The pancreas is an organ, about six inches long, that is located in the abdomen and it lies horizontally behind the lower part of the stomach. It sits in front of the spine above the level of the belly button.
The widest part of the pancreas is called the head. It is on the right side of the abdomen where the stomach is attached to the first part of the small intestine. The middle section is called the body and the thinnest section is called the tail. The tail extends to the left side of the abdomen adjacent to the spleen.
The pancreas has two main functions. The exocrine glands secrete enzymes that help aid digestion by breaking down proteins into small parts so they can be easily absorbed by the body and used for energy. The endocrine glands produce hormones including insulin. These hormones travel in the bloodstream throughout the body. They help the body to store or use the energy that comes from food. Insulin helps the body to regulate and process sugars.
Cancer begins in cells which are the building blocks that make up tissues. Tissues then make up the various organs in the body. When the body requires it, new cells are formed as normal cells grow and divide. When normal cells get old or damaged, they will die, and new cells will take their place. There are times when the process does not function
properly. New cells may form when the body doesn’t require them, and old and damaged cells will not die, as they should. A mass of tissue called a growth (nodule or tumor) is formed as a result of the buildup of these extra cells. These growths can be benign or malignant.
Pancreatic cancer begins in the cells that make up the tissues of the pancreas. Even when diagnosed early, the prognosis is generally poor because pancreatic cancer is rarely detected in its early stages and spreads rapidly. For that reason it is a leading cause of cancer deaths.
Pancreatic cancer can spread to other parts of the body by invading other tissues, shedding cancer cells into the abdomen or spreading to other organs.
- Invading – When a malignant pancreatic tumor grows it can invade organs adjacent to the pancreas like the stomach or small intestine.
- Shedding – Cancer cells can break off (shed) from the original pancreatic tumor. New tumors may then form on the surface of nearby organs and tissues as the cells shed into the abdomen.
- Spreading – When cancer cells break away from the original tumor they can spread to the liver and lungs through the blood vessels. These cancer cells can also spread through lymph vessels to nearby lymph nodes. They then may attach to other tissues and grow to form new tumors that could damage the tissues which they attached to.
Ninety five percent of pancreatic cancer is adenocarcinoma. This cancer occurs within the exocrine pancreas cells. A minority of pancreatic cancers begin in the islet cells and they are classified as neuroendocrine tumors.
Symptoms of Pancreatic Cancer
Pancreatic cancer is difficult to detect and diagnose for several reasons:
- There aren’t noticeable signs or symptoms in the early stages of the disease.
- Due to the fact that the pancreas is located deep in the belly in front of the spine, pancreatic cancer can grow silently for months before becoming detected.
- Symptoms for pancreatic cancer can easily be attributed to other less serious and more common illnesses. That explains why many people have an advanced stage of the disease when it is diagnosed.
The signs of pancreatic cancer may not appear until the cancer is well advanced and surgical removal is impossible. Once the tumor grows large enough to press on other nearby structures symptoms begin to appear. It is important to seek attention from your Connecticut physician if any of the following symptoms occur:
- Yellowing of the skin and whites of the eyes (jaundice). Sometimes it is accompanied with some of the following: darkened urine, pale-colored stool and skin irritation with itching.
- Upper abdomen pain that radiates to the back. It can be intermittent or made worse by eating.
- Significant weight loss for no known reason
- Appetite loss
- Nausea and vomiting
- Formation of blood clots in the deep veins of the extremities, or the superficial veins anywhere on the body
- Elevated blood sugar levels (diabetes mellitus). Patients with pancreatic cancer may develop diabetes months to years before it is diagnosed. It is particularly concerning when an elderly patient develops diabetes as it may be an early indication of the onset of pancreatic cancer.
- Clinical depression has been reported to be associated with pancreatic cancer but there is no known reason for the association
- Painless distended gallbladder
It is strongly recommended that you seek attention from a doctor or one of our surgeons at FCB Surgical Specialists if you experience any of these symptoms. These symptoms are also indicative of diseases other than pancreatic cancer and they will also be checked out by your doctor or surgeon.
Pancreatic cancer can metastasize. It usually metastasizes first to regional lymph nodes and later to the liver. It does not commonly metastasize to the lungs. Occasionally it will metastasize to the brain and bones.
