Introduction

Both the endocrine and exocrine portions of the pancreas can be affected by pancreatic cancer. The pancreas normally functions to excrete a substance used by the body to digest fats, proteins and carbohydrates. The hormomes insulin and glucagon are also produced in the pancreas. Insulin functions to reduce the body's blood sugar while glucagon will increase that level.


Description
Pancreatic cancer can occur in both the exocrine and endocrine portions of the organ. Most pancreatic tumors begin in the exocrine portion of the pancreas and very few turn out to be benign tumors. Ninety-five percent of the exocrine tumors originate in gland cells. Cancers from these cells are known as adenocarcinomas. The other five percent of pancreatic tumors can be classified as adenosquamous, squamous cell, and giant cell carcinomas.

Tumors in the endocrine portion of the pancreas are rather uncommon. The first is known as a neuroendocrine tumor, or NET. Neuroendicrine tumors are either functioning or non-functioning. A functioning NET will produce hormones and release them into the bloodstream while a non-functioning NET will not. About half of all neuroendocrine tumors are functioning and about half are non-funtioning. The other type of pancreatic endocrine tumor is called an islet cell tumor and can be either malignant or benign. Diagnosis of a islet cell tumor is difficult as both the malignant and benign tumors look vey much alike under the microscope. A clear diagnosis can only be given to the patient once the carcinoma has spread outside of the tumor since a malignant tumor will spread aggressively and benign tumors tend to stay contained within the pancreas. Islet cell tumors can also be specified as insulinomas, glucagonomas, gastrinomas, somatostatinomas, VIPomas, and PPomas.


Risk factors associated
  • Smoking
    • contains many carcinogens
    • smoking in college doubled/tripled chances
  • Age
    • chances increase 80% for people ages 60-80
  • Race
    • more common in African-Americans
  • Gender
    • more common in men since men usually smoke more than women
  • Religion
    • more common in people of the Jewish religion
    • This could possibly be related to mutated breast cancer gene that is inherited genetically which has been known to run in Jewish families
  • Chronic Pancreatitis
    • studies have shown that inherited chronic pancreatitis is greatly associated with pancreatic cancer
  • Diabetes
    • an onset of sugar diabetes in adulthood increases chances
    • 1% of people diagnosed with diabetes after age 50 are likely to get pancreatic cancer within 3 years of diagnosis
    • onset of diabetes after age 50 may also actually be a warning sign of pancreatic cancer
  • Peptic Ulcer Surgery
    • surgery removing a portion of the stomach increases chances
  • Diet
    • people have an increased risk if their diet is high in meat & fried foods
    • diets high in vegetables & fruits will decrease risk

Signs/symptoms
  • early cancers are not known to have any symptoms
  • jaundice
    • yellowed eyes & skin, darker urine
    • if tumor is blocking the bile duct leading to the organs in the digestive system
  • pain
    • upper portion of the abdomen that sometimes spreads to the back
    • may become worse while eating or lying down
    • develops as cancer grows/spreads
  • weakness, dizziness, chills muscle spasms, diarrhea
    • can be caused by the cancer stimulating the pancreas to produce too much hormones & insulin
  • loss of appetite
  • nausea of vomiting
  • weight loss

Detection/Diagnosing
  • Very important to differentiate between exocrine & endocrine cancers
    • different causes, risk factors, signs or symptoms, tests for diagnosis, treatments, & prognosis
  • The doctor performs a physically exam & gets the patient’s medical history as well as family medical history.
  • Doctor will also ask for blood, urine, & stool tests.
  • Angiogram
    • special x-ray of blood vessels
  • CT scans
    • to get cross section pictures of pancreas
  • Transabdominal ultrasound
  • Endoscopic ultrasound
  • ERCP
    • endoscopic retrograde cholangiopancreatogram
    • special x-rays taken of the common bile duct
    • tissue sample can also be taken through the endoscope
  • The only way of getting a sure diagnosis is to take a biopsy of some pancreatic tissue

Staging
  • Stage 0
    • tumor is only in top layers of pancreatic bile ducts
    • cancer cells are not outside of pancreas
  • Stage 1
    • tumor is only in pancreas
    • less than 2 centimeters large
  • Stage 2
    • tumor has now spread outside of the pancreas
    • no blood vessels attached
    • not grown into any major nerves
  • Stage 3
    • tumor has grown into major nerves and blood vessels
    • has possibly grown into lymph nodes
  • Stage 4
    • tumor has spread around the body

Survival rate/stage
  • 5 year
    • Stage 1: 21 to 37%
    • Stage 2: 6 to 12%
    • Stage 3: 2%
    • Stage 4: 1%

Treatment
  • Based on stage of cancer and type (endocrine vs. exocrine/malignant vs. benign)
  • Surgery
    • high chance of successfully treating cancer that has been diagnosed in the early stage
    • pancreas may be partially or completely removed
    • may be followed with radiation therapy and/or chemotherapy
  • Radiation Therapy
    • killing cancer cells with high energy x-rays
    • often used before to shrink the tumor before surgery or to relieve severe pain in patients with the third stage of cancer
  • Chemotherapy
    • killing cancer cells with drugs
    • drug is put into the bloodstream to kill cancer cells throughout the body
  • Targeted Therapy
    • treating the cancer by targeting certain genes, proteins, or the tissue that is allowing the cancer to grow and survive
    • FDA approved in 2005 only for patients with an advanced cancer
  • Relieving Blockages
    • placing a stent inside the body to allow bile or fluid to drain from a blocked area of the pancreas

Treatment side-effects
  • Side effects may go away in between treatments
  • Chemotherapy
    • poor appetite, nausea, vomiting, diarrhea, lethargy, sores in the mouth, and hair loss
    • patients are likely to get bleed, bruise, and get infections very easily as chemotherapy affects the bone marrow’s ability to produce erythrocytes, leukocytes, & thrombocytes
  • Drugs
    • certain drugs can cause the palms & soles of the feet to become uncomfortable and red (hand-foot syndrome)

Type of doctor
  • Medical oncologist
  • Radiation therapy oncologist

3-5 current statistics
  • About 43,140 adults in the United States in 2010 were diagnosed with pancreatic cancer (about 21,370 men & about 21,770 women)
  • About 36,800 people died from pancreatic cancer (about 18,770 men & about 18,030 women)
  • 10 to 15% of patients are diagnosed during the first stage, 35 to 40% of patients are diagnosed during the second stage, & 45 to 55% of patients are diagnosed during the third stage
  • 1 in every 71 people will develop pancreatic cancer

At least 2 famous people with/survived/died from
  • Patrick Swayze- Actor
  • Count Bassie- Jazz musician
  • Luciano Pavarotti- Opera singer