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Other Names:
Pancreatic Carcinoma, Cancer of Pancreas
Pancreatic Cancer

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Definition

Pancreatic carcinoma is a malignancy (cancer) of the pancreas.

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Causes, incidence, and risk factors

Pancreatic cancer is the 4th leading cause of death from cancer in the U.S. The disease is slightly more common in men than in women, and risk increases with age.

The cause is unknown, but the incidence is greater in smokers. Almost one-third of cases of pancreatic carcinoma can be attributed to cigarette smoking. A minority of cases are known to be related to hereditary syndromes.

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Symptoms

  • weight loss
  • abdominal pain
  • loss of appetite
  • jaundice
  • nausea
  • weakness
  • fatigue
  • vomiting
  • diarrhea
  • indigestion
  • back pain
  • clay-colored stools
  • paleness
  • depression

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Signs and tests

  • ERCP
  • abdominal CT scan
  • pancreatic biopsy
  • abdominal ultrasound
  • abdominal MRI
This disease may also alter the results of the following tests:
  • serum bilirubin
  • liver function tests

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Treatment

At the time of diagnosis, only about 20% of pancreatic tumors can be removed by surgery. The standard procedure is called a pancreaticoduodenectomy (Whipple procedure).

This surgery for pancreatic cancer should be done at centers that perform the procedure frequently. Some studies suggest that surgery is best performed at hospitals that perform at least 9 of these surgeries per year.

When the tumor is confined to the pancreas but cannot be removed, a combination of radiation therapy and chemotherapy may be recommended. When the tumor has spread to other organs (metastasized) such as the liver, chemotherapy alone is usually used. The standard chemotherapy agent is gemcitabine, but other drugs may be used. Gemcitabine provides clinical improvement in approximately 25% of patients.

For patients who have biliary obstruction (blockage of the vessels that transport bile) and the tumor cannot be totally removed, the obstruction must be relieved. There are generally two approaches to this, surgery and placement of a biliary stent (similar to stents placed in the arteries of the heart to relieve blockages) during ERCP.

Management of pain and other symptoms is an important part of the treatment of advanced pancreatic cancer. Hospice can be very helpful to patients for both pain and symptom management and psychological support for the patient and the family during the course of the illness.

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Support Groups

The stress of illness can often be helped by joining a support group where members share common experiences and problems. See cancer - support group. Also see the discussion of hospice in the treatment section above.

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Expectations (prognosis)

For patients with pancreatic cancer that are resectable (can be surgically removed), some patients are cured. However, cure rates are significantly less than 50%.

Chemotherapy and radiation are often given after surgery to attempt to increase the cure rate. Patients with pancreatic cancer that can be removed successfully with surgery should consider enrollment in a clinical trial (a medical research study to determine the best treatment).

For patients with pancreatic cancer that cannot be removed completely with surgery or cancer that has spread beyond the pancreas, cure is not currently possible. The average (median) survival is generally less than 1 year.

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Complications

Pancreatic cancer can result in weight loss, liver dysfunction, infections, and pain. Symptoms such as pain can usually be controlled with aggressive pain management.

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Calling your health care provider

Call for an appointment with your health care provider if you have persistent abdominal pain, loss of appetite, fatigue, back pain, or other symptoms suggestive of this disorder.

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Prevention

If you smoke, stop smoking. If your diet is high in fat, dietary adjustments may help reduce the risk.

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Pancreatic Cancer