Introduction	What is Pancreatic Cancer	What is the Pancreas	Statistics	Signs and Symptoms
Risk Factors	Diagnosis	Staging	Treatment	Raising Awareness

 What is Pancreatic Cancer?

Pancreas cancer, or pancreatic Aden carcinoma, occurs when there is an uncontrolled growth of abnormal cells in the pancreas that forms a mass or a tumour. It is the deadliest solid organ tumour with fatality rates approaching 100%. Because the pancreas lies deep within the abdomen it is difficult for a doctor to feel a pancreatic tumour during an examination. Pancreatic cancer has no early warning signs and no effective screening or early detection tests. As a result, cancer is rarely discovered until it has metastasized and spread to other organs. The majority of patients diagnosed with this disease are older than 60 years of age (80%). Unfortunately pancreatic cancer can occur in younger people, especially those who have a family history. .

It is our hope that effective diagnostic tests and newer treatments will improve these statistics and offer hope for patients who are diagnosed with this insidious disease.
 

Introduction	What is Pancreatic Cancer	What is the Pancreas	Statistics	Signs and Symptoms
Risk Factors	Diagnosis	Staging	Treatment	Raising Awareness

   What is the Pancreas?

The pancreas is an organ of the digestive system and is located in the upper middle abdomen behind the stomach and in front of the spine (Figure 1). It is pear-shaped and approximately 2 inches wide by 6 to 8 inches long.

  The pancreas is composed of three sections:

• The widest part is called the head and is located on the right side of the abdomen near the duodenum.

• The middle section is the body, and is directly behind the stomach.

• The thin end is called the tail and is located on the left side of the abdomen near the spleen(Figure2).

The pancreas makes insulin and other hormones. These hormones enter the bloodstream and travel throughout the body. They help the body use or store the energy that comes from food. For example, insulin helps control the amount of sugar in the blood. The pancreas also makes pancreatic juices. These juices contain enzymes that help digest food. The pancreas releases the juices into a system of ducts leading to the common bile duct. The common bile duct empties into the duodenum which is the first section of the small intestine.

Heywood Bank's cartoon - what is the pancreas-video

Wierd Al Jankovic - the Pancreas -video

The anatomy of the pancreas & what it does - video

        The Pancreas and where it is located in your body

    

  

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Introduction	What is Pancreatic Cancer	What is the Pancreas	Statistics	Signs and Symptoms
Risk Factors	Diagnosis	Staging	Treatment	Raising Awareness

 

The Facts and Statistics

The statistics are grim as is the prognosis. Pancreatic cancer is often a silent killer. Most cases are asymptomatic and the later the cancer is caught the lower the chances of survival. When it comes to pancreatic cancer, statistics offer an understanding of the disease and its impact.

Cancer survival statistics should be interpreted with caution. Estimates are based on data from thousands of cases of pancreatic cancer in the United States and Canada each year, but the actual risk for a particular individual may differ :

Pancreatic cancer is the fourth leading cause of cancer deaths in men and women in both Canada and the US and there is no cure.

Pancreatic cancer is difficult to diagnose as there is not reliable screening test for early detection and symptoms are often vague and easily confused with other diseases.

Every 15 minutes a North American is diagnosed with pancreatic cancer; every 17 minutes. someone dies.

3 out of 4 patients with pancreatic cancer will die within one year of their diagnosis. The 5 year survival rate is a dismal 5 %; the lowest of all cancers. 

The 99% mortality rate is the highest of any cancer; by the time pancreatic cancer is diagnosed, it is usually too late for a promising outcome as the cancer has metastisized and spread to surrounding organs. Options for treatment are minimal at this stage.

Pancreatic cancer is treatable when caught early; approximately 30% are fortunate to have this disease caught early, making them candidates for surgery. The 5-yr survival rates approach 20% if the cancer is removed while it is small and has not spread tothe lymph nodes.

The risk of developing pancreatic cancer is about the same for both men and women.

It is the 3rd leading cause of cancer death among 40-59 year old men

Pancreatic cancer increases considerably with age. 80% of cases diagnosed are found in individuals over the age of 60.

Pancreatic cancer affects both men and women of all races and varying ages. Individuals of African-American descent and of Ashkenazi-Jewish heritage are 40-50% more likely to develop cancer of the pancreas than Caucasians.

