Pancreatic cancer is the fourth most common cause of cancer death in the US.
The pancreas is a small gland located in the abdomen between the stomach and the intestines. It is mainly composed of the exocrine cells that make digestive enzymes and the endocrine (islet) cells that make hormones such as insulin, which controls blood sugar levels. Pancreatic cancer occurs when a cell in the pancreas is damaged and starts to grow out of control.
The vast majority of pancreatic cancers start in exocrine cells found in the pancreas ducts, or small channels that carry digestive enzymes to the intestines. These cancers are called adenocarcinomas that begin in the tissue lining the pancreas, although as many as 20 different types of tumors can be found in the pancreas. As a pancreatic tumor grows, it can invade nearby organs – such as the bile duct, intestine, or stomach – or adjacent blood vessels. Tumor cells can break away and spread to the lymph nodes or liver, or to other places in the abdomen.
Dr. Bilchik and his team diagnose and treat pancreatic cancer with the most advanced therapies available. We provide focused, personalized care via a team that consists of surgeons, oncologists, radiologists, gastroenterologists and specially trained support staff, all to help you make the most informed decision about your care.
As a center that has advanced technology and expertise, we offer innovative treatments, including minimally invasive surgery and focused radiation therapy, against pancreatic cancer.
The pancreas contains two main types of cells:
- Exocrine cells that produce digestive juices
- Endocrine cells that produce hormones
Adenocarcinoma starts in exocrine cells and accounts for 95% of pancreatic cancers. It occurs in the lining of the pancreatic ducts.
Islet cell carcinoma involves endocrine cells. Most islet cell carcinomas are malignant, but insulin-producing islet cell tumors are often benign (non-cancerous). Islet cell tumors can be:
- Functional and produce abnormally high amounts of hormones leading to symptoms such as light headedness, pain, weakness, low and high sugar levels and jaundice.
- Non-functional and produce no hormones
Pancreaticoblastoma is very rare. This type of pancreatic cancer is found mostly in young children. Isolated sarcomas and lymphomas can also occur in the pancreas. These are very rare.
Pseudopapillary neoplasms are mostly found in women in their teens and 20s. Patients can present with pain, jaundice, weight loss or a mass. These cancers mainly originate in the head of the pancreas. Resection of the tumor is often curative.
Ampullary cancer is a rare type of exocrine tumor that begins where the bile duct from the liver and the pancreatic duct join with the small intestine. Since it causes jaundice, it may be found earlier than other types of pancreatic cancer and therefore has a better outcome.
There are several very rare types of pancreatic cancers, including:
- Adenosquamous carcinoma
- Squamous cell carcinoma
Some neuroendocrine tumors that can occur in the pancreas can be either benign or malignant:
Insulinoma is a rare pancreatic tumor that secretes insulin, the hormone that lowers glucose levels in the blood.
Gastrinoma is a tumor that secretes above-average levels of gastrin, a hormone that stimulates the stomach to secrete acids and enzymes. Gastrinoma can also cause stomach ulcers and can spread to the liver.
Glucagonoma is a tumor that secretes glucagon, a hormone that raises levels of glucose in the blood, often leading to a characteristic rash.
There are no early warning signs for pancreatic cancer. In fact, symptoms may be so non-specific they are often ignored.
The following are the other most common symptoms associated with pancreatic cancer:
- Pain in the upper abdomen (belly) or upper back
- Loss of appetite
- Weight loss
- Jaundice (yellow skin and eyes, and dark urine)
- Extreme fatigue
- An enlarged abdomen from a swollen gallbladder
- Pale, greasy stools that float in the toilet
Many of these symptoms can also be caused by other, more common health problems. For example, hepatitis, gallstones, and other liver problems can block the bile duct and are much more common causes of jaundice. Tell your doctor if you have any of these symptoms to ensure proper diagnosis and treatment.
Other signs of pancreatic cancer, such as an enlarged gallbladder or the sudden onset of type II diabetes, may be found by a physician during an exam, even if there are no other noticeable symptoms.
Risk factors for pancreatic cancer include:
Most pancreatic cancer occurs in people over the age of 55.
Heavy cigarette smokers are two or three times more likely than nonsmokers to develop pancreatic cancer.
Obesity and physical inactivity
Pancreatic cancer is more common in people who are very overweight and in people who are not physically active.
Pancreatic cancer occurs more often in people who have type 2 diabetes than in those who do not.
More men than women are diagnosed with pancreatic cancer.
Approximately 10 percent of people with pancreatic cancer have one or more inherited genetic mutations that can also cause other diseases, including familial atypical multiple mole melanoma syndrome, familial breast cancer, Peutz-Jeghers syndrome, and hereditary pancreatitis.
Mutations in the genes BRCA1 and BRCA2, which increase the risk of breast, prostate, and certain gynecologic cancers, have been found in some families with a history of pancreatic cancer. Other inherited genetic factors have been identified, but do not greatly increase an individual’s risk of developing pancreatic cancer.
African-Americans are more likely than Asians, Hispanics, or whites to be diagnosed with pancreatic cancer.
The risk for developing pancreatic cancer is higher if a person’s mother, father, or a sibling had the disease. An estimated 5 to 10% of people with pancreatic cancer have one or more family members who have had the disease. According to the National Cancer Institute, people with a strong family history of pancreatic cancer are nine times more likely to develop pancreatic cancer than others.
Cirrhosis of the liver
People with cirrhosis have a higher risk of pancreatic cancer.
Exposure to certain occupational pesticides, dyes, and chemicals used in the metal industry may increase the risk of pancreatic cancer.
Long-term inflammation of the pancreas, often caused by excessive alcohol abuse, has been linked to an increased risk for pancreatic cancer.
Exposure to carcinogens such as asbestos, pesticides, dyes, and petrochemicals may be linked to pancreatic cancer.
Benign and Pre-cancerous Pancreatic Lesions
Advances in imaging technology have dramatically increased the number of small abnormalities that are found in the pancreas. Most of these abnormalities are identified during imaging for another condition. Many of them are benign, fluid-filled cysts and are unlikely to cause symptoms or shorten a person’s life. Others are pre-cancerous and have the ability to turn into pancreatic cancer.