- The Pancreas
- What Is Cancer?
- Diagnosis and Staging
- Orthodox Treatment
- Side Effects of Orthodox Treatment
- Pain Control
The pancreas is located in the abdomen. It is surrounded
by the stomach, intestines, and other organs. The pancreas
is about 6 inches long and is shaped like a long, flattened
pear--wide at one end and narrow at the other. The wide part
of the pancreas is called the head, the narrow end is the
tail, and the middle section is called the body of the pancreas.
The pancreas is a gland that has two main functions. It makes
pancreatic juices, and it produces several hormones, including
Pancreatic juices contain proteins called
enzymes that help digest food. The pancreas releases these
juices, as they are needed, into a system of ducts. The main
pancreatic duct joins the common bile duct from the liver
and gallbladder. (The common bile duct carries bile, a fluid
that helps digest fat.) Together these ducts form a short
tube that empties into the duodenum, the first section of
the small intestine.
Pancreatic hormones help the body use or store the energy
that comes from food. For example, insulin helps control the
amount of sugar (a source of energy) in the blood. The pancreas
releases insulin and other hormones when they are needed.
The hormones enter the bloodstream and travel throughout the
What Is Cancer?
Cancer is a group of many different diseases. Cancer occurs
when cells divide without order and invade and destroy the
tissue around them. To understand cancer, it is helpful to
know about normal cells and about what happens when cells
The body is made up of many types of cells. Normally, cells
grow and divide to produce more cells only when the body needs
them. This orderly process helps keep the body healthy.
Sometimes cells keep dividing when new cells are not needed,
forming a mass of extra tissue called a growth or tumor. Tumors
can be benign or malignant.
Benign tumors are not cancer. They often can be removed,
and they usually do not come back. Cells in benign tumors
do not spread to other parts of the body. Most important,
benign tumors are rarely a threat to life.
Malignant tumors are cancer. Cells in malignant tumors
are abnormal and divide without control or order. These cancer
cells can invade and destroy the tissue around them. Also,
cancer cells can break away from malignant tumor and enter
the bloodstream or the lymphatic system. This process is the
way cancer spreads from the original (primary) tumor to form
new tumors in other parts of the body. The spread of cancer
is called metastasis.
More than 100 different types of cancer are known--and several
types of cancer can develop in the pancreas. Cancer of the
pancreas is also called pancreatic cancer or carcinoma of
the pancreas. Most pancreatic cancers begin in the ducts that
carry pancreatic juices. A rare type of pancreatic cancer
begins in the cells that produce insulin and other hormones.
These cells are called islet cells, or the islets of Langerhans.
Cancers that begin in these cells are called islet cell cancers.
As pancreatic cancer grows, the tumor may invade organs that
surround the pancreas, such as the stomach or small intestine.
Pancreatic cancer cells also may break away from the tumor
and spread to other parts of the body. When pancreatic cancer
cells spread, they often form new tumors in lymph nodes and
the liver, and sometimes in the lungs or bones. The new tumors
have the same kind of abnormal cells and the same name as
the primary (original) tumor in the pancreas. For example,
if pancreatic cancer spreads to the liver, the cancer cells
in the liver are pancreatic cancer cells. The disease is metastatic
pancreatic cancer; it is not liver cancer.
Pancreatic cancer has been called a "silent" disease
because it usually does not cause symptoms early on. The cancer
may grow for some time before it causes pressure in the abdomen,
pain, or other problems. When symptoms do appear, they may
be so vague that they are ignored at first. For these reasons,
pancreatic cancer is hard to find early. In many cases, the
cancer has spread outside the pancreas by the time it is found.
When symptoms appear, they depend on the location and size
of the tumor. If the tumor blocks the common bile duct so
that bile cannot pass into the intestines, the skin and whites
of the eyes may become yellow, and the urine may become dark.
This condition is called jaundice.
As the cancer grows and spreads, pain often develops in the
upper abdomen and sometimes spreads to the back. The pain
may become worse after the person eats or lies down. Cancer
of the pancreas can also cause nausea, loss of appetite, weight
loss, and weakness.
Islet cell cancer can cause the pancreas to make too much
insulin or other hormones. When this happens, the person may
feel weak or dizzy and may have chills, muscle spasms, or
These symptoms may be caused by cancer or by other, less
serious problems. Only a doctor can tell for sure.
Diagnosis and Staging
ITo find the cause of a person's symptoms, the doctor performs
a physical exam and asks about the person's medical history.
In addition to checking general signs of health, the doctor
may perform blood, urine, and stool tests.
