Pancreatic cancer is currently the fourth leading cause of cancer death in the United States, claiming 38,460 lives annually. The rate of incidence seems to be increasing; not only is the disease becoming more common, but it is also extremely difficult to treat: signs and symptoms of the disease seldom show until more advanced stages of cancer. By the time symptoms do show up, cancer cells are likely to have metastasized to other parts of the body, often rendering surgical removal of tumors impossible. While there is currently no treatment for pancreatic cancer, medical research is advancing rapidly.
There are several stages involved in pancreatic cancer, and two models for accurately describing them. In the Tumor, Node, Metastasis (TNM) system, tumor size, lymph node health and metastasis activity are measured separately, each with its own number scale. For tumors, T1 means that a tumor is less than 2cm across in any direction; T2 means that the tumor is larger than 2cm across; T3 means that the tumor has started to grow into the tissues, duodenum and bile ducts that surround the pancreas; finally, T4 means that the tumor has grown into the spleen, large intestines and major blood vessels. For lymph nodes, N0 means that there are no lymph nodes containing cancer; N1 means that there are lymph nodes containing cancer, and so the tumor has likely metastasized beyond the pancreas. Finally, for metastasis (tumor migration), M0 means the tumor has not spread, and M1 means that it has.
The second model for pancreatic cancer involves 4 numbered stages, as follows:
Stage 1: the tumor has not progressed outside of the pancreas. The TNM equivalent would be T1 or 2; N0; M0, meaning that there has been no spread and that the tumor is relatively small.
Stage 2: the tumor has grown into nearby tissues and perhaps the duodenum. Lymph nodes are not affected. The TNM equivalent would be T3; N0; M0.
Stage 3: the tumor may be quite large and has spread to the lymph node system, and thus is capable of spread to other organs. The TNM equivalent would be T1, 2 or 3; N1; M0.
Stage 4: this stage is often divided into two sub-stages. 4A describe a situation in which cancer has grown into nearby organs including the spleen and/or stomach, as well as large blood vessels. The TNM equivalent for this stage would be T4; N1 or 2; M0. Stage 4B describes a situation in which cancer has spread to other organs such as the liver or lungs, and has a TNM equivalent of T1, 2, 3, or 4; N0 or 1; M1.
Signs and Symptoms
There are several symptoms that may be indicative of pancreatic cancer:
- Upper abdominal pain that may extend to your middle or upper back.
- Weight loss due to malignant cancer cells’ tendency to deprive healthy cells of nutrients
- Jaundice—yellowing of skin and whites of the eyes. This condition is fairly common among pancreatic cancer patients, and develops when blood cells become worn out and break down into bilirubin. Normally, bilirubin is eliminated in the bile which is a fluid produced by the liver. However, if a pancreatic tumor blocks the flow of bile, jaundice may occur.
- Sever itch may occur due to build up of bile acids
- Nausea and vomiting can occur during later stages, if a pancreatic tumor has grown sufficiently large to block a portion of the digestive tract (usually the duodenum)
- Digestive problems may occur, as the pancreas is an integral part of the digestive system
- If you exhibit any of these symptoms, you should contact your physician as soon as possible.
Current medical research is unsure of the exact cause of pancreatic cancer. However, genetics seem to play a big role, as they do with other cancers: persons with family members who have been diagnosed with pancreatic cancer have a higher risk of developing it themselves.
In addition, a number of diseases have been associated with elevated risk levels for pancreatic cancer, including:
- Familial adementous polyposis
- Nonpolyposis colon cancer
- Familial breast cancer associated with the BRAC2 gene
- Hereditary pancreatitis
- Familial atypical multiple mole-melanoma syndrome (a form of skin cancer)
A hereditary predisposition to any of the above diseases can lead to an increased risk to pancreatic cancer. However, this predisposition accounts for only about 10% of all pancreatic cancer; a far greater number of cases are developed due to environmental and lifestyle factors, such as smoking, diet, and chemical exposure.
Additional risk factors include:
- Old age: the vast majority of pancreatic cancer cases occur in people aged 65 years and above
- Race: black men and women have a higher likelihood to develop pancreatic cancer
- Sex: men are more likely to develop pancreatic cancer
- Cigarette smoking: smokers are two to three times more likely to have pancreatic cancer than nonsmokers; smoking is the single greatest risk factor—smoking is associated in almost one third of all pancreatic cancer cases
- Diabetes: abnormal glucose metabolism increase the risk of pancreatic cancer
- Weight and diet: overweight and obese people, and people with diets high in animal fats and low in fruits and vegetables are more likely to develop pancreatic cancer
- Chemical exposure: people working with petroleums such as gasoline and fuel oils have a higher risk of pancreatic cancer
Currently, there is no treatment with a very strong success rate; the majority of patients diagnosed with pancreatic cancer have little chance of survival (less than 6 months). Virtually all patients die within seven years of surgery.
Palliative treatment options include stenting of the obstructed biliary tree (to relieve jaundice), surgical bilary bypass (especially in younger patients) and complex pain relief options. As well, enzyme supplements may be useful, as the main pancreatic duct is usually blocked. Chemotherapy is an option and has been shown to increase the chance of survival, especially over longer periods of time. Curative treatment options include partial or total removal of the pancreas to prevent metastasis. Postoperative morbidity is high (30-40%), and patients generally require intensive care for at least 24 hours after surgery.
“The Stages of Pancreatic Cancer,” by CancerHelp UK. Last updated on 24 February, 2006. <http://www.cancerresearchuk.org/cancer-help/>
“Pancreatic Cancer Home Page,” hosted by the Johns Hopkins medical institute. Last updated 12 May, 2006. < http://www.path.jhu.edu/pancreas/>
Confronting Pancreatic Cancer. Constantly updated. <www.Pancreatica.org>
“MedlinePlus: Pancreatic Cancer” at the National Institute of Health. Constantly updated. <http://www.nlm.nih.gov/medlineplus/pancreaticcancer.html>
“Pancreatic Cancer,” at the Mayo Clinic. Last updated 12 April, 2006. <http://www.mayoclinic.com/health/pancreatic-cancer/DS00357>
Fast Facts: Diseases of the Pancreas and Biliary Tract by John P Neoptolemos and Manoop S Bhutani. Published in 2006 by Health Press Limited. <www.fastfacts.com>