It is estimated that 3,900 Canadians (42,470 in the US and more than 250,000 worldwide) will be diagosed with pancreatic cancer in 2009. Approximately 3,800 Canadians (35,240 in the US) will die.

The lifetime probability of developing pancreatic cancer is approximately 1 in 79.

Pancreatic cancer also has a genetic component with 3-10% of cases having an inherited component.

The major concern when diagnosing pancreatic cancer is whether or not the cancer has spread (metastasized) outside the pancreas. This will determine if surgery is an option.  Unfortunately, only 10-20% of cases are eligible. Surgical resection of the pancreas known as the Whipple procedure and the distal pancreatectomy are the only chances of recovery and are associated with improving 5-year survival rates in the range of 15-24% and even higher.

A diet marked by high red meat consumption may pose some danger as does smoking. See potential 'Risk Factors' below.

The risk of this cancer increases with age, and 90% of patients are older than 55. Men, African-Americans, smokers, diabetics, people with chronic pancreatitis, the obese, and those with a family history of pancreatic cancer tend to be at highest risk.

Too little funding despite being the leading cause of cancer death. An estimated 66 million US dollars was spent on pancreatic cancer research in 2005 of the National Cancer Institute's (NCI) cancer research budget. This is just a mere 2% of the NCI's 4.825 billion US dollar cancer research budget for 2009

Resouces : Healthy Ontario, National Cancer Institute, American Cancer Society, Canadian Cancer Society, Mount Sinai, John Hopkins

Introduction	What is Pancreatic Cancer	What is the Pancreas	Statistics	Signs and Symptoms
Risk Factors	Diagnosis	Staging	Treatment	Raising Awareness

What are the signs and symptoms?

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Pancreatic cancer is sometimes called a "silent disease" because early pancreatic cancer often does not cause symptoms until the disease is well advanced. The insidious thing about the disease is that many of the symptoms seem normal, so they're easily overlooked. As a result, the cancer has often progressed by the time it is diagnosed and well into the advanced stages and usually spread to other organs. The signs and symptoms can be confusing to not only patients but to healthcare providers because they vary, depending on where the tumor is located in the pancreas (the head, body, or tail). When they do appear, they can include:

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These symptoms are not sure signs of pancreatic cancer but have been linked to a diagnosis. Anyone with these symptoms should see a doctor so that the doctor can diagnose and treat any problem as early as possible.

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Introduction	What is Pancreatic Cancer	What is the Pancreas	Statistics	Signs and Symptoms
Risk Factors	Diagnosis	Staging	Treatment	Raising Awareness

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What are the Risk Factors?

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There is a long list of risk factors for pancreatic cancer. Risk factors are characteristics, habits, or environmental exposures that have been shown to increase the odds of developing a disease. You can decrease some of your risk by maintaining a healthy body weight, eating a healthy diet that is high in fruits and vegetables. Some risk factors that you cannot influence are your age, DNA and your family history. Not everyone who has one or more of these risk factors will develop pancreatic cancer.

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Risk Factors

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Smoking - if you smoke you are two to three times more likely to get this disease.

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Diet - a diet high in cholesterol, fried foods, red and processed meats may increase the risk of pancreatic cancer. A diet high in fruits, vegetables and fibre may actually reduce your risk.

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Gender - men tend to develop pancreatic cancer more than women.

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Obesity - people who are significantly overweight are 20 times more likely to develop pancreatic cancer compared with those who are not.

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Age - mostly affects people 55 years of age and older.

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Race - individuals of African American and of Ashkenazi-Jewish heritage are 40-50% more likely to develop cancer of the pancreas than Caucasians. The reasons are not clear but genetics and unknown factors may influence the likelihood in these races.

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Medical Factors - the incidence of pancreatic cancer is higher in people who have or had the following medical conditions: Chronic pancreatitis (inflammation that causes irreversible damage) and long-standing diabetes (high blood sugar). *In a study of more than 2,000 people with diabetes over 50 years of age, researchers at the Mayo Clinic in Rochester, Minnesota, found an association between newly developed sugar diabetes and pancreatic cancer. Within 3 years of diagnosis, people with diabetes had a risk of pancreatic cancer that was eight times that of same-age, average persons. It is thought that new-onset diabetes may be an indicator that would allow for earlier detection and treatment of pancreatic cancer. It is too early to tell if this indicator can be used to screen people over the age of 50 for pancreatic cancer.