The doctor usually orders procedures that produce pictures
of the pancreas and the area around it. Pictures can help
the doctor diagnose cancer of the pancreas. They also can
help the doctor determine the stage, or extent, of the disease
by showing whether the cancer affects nearby organs. Pictures
that show the location and extent of the cancer help the doctor
decide how to treat it. Procedures to produce pictures of
the pancreas and nearby organs may include:
- An upper GI series, sometimes called a barium swallow.
A series of x-rays of the upper digestive system is taken
after the patient drinks a barium solution. The barium shows
an outline of the digestive organs on the x-rays.
- CT scanning, the use of an x-ray machine linked with a
computer. The x-ray machine is shaped like a doughnut with
a large hole. The patient lies on a bed that passes through
the hole, and the machine moves along the patient's body,
taking many x-rays. The computer puts the x-rays together
to produce detailed pictures.
- MRI, the use of a powerful magnet linked to a computer.
The MRI machine is very large, with space for the patient
to lie in a tunnel inside the magnet. The machine measures
the body's response to the magnetic field, and the computer
uses this information to make detailed pictures of areas
inside the body.
- Ultrasonography, the use of high-frequency sound waves
that cannot be heard by humans. An instrument sends sound
waves into the patient's abdomen. The echoes that the sound
waves produce as they bounce off internal organs create
a picture called a sonogram. Healthy tissues and tumors
produce different echoes.
- ERCP, a method for taking x-rays of the common bile duct
and pancreatic ducts. The doctor passes a long, flexible
tube (endoscope) down the throat, through the stomach, and
into the small intestine. The doctor then injects dye into
the ducts and takes x-rays.
- PTC, in which a thin needle is put into the liver through
the skin on the right side of the abdomen. Dye is injected
into the bile ducts in the liver so that blockages in the
ducts can be seen on x-rays.
- Angiography, x-rays of blood vessels taken after the injection
of dye that makes the blood vessels show up on the x-rays.
Pictures of the pancreas and nearby organs provide important
clues as to whether a person has cancer. However, doing a
biopsy is the only sure way for the doctor to learn whether
pancreatic cancer is present. In a biopsy, the doctor removes
a tissue sample. A pathologist looks at the tissue under a
microscope to check for cancer cells.
Sometimes, the biopsy to diagnose pancreatic cancer is done
during surgery. In one type of surgery, called laparoscopy,
the doctor inserts a lighted instrument shaped like a thin
tube into the abdomen through a small incision. In addition
to removing tissue samples to be examined under the microscope,
the doctor can see inside the abdomen to determine the location
and extent of the disease. During the laparoscopy, the doctor
can decide whether a larger operation called a laparotomy
is needed to remove the tumor or to relieve symptoms caused
by the cancer.
In some cases, a laparotomy is necessary to make a diagnosis.
In this operation, the doctor makes a larger incision and
directly examines the organs in the abdomen. If cancer is
found, the doctor can go ahead with further surgery.
Cancer of the pancreas is very hard to control. This disease
can be cured only when it is found at an early stage, before
it has spread. However, treatment can improve the quality
of a person's life by controlling the symptoms and complications
of this disease.
People with pancreatic cancer are often treated by a team
of specialists, which may include surgeons, medical oncologists,
radiation oncologists, and endocrinologists. The choice of
treatment depends on the type of cancer, the location and
size of the tumor, the extent (stage) of the disease, the
person's age and general health, and other factors. Cancer
that begins in the pancreatic ducts may be treated with surgery,
radiation therapy, or chemotherapy. Doctors sometimes use
combinations of these treatments. Researchers are also studying
biological therapy to see whether it can help when pancreatic
cancer has spread to other parts of the body or has recurred.
Islet cell cancer is usually treated with surgery or chemotherapy.
Doctors may decide to use one method or a combination of treatment
Some people take part in a clinical trial (research study)
using new treatment methods. Such studies are designed to
improve cancer treatment.
Methods of Treatment
Surgery may be done to remove all or part of the pancreas
and other nearby tissue. The type of surgery depends on the
type of pancreatic cancer, the location of the tumor in the
pancreas, the person's symptoms, whether the cancer involves
other organs, and whether the cancer can be completely removed.
In the Whipple procedure, the surgeon removes the head of
the pancreas, the duodenum, part of the stomach, and other
nearby tissue. A total pancreatectomy is surgery to remove
the entire pancreas as well as the duodenum, common bile duct,
gallbladder, spleen, and nearby lymph nodes.
Sometimes, the cancer cannot be completely removed. However,
surgery can help to relieve symptoms that occur if the duodenum
or bile duct is blocked. To relieve such symptoms, the surgeon
creates a bypass around the blockage.
Radiation therapy (also called radiotherapy) is the
use of high-energy rays to damage cancer cells and stop them
from growing and dividing. Like surgery, radiation therapy
is local therapy; the radiation can affect cancer cells only
in the treated area. The radiation to treat pancreatic cancer
comes from a machine that aims the rays from radioactive material
at a specific area of the body.
