Pancreatic Cancer: The Silent Killer


images-25.jpegPancreatic cancer is currently the fourth most common cause of cancer-related deaths in the United States. Over the past five years approximately 32,000 Americans were diagnosed each year with pancreatic cancer, and about the same number died each year. About 23% of patients survive 1 year after diagnosis, and fewer than 5% of persons with the disease are alive 5 years after diagnosis.
Tumors can develop in both the exocrine and the endocrine tissue of the pancreas, although 95% arise from the exocrine parenchyma (functional tissue) and are referred to as adenocarcinomas. The remaining 5% of pancreatic tumors develop from endocrine cells of the pancreas; they are named according to the hormone they produce (i.e., insulinomas, glucagonomas). Adenocarcinoma of the ductal origin is the most common exocrine cell type (75% to 92%), and it occurs most frequently in the head of the pancreas. Pancreatic adenocarcinoma grows rapidly, spreading to the stomach, duodenum, gallbladder, liver, and intestine by direct extension and invasion of lymphatic and vascular systems. Further metastatic spread to the lung, peritoneum, and spleen can occur. Metastatic tumors from cancers in the lung, breast, thyroid, or kidney or skin melanoma have been found in the pancreas.

Statistics

The American Cancer Society's[1] most recent estimates for pancreatic cancer in the
United States are for 2011:

  • About 44,030 people (22,050 men and 21,980 women) will be diagnosed with pancreatic cancer.
  • About 37,660 people (19,360 men and 18,300 women) will die of pancreatic cancer
  • Since 1998, rates of pancreatic cancer have increased somewhat in men and women.
  • The lifetime risk of developing pancreatic cancer is about 1 in 71 (1.41%). This is about the same for both men and women.

Read about the rare form of pancreatic cancer Steve Jobs battled.images-24.jpeg
Pancreatic neuroendocrine tumors, also known as islet cell tumors, are a rare form of pancreatic cancer compared to the more common, and aggressive adenocarcinoma.

Signs & Symptomsimages-12.jpeg

Cancer of the pancreas is sometimes called a “silent” disease
because symptoms are not usually present in early stages. Many patients have advanced disease by the time it becomes noticeable to the patient and the doctors. Symptoms that do develop are often vague. Individuals may experience different symptoms depending on the location, type and stage of the tumor. Symptoms that commonly lead to diagnosis include: jaundice, abdominal and/or back pain, unexplained weight loss and loss of appetite. A person with advanced pancreatic cancer may experience all of these symptoms and others including ascites and blood clots. Ascites is the abnormal build up of fluid in the abdominal cavity. Blood clots most often form in the legs and may easily go unnoticed. Symptoms such as fatigue, weakness, digestive difficulties and depression may occur at any time.[2] If one or more of the signs and symptoms described here is present, certain exams and tests may be done to find out whether they are caused by pancreatic cancer or by some other disease. See Signs & Symptoms of Exocrine Pancreatic Cancer and Endocrine Tumors.

Risk Factors

Scientists still do not know exactly what causes most cases of pancreatic cancer, but they have found several risk factors that can make a person more likely to get this disease. Recent research has shown that some of these risk factors affect the DNA of cells in the pancreas, which can result in abnormal cell growth and may cause tumors to form.
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Click on photo for more information

Researchers have made great progress in understanding how certain changes in DNA can cause normal cells to become cancerous. DNA is the chemical in each cell that carries our genes -- the instructions for how our cells function. We look like our parents because they are the source of our DNA. But DNA affects more than our outward appearance. Some genes contain instructions for controlling when our cells grow and divide. Certain genes that promote cell division are called oncogenes. Others that slow down cell divisio
n or cause cells to die at the right time are called tumor suppressor genes. Cancers can be caused by DNA mutations (defects) that turn on oncogenes or turn off tumor suppressor genes.

Several cancer family syndromes have been found in which inherited DNA mutations cause a very high risk of developing certain cancers. In some of these, there is an increased risk of getting pancreatic cancer. Most often, DNA mutations of oncogenes or tumor suppressor genes related to cancers of the pancreas occur after you are born, rather than having been inherited. These acquired mutations may result from cancer-causing chemicals in our environment, diet, or tobacco smoke. Sometimes they occur for no apparent reason.[3]

Researchers have found several factors that affect a person's chance of getting cancer of the pancreas. Most of these are risk factors for exocrine pancreatic cancer. See a list of risk factors for pancreatic cancer.