Many people who get pancreatic cancer had some of the following risk factors, while others may have had none of them. The factors that present a potential for increasing the risk of pancreatic cancer include.
- Increased age; especially over sixty
- African American descent
- Chronic inflammation of the pancreas (pancreatitis)
- Family history of pancreatic cancer
- Males are at a 30% risk higher than females
- Diets low in vegetables and fruits
- Diets high in red meat
Treatments & Drugs
Several factors determine the treatment that will be selected to treat the pancreatic cancer. They include the stage of the cancer and the location of the cancer. The patient’s age, overall health and personal preferences are also taken into consideration. The primary goal is to eliminate the cancer when possible. If that is not an option then the goal is to prevent the cancer from growing and spreading. There are cases when treatment is not an option because the cancer is advanced and the treatments will not offer any benefits.
Other means may be suggested to relieve the symptoms and help make the patient as comfortable as possible.
Your medical doctor will discuss surgery as an option. When the cancer is confined to the pancreas, surgery is an option. The various surgeries used for the treatment of pancreatic cancer include:
- Surgery for tumors in the pancreatic head – The Whipple procedure (pancreatodudenectomy) may be performed if the cancer is in the head of the pancreas. This procedure includes removing the head of the pancreas, a portion of the small intestine (duodenum), gallbladder, part of the bile duct and possibly a portion of the stomach. The remaining parts of the pancreas, stomach, and intestines are then reconnected so that food can be digested.The surgeons at FCB Surgical Specialists are some of the most experienced and expert pancreatic surgeons in Connecticut and New York. Dr. David Cornell is surgical oncologist in our
Connecticut offices and an expert whipple surgeon.The hospital stay can extend to ten days for the Whipple procedure and recovery at home will take several weeks. There are risks of infection and bleeding. After surgery some patients
may experience nausea and vomiting if they experience difficulty with the stomach emptying.
- Surgery for tumors in the pancreatic tail and body – The removal of the tail of the pancreas alone or with a small portion of the body of the pancreas is called a distal pancreatectomy. The spleen may also be removed during this procedure.
Most people with pancreatic cancer get chemotherapy. Chemotherapy is the use of a drug or a combination of medications to kill cancer cells. They can be taken orally or they
can be injected into a vein. The procedure may involve one drug or a combination of drugs. The medicine travels in the bloodstream throughout the body.
While a person is receiving chemotherapy, imaging studies are conducted at various intervals to help evaluate the decrease or increase of the tumor size. If the tumor grows with the chemotherapy treatment, it may be an indication that the cancer has become resistant to the therapy, and an alternate treatment plan should be considered.
Chemotherapy, after surgery, can lower the chances of the cancer returning, and it is usually given to people with early pancreatic cancer. There are some instances where it is given prior to the surgery. Chemotherapy for metastatic pancreatic cancer can extend life and improve the quality of life for people with the disease. Chemotherapy is usually given in an outpatient setting at the Norwalk Hospital Cancer Center or St. Vincent’s Medical Center’s Cancer Treatment Center in Bridgeport.
Chemotherapy can also be combined with radiation (chemoradiation). This treatment is generally used to treat cancers that have spread outside of the pancreas to organs located near it, but not to organs outside of the area. Chemoradiation may also be used to try to prevent a reoccurrence of the pancreatic cancer, even if the cancer has not spread outside of the pancreas. Chemotherapy is also combined with targeted drug therapy treatments in patients with advanced pancreatic cancer.
The purpose of radiation therapy is to kill cancer cells that cannot be surgically removed with the goal of trying to reduce the risk of cancer returning or spreading. It is also used to treat tumors that cannot be removed surgically and are causing symptoms like jaundice and pain.
High energy beams are used to kill cancer cells or to keep them from growing. The radiation comes from a machine that aims radiation beams at the cancer in the abdomen. It is generally given at St. Vincent’s Medical Center’s Cancer Center in Bridgeport and Norwalk Hospital’s Cancer Center, five days a week, for up to six weeks. Each session lasts approximately thirty minutes.
Radiation treatments may be used before, as well as after the cancer surgery. It may also be combined with chemotherapy, even if the patient does have surgery. When pancreatic cancer cannot be treated surgically, radiation is often used in combination with chemotherapy to treat the cancer.