Chemotherapy is the use of drugs to kill cancer cells.
It may be given alone or along with radiation therapy to relieve
symptoms of the disease if the cancer cannot be removed. When
the cancer can be removed, doctors sometimes give chemotherapy
after surgery to help control the growth of cancer cells that
may remain in the body. The doctor may use one drug or a combination
Chemotherapy is usually given in cycles: a treatment period
followed by a recovery period, then another treatment period,
and so on. Most anticancer drugs are given by injection into
a vein (IV); some are given by mouth. Chemotherapy is a systemic
therapy, meaning that the drugs flow through the body in the
Biological therapy (also called immunotherapy) is
a form of treatment that uses the body's natural ability (immune
system) to fight disease or to protect the body from treatment
side effects. Researchers are testing several types of biological
therapy, alone or in combination with chemotherapy. These
treatments may be used when pancreatic cancer has spread to
other organs or when it has recurred.
Side Effects of Orthodox Treatment
It is hard to limit the effects of treatment so that only
cancer cells are removed or destroyed. Because treatment also
damages healthy cells and tissues, it often causes unpleasant
The side effects of cancer treatment vary. They depend mainly
on the type and extent of the treatment. Also, each person
Surgery--The side effects of surgery
depend on the location of the tumor, the type of operation,
the patient's general health, and other factors. Although
patients are often uncomfortable during the first few days
after surgery, this pain can be controlled with medicine.
Patients should feel free to discuss pain relief with the
doctor or nurse. It is also common for patients to feel tired
or weak for a while. The length of time it takes to recover
from an operation varies for each patient.
Radiation Therapy--With radiation
therapy, the side effects depend on the treatment dose and
the part of the body that is treated. The most common side
effects are tiredness, skin reactions (such as a rash or redness)
in the treated areas, and loss of appetite. Radiation therapy
also may cause a decrease in the number of white blood cells,
cells that help protect the body against infection.
Chemotherapy--The side effects
of chemotherapy depend mainly on the drugs and the doses the
patient receives. Generally, anticancer drugs affect cells
that divide rapidly. These include blood cells, which fight
infection, help the blood to clot, or carry oxygen to all
parts of the body. When blood cells are affected by anticancer
drugs, patients are more likely to get infections, may bruise
or bleed easily, and may have less energy. Cells that line
the digestive tract also divide rapidly. As a result of chemotherapy,
patients may have side effects, such as loss of appetite,
nausea and vomiting, hair loss, or mouth sores. For some patients,
the doctor may prescribe medicine to help with side effects,
especially with nausea and vomiting. Usually, these side effects
gradually go away during the recovery period or after treatment
Hair loss, another side effect of chemotherapy, is a major
concern for many patients. Some chemotherapy drugs only cause
the hair to thin out, while others may result in the loss
of all body hair. Patients may feel better if they decide
how to handle hair loss before starting treatment.
In some men and women, chemotherapy drugs cause changes that
may result in a loss of fertility (the ability to have children).
Loss of fertility may be temporary or permanent depending
on the drugs used and the patient's age. For men, sperm banking
before treatment may be a choice. Women's menstrual periods
may stop, and they may have hot flashes and vaginal dryness.
Periods are more likely to return in young women.
In some cases, bone marrow transplantation and peripheral
stem cell support are used to replace tissue that forms blood
cells when that tissue has been destroyed by the effects of
chemotherapy or radiation therapy.
Biological Therapy--The side effects
of biological therapy depend on the type of treatment. Often,
these treatments cause flu-like symptoms such as chills, fever,
muscle aches, weakness, loss of appetite, nausea, vomiting,
and diarrhea. Some patients get a rash, and some bleed or
bruise easily. In addition, interleukin therapy can cause
Pain is a common problem for people with pancreatic cancer,
especially when the cancer grows outside the pancreas and
presses against nerves and other organs. However, the doctor
can usually relieve or reduce pain. It is important for patients
to report their pain so the doctor can take steps to help
There are several ways to control pain caused by pancreatic
cancer. In most cases, the doctor prescribes medicine to control
the pain. Sometimes a combination of pain medicines is needed.
Medicines that relieve pain may make people drowsy and constipated,
but resting and taking laxatives can help. In some cases,
pain medicine is not enough. The doctor may use other treatments
that affect nerves in the abdomen. For example, the doctor
may inject alcohol into the area around certain nerves to
block the feeling of pain. The injection can be done during
surgery or by using a long needle inserted through the skin
into the abdomen. This procedure rarely causes problems and
usually provides pain relief. Sometimes, the doctor cuts nerves
in the abdomen during surgery to block the feeling of pain.
In addition, radiation therapy can help relieve pain by shrinking