Diagnosis of Pancreatic Cancer

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Click on photo for more diagnostic information
One reason for the often poor outlook for people with exocrine pancreatic cancer is that very few of these cancers are found early. The pancreas is located deep inside the body, so early tumors cannot be seen or felt by health care providers during routine physical exams. Patients usually have no symptoms until the cancer has spread to other organs. Currently, there are no blood tests to find early cancers of the pancreas. Researchers are exploring if endoscopic ultrasound can be useful to screen people with a high risk of pancreatic cancer. See a list of tests currently used for the diagnosis of pancreatic cancer.



Stages of Pancreatic Cancer

The stage of a pancreatic cancer (extent of disease at diagnosis) is the most important factor in choosing treatment options and predicting patient's outcome. The diagnostic tests described (see the section, “Dx of Pancreatic Cancer”) are the ones used to determine the stage of the cancer. A staging system is a standardized way in which the cancer care team describes the extent that a cancer has spread. The main system used to describe the stages of cancers of the pancreas is the American Joint Committee on Cancer (AJCC) TNM system. An in-depth discussion of the TNM system for staging can be found by clicking here.

  • Stage I: Cancer is found only in the pancreas itself and not in other organs.
  • Stage II: Cancer has spread to nearby organs, such as the duodenum or bile duct, but has not entered the lymph nodes.
  • 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, and colon, that are near the pancreas, but it has not spread to 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: 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.Stages of Pancreatic Cancer


Common Terms

From a practical standpoint, how far the cancer has spread often can't be determined accurately without surgery. That's why doctors often use a simpler staging system, which divides cancers into groups based on whether or not it is likely they can be removed surgically. These groups are called resectable, locally advanced (unresectable), and metastatic. These terms can be used to describe both exocrine and endocrine pancreatic cancers. Click her for Common Terminology related to pancreatic cancer for more information. Also, click here for The Cancer Dictionary.

Medical Treatment

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The 3 main types of treatment for exocrine pancreatic cancer are:
  • surgery
  • radiation therapy
  • chemotherapy
Depending on the stage of the cancer, some of these treatments may be combined. Pancreatic endocrine tumors are also treated with these 3 types of therapy. In addition, drugs (besides chemotherapy) can be helpful. For a full discussion of treatments and side effects see Treatment of Pancreatic Cancers.


Nursing Management

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Utilizing the complete nursing process is critical when caring for patients with pancreatic cancer. From assessment to evaluating outcomes it is important that the planning of care is carefully considered and continually updated. Click here for care planning notes and specific nursing process information we have gathered to assist the professional nurse in the care of patients being treated for pancreatic cancer. Additionally, we have included several links below for use during care planning, teaching, and discharge.


Post Treatment Information for Patients
Patient Teaching Material
Resources for Nurses
Evidence Based Research


Pancreatic Cancer Research

Research into the causes, diagnosis, and treatment of pancreatic cancer is under way in many medical centers throughout the world. Clinical trials of numerous drugs and treatments are ongoing in addition to extensive research in genetics and early detection. See Research Trends for more information. Also, see NEW Research for related pancreatic research articles!


Resources & Links

Click here for a list of resources and useful links related to Pancreatic Cancer.








http://www.umgcc.org/gi_program/pan-stages.htm
  1. ^ Source for statistics:
    *Pancreatic cancer survival by stage. American Cancer Society. http://www.cancer.org/Cancer/PancreaticCancer/DetailedGuide/pancreatic-cancer-survival-rates.
      • Yao JC, Eisner MP, Leary C, et al. Population-based study of islet cell carcinoma . Annals of Surgical Oncology. 2007; 14: 3492–3500.
  2. ^
    http://pancan.org/section_facing_pancreatic_cancer/learn_about_pan_cancer/symptoms/index.php
  3. ^
    http://www.cancer.gov/cancertopics/types/pancreatic