Pancreatic Cancer

In the early stages, pancreatic cancer typically causes no symptoms until the tumor has grown large. Thus, at the time of diagnosis, the tumor has already spread (metastasized) beyond the pancreas in 90% of cases.

Eventually, most people develop severe upper abdominal pain, which may also be felt in the middle of the back. The pain may be relieved by bending forward or assuming the fetal position.

Weight loss is common.

Early diagnosis of tumors in the body or tail of the pancreas is difficult because symptoms occur late and physical examination and blood test results are often normal. When adenocarcinoma of the pancreas is suspected, the preferred tests are CT Computed Tomography and Magnetic Resonance Imaging of the Digestive Tract Computed tomography (CT) and magnetic resonance imaging (MRI) scans are good tests for assessing the size and location of abdominal organs. Additionally, cancerous (malignant) or noncancerous... read more or a specialized type of MRI called MRCP (see Magnetic Resonance Imaging Magnetic Resonance Imaging Imaging tests of the liver, gallbladder, and biliary tract include ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), endoscopic retrograde cholangiopancreatography... read more ). These imaging tests are usually followed by endoscopic ultrasonography Ultrasonography Imaging tests of the liver, gallbladder, and biliary tract include ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), endoscopic retrograde cholangiopancreatography... read more (a tiny ultrasound probe on the tip of an endoscope is passed through the mouth into the stomach and the first segment of the small intestine). A tissue sample (biopsy) can be taken through the endoscope during the procedure.

To confirm the diagnosis of pancreatic cancer, a doctor may obtain a sample of the pancreas for examination under a microscope (biopsy) by inserting a needle through the skin using CT or an ultrasound scan Ultrasound Scanning (Ultrasonography) of the Abdomen Ultrasound scanning uses sound waves to produce pictures of internal organs (see also Ultrasonography). An ultrasound scan can show the size and shape of many organs, such as the liver and pancreas... read more as a guide. However, this approach sometimes misses the tumor. The same approach may be used to obtain a biopsy sample from the liver to look for cancer that has spread from the pancreas. If the results of these tests are normal but the doctor still strongly suspects adenocarcinoma, the pancreas may be evaluated surgically.

Endoscopic retrograde cholangiopancreatography (see figure ) is another test that may be done for people who have jaundice. Blood tests are also done.

The only hope of a cure is surgery, but surgery can be done only in people whose cancer has not spread. However, in most people, the tumor has already spread at the time of diagnosis. With surgery, either the pancreas and some of the first part of the small intestine (the duodenum) or just parts of the pancreas are removed.

Chemotherapy or chemoradiation may be given before surgery.

Obstruction of bile flow may be temporarily relieved by placement of a tube (stent) in the lower portion of the duct that drains bile from the liver and gallbladder. An alternative treatment method is the surgical creation of a channel that bypasses the obstruction. For example, an obstruction of the small intestine can be bypassed by a channel that connects the stomach with a portion of the small intestine that is beyond the obstruction. If these procedures do not relieve itchiness, people may be given cholestyramine by mouth.

Mild pain may be relieved by aspirin or acetaminophen. Most often, stronger painkillers, such as codeine, oxycodone, or morphine, are needed. For people with severe pain, injections into nerves to block pain sensations provide relief.

The lack of pancreatic digestive enzymes can be treated with oral enzyme preparations. If diabetes develops, insulin treatment may be needed.

Because adenocarcinoma of the pancreas is fatal in most cases, a doctor usually discusses end-of-life care with the person, family members, and other health care professionals (see Treatment Options at the End of Life Treatment Options at the End of Life Often, the available choices for end-of-life care involve a decision whether to accept the likelihood of dying sooner but to be more comfortable or attempt to live slightly longer by receiving... read more ).

Because adenocarcinoma of the pancreas has often spread to other parts of the body before it is discovered, the prognosis for pancreatic cancer is very poor. Fewer than 2% of people with adenocarcinoma of the pancreas survive for 5 years after the diagnosis.