor is limited to the pancreas and is more than 2.0 cm in greatest dimension.
• Stage IIA: The tumor extends beyond the pancreas, but there is no involvement of the celiac axis or superior mesenteric artery.
• Stage IIB:  There is involvement of regional lymph nodes.
• Stage III:  There is involvement of the celiac axis or superior mesenteric artery; these tumors are considered unresectable.
• Stage IV: The tumor has spread beyond the pancreas and lymph nodes to distant organs. 

     The treatment of pancreatic carcinoma is highly dependent upon the stage. In general, only 10% of pancreatic tumors are localized to such an extent that they can be surgically removed.  When the tumor is localized and does not involve regional blood vessels, the standard treatment is a Whipple resection (removal of the head of the pancreas, common bile duct, gallbladder, and part of the first portion of the small intestine).  In general, radiation and chemotherapy are delivered after a Whipple resection.  The five-year survival rate with surgery, radiation and chemotherapy approaches 20%.  When the tumor is localized and has not spread but involves the regional blood vessels, it is termed locally advanced pancreatic carcinoma.  The general treatment may involve chemotherapy and radiation, chemotherapy only, bypass of the small intestines to avoid obstruction, or supportive care (control of pain and symptoms related to the disease).  

     When these tumors involve the regional blood vessels, cure is very uncommon.  Radiation and chemotherapy can improve symptoms associated with the tumor, however.  Research is being conducted using chemotherapy agents such as gemcitabine alone or in combination with other agents like cisplatin or CPT-11. When the tumor spreads to distant organs, the treatment becomes individualized.  The chemotherapy agent gemcitabine has been shown to improve the performance status, and possibly survival,  among patients with Stage IV disease.  

Research & Clinical Trials

     If you are diagnosed with pancreatic carcinoma, you should consider participating in a research protocol.  Protocols often evaluate new agents that may have beneficial effects in the treatment of pancreatic carcinoma.  For more information regarding protocols for pancreatic carcinoma, contact the National Cancer Institute at www.nci.gov.  In addition, there are ongoing studies at the Emory University Hospital and Emory Clinic. 

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