Environmental Factors - occupational exposure to some chemicals, such as pesticides, dyes, or chemicals related to gasoline, may increase the risk for pancreatic cancer.

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Family History - pancreatic cancer may be inherited because it tends to run in families. 5 to 10% of pancreatic cancers result from hereditary factors and researchers believe that studying specific cancer genes may provide a better understanding of the causes of pancreatic cancer. (Pancreatic Cancer Canada is currently raising funds to support ongoing studies in a Familial Pancreas Study at Princess Margaret Hospital in the early detection of Pancreatic Cancer - Transabdominal Ultrasound, MRI and Biomarkers.)
 

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Introduction	What is Pancreatic Cancer	What is the Pancreas	Statistics	Signs and Symptoms
Risk Factors	Diagnosis	Staging	Treatment	Raising Awareness

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Diagnosis

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Several steps occur in making a diagnosis of pancreatic cancer. First comes the initial examination, where your doctor will inquire about your medical history, family history, possible risk factors and symptoms. It is crucial that you answer these questions honestly as this will help both you and your doctor during the diagnostic process. You will also have a physical examination where your doctor will check your abdomen for tenderness, fluid builds up, the enlargement of your gallbladder or liver (that may result from blockage of the bile duct) and masses. Your lymph nodes will also be checked for tenderness and swelling. Any sign of jaundice will be noted. Your doctor may order blood or urine tests, the testing of stool samples or imaging tests. Imaging tests are the most important tests used to detect pancreatic cancer and can be as simple as an x-ray or as complex any of the following procedures:

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Computed Tomography (CT) Scan - is an x-ray machine linked to a computer that takes a series of detailed pictures. The x-ray machine is shaped like a donut with a large hole. The patient lies on a bed that passes through the hole. As the bed moves slowly through the hole, the machine takes many x-rays. The computer puts the x-rays together to create pictures of the pancreas and other organs and blood vessels in the abdomen. CT scanners are used to image the pancreas more accurately and diagnose about 98% of all pancreatic cancers and distant metastases.

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Ultrasonography - is another type of imaging test that is commonly used. Ultrasonography is also called a sonogram or an ultrasound scan. The ultrasound device uses sound waves that cannot be heard by humans. The sound waves produce a pattern of echoes as they bounce off internal organs. The echoes create a picture of the pancreas and other organs inside the abdomen. The echoes from tumours are different from echoes made by healthy tissues and that is how doctors can detect pancreatic cancer. The two types of Ultrasound are as follows:

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Transabdominal Ultrasound - is used to make images of the pancreas which will be displayed on a computer screen. The doctor places the ultrasound device on the abdomen and slowly moves it around. The process is non-invasive.

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(EUS) Endoscopic Ultrasound - is where the doctor passes a thin, lighted tube 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 that makes sound waves and images . The doctor slowly withdraws the endoscope from the intestine toward the stomach to make images of the pancreas and surrounding organs and tissues. During this procedure, you will receive numbing medication for your throat and a mild sedative

Magnetic Resonance Imaging (MRI) - uses radio waves and powerful magnets, instead of X-rays as in a CT scan, to view internal structures and organs. The energy from the radio waves is absorbed by the body and then released. A computer translates the patterns formed by this energy release into detailed images of areas inside the body. MRI produces cross-sectional slices like a CT scanner, but also produces slices that are parallel to the length of the body.

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Endoscopic Retrograde Cholangiopancreatography - is when 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 tumour or other condition.

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PTC - percutaneous transhepatic cholangiography  is a procedure where 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.

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Biopsies - the only definitive method to diagnose cancer is to examine pancreatic cancer cells under a microscope and this requires a biopsy. A biopsy is the process of removing tissue samples so doctors can check for cancer cells. Biopsy specimens can be obtained in numerous ways and don't necessarily require  surgery:

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Introduction	What is Pancreatic Cancer	What is the Pancreas	Statistics	Signs and Symptoms
Risk Factors	Diagnosis	Staging	Treatment	Raising Awareness

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Staging

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Doctors use several systems to stage pancreatic cancer. The results of various diagnostic tests will indicate how far the cancer has progressed, determine the stage and help determine what form of treatment can be used. The most commonly used method to stage cancers is the TNM classification ( shown below) but is not routinely applied to pancreatic cancer. A more common classification is one that places pancreas cancer into three categories: