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National Cancer Institute

PDQ® bullet Treatment  bullet Patients

Pancreatic cancer


Table of Contents

OVERVIEW OF PDQ
What is PDQ?
How to use PDQ
DESCRIPTION
What is cancer of the pancreas?
STAGE EXPLANATION
Stages of cancer of the pancreas
Stage I
Stage II
Stage III
Stage IVA
Stage IVB
Recurrent
TREATMENT OPTION OVERVIEW
How cancer of the pancreas is treated
Treatment by stage
STAGE I PANCREATIC CANCER
STAGE II PANCREATIC CANCER
STAGE III PANCREATIC CANCER
STAGE IVA PANCREATIC CANCER
STAGE IVB PANCREATIC CANCER
RECURRENT PANCREATIC CANCER
TO LEARN MORE

OVERVIEW OF PDQ


What is PDQ?

PDQ is a computer system that gives up-to-date information on cancer and its prevention, detection, treatment, and supportive care. It is a service of the National Cancer Institute (NCI) for people with cancer and their families and for doctors, nurses, and other health care professionals.

To ensure that it remains current, the information in PDQ is reviewed and updated each month by experts in the fields of cancer treatment, prevention, screening, and supportive care. PDQ also provides information about research on new treatments (clinical trials), doctors who treat cancer, and hospitals with cancer programs. The treatment information in this summary is based on information in the PDQ summary for health professionals on this cancer.


How to use PDQ

PDQ can be used to learn more about current treatment of different kinds of cancer. You may find it helpful to discuss this information with your doctor, who knows you and has the facts about your disease. PDQ can also provide the names of additional health care professionals who specialize in treating patients with cancer.

Before you start treatment, you also may want to think about taking part in a clinical trial. PDQ can be used to learn more about these trials. A clinical trial is a research study that attempts to improve current treatments or finds information on new treatments for patients with cancer. Clinical trials are based on past studies and information discovered in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help patients with cancer. Information is collected about new treatments, their risks, and how well they do or do not work. When clinical trials show that a new treatment is better than the treatment currently used as "standard" treatment, the new treatment may become the standard treatment. Listings of current clinical trials are available on PDQ. Many cancer doctors who take part in clinical trials are listed in PDQ.

To learn more about cancer and how it is treated, or to learn more about clinical trials for your kind of cancer, call the National Cancer Institute's Cancer Information Service. The number is 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615. The call is free and a trained information specialist will be available to answer cancer-related questions.

PDQ is updated whenever there is new information. Check with the Cancer Information Service to be sure that you have the most up-to-date information.


DESCRIPTION


What is cancer of the pancreas?

Cancer of the pancreas is a disease in which cancer (malignant) cells are found in the tissues of the pancreas. The pancreas is about 6 inches long and is shaped something like a thin pear, wider at one end and narrowing at the other. The pancreas lies behind the stomach, inside a loop formed by part of the small intestine. The broader right end of the pancreas is called the head, the middle section is called the body, and the narrow left end is the tail.

The pancreas has two basic jobs in the body. It produces juices that help break down (digest) food, and hormones (such as insulin) that regulate how the body stores and uses food. The area of the pancreas that produces digestive juices is called the exocrine pancreas. About 95% of pancreatic cancers begin in the exocrine pancreas. The hormone-producing area of the pancreas is called the endocrine pancreas. Only about 5% of pancreatic cancers start here. This summary has information on cancer of the exocrine pancreas. For more information on cancer of the endocrine pancreas (also called islet cell cancer) see the PDQ patient information summary on islet cell carcinoma.

Cancer of the pancreas is hard to find (diagnose) because the organ is hidden behind other organs. Organs around the pancreas include the stomach, small intestine, bile ducts (tubes through which bile, a digestive juice made by the liver, flows from the liver to the small intestine), gallbladder (the small sac below the liver that stores bile), the liver, and the spleen (an organ that filters blood to remove excess or damaged blood cells). The signs of pancreatic cancer are like many other illnesses, and there may be no signs in the first stages. A doctor should be seen if there are any of the following symptoms: nausea, loss of appetite, weight loss without trying to lose weight, pain in the upper or middle of the abdomen, or yellowing of the skin (jaundice).

If there are symptoms, a doctor will conduct an examination and order tests to see if there is cancer and determine what the treatment should be. Patients may have an ultrasound, a test that uses sound waves to find tumors. A CT (computed tomographic) scan, a special type of x-ray that uses a computer to make a picture of the inside of the abdomen, may also be done. Another special scan called MRI (magnetic resonance imaging), which uses magnetic waves to make a picture of the inside of the abdomen, may be done as well if there are questions as to whether the blood supply to unaffected organs has been partially blocked by the cancer.

A test called an ERCP (endoscopic retrograde cholangiopancreatography) may also be done. During this test, a flexible tube is put down the throat, through the stomach, and into the small intestine. The doctor can see through the tube and inject dye into the drainage tube (duct) of the pancreas so that the area can be seen more clearly on an x-ray. During ERCP, the doctor may also put a fine needle or a brush like a pipe cleaner into the pancreas to take out some cells. This is called a biopsy. The cells can then be looked at under a microscope to see if they contain cancer. More important, if there is jaundice, a catheter or fine tube may be inserted into the bile duct through the pancreas duct to relieve the janudice.

PTC (percutaneous transhepatic cholangiography) is another test that can help find cancer of the pancreas. During this test, a thin needle is put into the liver through the right side. Dye is injected into the bile ducts in the liver so that blockages can be seen on x-rays. To relieve janudice, a fine tube is sometimes left in the right side of the liver to drain it.

In some cases, a needle can be inserted into the pancreas during an x-ray or ultrasound so that cells can be taken out to see if they contain cancer. Surgery may be needed to see if there is cancer of the pancreas. If this is the case, the doctor will cut into the abdomen and look at the pancreas and the tissues around it for cancer. If cancer is found and it looks like it has not spread to other tissues, the doctor may remove the cancer or relieve blockages caused by the tumor.


STAGE EXPLANATION


Stages of cancer of the pancreas

Once cancer of the pancreas is found, more tests will be done to find out if the cancer has spread from the pancreas to the tissues around it or to other parts of the body. This is called staging. The following stages are used for cancer of the pancreas:


Stage I

Cancer is found only in the pancreas itself and has not spread to other organs.


Stage II

Cancer has spread to nearby organs, such as the duodenum or bile duct, but has not entered the lymph nodes. (Lymph nodes are small, bean-shaped structures that are found throughout the body; they produce and store infection-fighting cells).


Stage III

Cancer has spread to lymph nodes near the pancreas. The cancer may or may not have spread to nearby organs.


Stage IVA

Cancer has spread to organs, such as the stomach, spleen, or colon, that are near the pancreas but has not spread distant organs, such as the liver or lungs.


Stage IVB

Cancer has spread to organs, such as the stomach, spleen, or colon, that are near the pancreas or to places far away from the pancreas, such as the liver or lungs.


Recurrent

Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the pancreas or in another part of the body.


TREATMENT OPTION OVERVIEW


How cancer of the pancreas is treated

There are treatments for all patients with cancer of the pancreas. Three kinds of treatment are used:

Surgery may be used to take out the tumor. A doctor may take out the cancer using one of the following operations:

If the cancer has spread and it cannot be removed, the doctor may do surgery to relieve symptoms. If the cancer is blocking the small intestine and bile builds up in the gallbladder, the doctor may do surgery to go around (bypass) all or part of the small intestine. During this operation, the doctor will cut the gallbladder or bile duct and sew it to the small intestine. This is called biliary bypass. Surgery or x-ray procedures may also be done to put in a tube (catheter) to drain bile that has built up in the area. During these procedures, the doctor may make the catheter drain through a tube to the outside of the body or the catheter may go around the blocked area and drain the bile to the small intestine. In addition, if the cancer is blocking the flow of food from the stomach, the stomach may be sewn directly to the small intestine so the patient can continue to eat normally.

Radiation therapy uses high-energy x-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes in the area where the cancer cells are found (internal radiation therapy).

Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by a needle in the vein or muscle. Chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells outside the pancreas.

The use of biological therapy (using the body's immune system to fight cancer) is being tested in clinical trials for pancreatic cancer. Biological therapy searches for ways that the cancer tissue is different from normal pancreas tissue, and tries to get the body to fight the cancer. It uses materials made by the body or made in a laboratory to boost, direct, or restore the body's natural defenses against disease. Some biological therapies are sometimes called biological response modifier (BRM) therapy or immunotherapy.


Treatment by stage

Treatment of cancer of the pancreas depends on the stage of the disease, and the patient's age and overall condition.

Standard treatment may be considered because of its effectiveness in patients in past studies, or participation in a clinical trial may be considered. Most patients with cancer of the pancreas are not cured with standard therapy and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Clinical trials are ongoing in most parts of the country for all stages of cancer of the pancreas. To learn more about clinical trials, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.


STAGE I PANCREATIC CANCER

Treatment may be one of the following:

1. Surgery to remove the head of the pancreas, part of the small intestine, and some of the surrounding tissues (Whipple procedure).

2. Surgery to remove the entire pancreas and the organs around it (total pancreatectomy).

3. Surgery to remove the body and tail of the pancreas (distal pancreatectomy).

4. Surgery followed by chemotherapy and radiation therapy.

5. Clinical trials of radiation therapy with or without chemotherapy given before, during, or after surgery.


STAGE II PANCREATIC CANCER

Treatment may be one of the following:

1. Surgery to remove all or part of the pancreas with or without chemotherapy and radiation therapy.

2. External radiation therapy with or without chemotherapy.

3. Surgery or other treatments to reduce symptoms.

4. Clinical trials of radiation therapy and chemotherapy given before surgery.

5. Clinical trials of radiation therapy plus drugs to make cancer cells more sensitive to radiation (radiosensitizers).

6. Clinical trials of chemotherapy.

7. Clinical trials of radiation therapy given during surgery with or without internal radiation therapy.


STAGE III PANCREATIC CANCER

Treatment may be one of the following:

1. Surgery to remove all or part of the pancreas with or without chemotherapy and radiation therapy.

2. External radiation therapy with or without chemotherapy.

3. Surgery or other treatments to reduce symptoms.

4. Clinical trials of radiation therapy and chemotherapy given before surgery.

5. Clinical trials of surgery plus radiation therapy plus drugs to make cancer cells more sensitive to radiation (radiosensitizers).

6. Clinical trials of chemotherapy.

7. Clinical trials of radiation therapy given during surgery, with or without internal radiation therapy.


STAGE IVA PANCREATIC CANCER

Treatment may be one of the following:

1. Surgery to remove all or part of the pancreas with or without chemotherapy and radiation therapy.

2. External radiation therapy with or without chemotherapy.

3. Surgery or other treatments to reduce symptoms.

4. Clinical trials of radiation therapy and chemotherapy given before surgery.

5. Clinical trials of surgery plus radiation therapy plus drugs to make cancer cells more sensitive to radiation (radiosensitizers).

6. Clinical trials of chemotherapy.

7. Clinical trials of radiation therapy given during surgery, with or without internal radiation therapy.


STAGE IVB PANCREATIC CANCER

Treatment may be one of the following:

1. Chemotherapy.

2. Treatments for pain and other symptoms.

3. Surgery or other treatments to reduce symptoms.

4. Clinical trials of chemotherapy or biological therapy.


RECURRENT PANCREATIC CANCER

Treatment may be one of the following:

1. Chemotherapy.

2. Surgery or other treatments to reduce symptoms.

3. External radiation therapy to reduce symptoms.

4. Treatments for pain.

5. Other medical care to reduce symptoms.

6. Clinical trials of chemotherapy or biological therapy.


TO LEARN MORE

TO LEARN MORE..... CALL 1-800-4-CANCER

To learn more about cancer of the pancreas, call the National Cancer Institute's Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615. By dialing this toll-free number, you can speak with a trained information specialist who can answer your questions.

The Cancer Information Service also has booklets about cancer that are available to the public and can be sent on request. The following booklet about cancer of the pancreas may be helpful:

What You Need To Know About Cancer of the Pancreas

The following general booklets on questions related to cancer may also be helpful:

What You Need To Know About Cancer
Taking Time: Support for People with Cancer and the People Who Care About
Them
What Are Clinical Trials All About?
Chemotherapy and You: A Guide to Self-Help During Treatment
Radiation Therapy and You: A Guide to Self-Help During Treatment
Eating Hints for Cancer Patients
Advanced Cancer: Living Each Day
When Cancer Recurs: Meeting the Challenge Again

There are many other places where people can get material and information about cancer treatment and services. The social service office at a hospital can be checked for local and national agencies that help with getting information about finances, getting to and from treatment, getting care at home, and dealing with problems.

For more information from the National Cancer Institute, please write to this address:

National Cancer Institute
Office of Cancer Communications
31 Center Drive, MSC 2580
Bethesda, MD 20892-2580

Date Last Modified: 04/1999


If you want to know more about cancer and how it is treated, or if you wish to know about clinical trials for your type of cancer, you can call the NCI's Cancer Information Service at 1-800-422-6237, toll free. A trained information specialist can talk with you and answer your questions.


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