There are different methods through which radiation therapy can be delivered. External beam radiation is the method wherein the beam comes from a machine outside the body. Brachytherapy is the procedure where radiation is placed inside the body near the cancer. Intraoperative radiation is the procedure during which radiation therapy is used during the surgery.
This therapy consists of drugs that are used to attack specific abnormalities within the cancer cells and slow their growth and prevent them from spreading. Those with pancreatic cancer whoare unable to have surgery may receive targeted therapy.
Erllotinib (Tarceva) is a targeted drug that blocks chemicals that signal cancer cells to grow and divide. It is often combined with chemotherapy as a form of treatment for people with advanced pancreatic cancer. Clinical trials investigating other targeted drug treatments are in process.
Pancreatic cancer can cause symptoms like jaundice from obstruction of the bile duct and pain. These symptoms cannot always be relieved by the other therapies.
The following procedures cannot cure the cancer but they are aimed at relieving the symptoms.
- Celiac Plexus Neurolysis (CPN) – This is often referred to as a celiac block. It involves the injection of a chemical, which is usually alcohol, into the nerves that receive pain signals from the pancreas. This injection will damage or numb those nerves and will reduce the pain caused by the pancreatic tumor. This injection is performed using an endoscope with the guidance of ultrasoundor through the skin with the use of a CT scanner for guidance.
- Biliary Stenting – A hollow tube called a stent, is placed in the bile duct to keep it open. The external pressure of a growing pancreatic tumor could cause it to close. This prevents jaundice because it allows bile to flow freely from the liver, past the pancreas, and into the intestine. This procedure is performed with an endoscope by a gastroenterologist or through the skin under CT guidance by an interventional radiologist.
Studies used to test new forms of treatments are called clinical trials. Many clinical trials are underway at Norwalk Hospital and St. Vincent’s Medical Center. They may include new surgical approaches, new approaches to radiation, testing new drugs, or even new methods such as gene therapy. These studies can lead to new methods becoming part of the standard treatment for the cancer when their results indicate safety and effectiveness.
Clinical trials in Connecticut offer access to treatments that aren’t ordinarily available. While they may produce serious unexpected side effects, they may provide positive results that would not have been received with the normally approved standard treatments. Clinical trials are closely monitored by the federal government to ensure safety for the patients participating in the trials.
New treatments that are participating in clinical trials include:
- Pancreatic cancer vaccines – Normally vaccines are used to prevent illness. In this case vaccines are being used to treat the cancer rather than protect from it. Studies of these vaccines are still in the very early stages. Cancer treatment vaccines are used as an attempt to strengthen the immune system in an effort to help it recognize cancer cells as intruders, and attack a particular protein that is secreted by pancreatic cancer cells.
- Drugs that can be used to prevent cancer from growing new blood vessels – This is a category of drugs called anglogenesis inhibitors. Cancer cells are unable to get the necessary nutrients they require in order to grow when they do not have access to new blood vessels. The new blood vessels would also provide cancer the vehicle in which to move to other parts of the body.
There is no evidence that there are actual steps that can be taken to prevent the occurrence of pancreatic cancer. However, certain lifestyle adjustments may help reduce the risk of it. They include:
- Maintaining a healthy weight
- Exercising almost daily
- Quit smoking
- Choosing a healthy diet
The onset of pancreatic cancer can change a patient’s life and as well as the lives of their family and friends. Needing help after receiving this diagnosis is not uncommon, and there are many sources of support that help patients and their loved ones deal with all of the emotions and concerns that the diagnosis brings. Support groups at Norwalk Hospital and St. Vincent’s Medical Center offer support. There are also other support groups in person, over the telephone, or on the internet. In these groups patients and/or the family members will meet or talk to other patients and their family members. They will share their experiences and acquired knowledge about how to deal with the disease and the effects of the treatments.
The resources available at FCB Surgical Specialists in Connecticut include pancreatic cancer surgeons, an experienced surgical oncologist and a caring and compassionate staff. We are available to provide support and help to deal with the emotions, concerns and physical issues that accompany this diagnosis.
Counselors, social workers and clergy members can also assist in providing emotional support as well as suggesting resources if needed for financial aid, transportation and home care.