Frequently Asked Questions

The pancreas is an oblong flattened gland located deep in the abdomen. It is an integral part of the digestive system. It is about 6 inches long and is shaped like a flat pear. The widest part of the pancreas is the head, the middle section is the body, and the thinnest part is the tail.

The pancreas produces insulin and other hormones. These hormones help the body use or store the energy that comes from food. The pancreas also makes pancreatic juices which contain enzymes that help digest food. The pancreas releases the juices into a system of ducts leading to the common bile duct. The common bile duct empties into the duodenum, the first section of the small intestine.

Cancer is the illness or condition that is caused when cells multiply uncontrollably forming a growth or tumor and destroying healthy tissue.

Benign tumors are not cancer and are usually not life threatening. In most cases, benign tumors can be removed and do not come back. Cells from benign tumors do not spread to tissues around them or to other parts of the body.

Malignant tumors are cancer. The term malignant is used to describe a tumor that invades the tissue around it and may spread to other parts of the body. Malignant tumors are more serious and may be life threatening.

Cancer cells can break away from a malignant tumor and enter the bloodstream or lymphatic system. That is how cancer cells metastasize, or spread from the original cancer (primary tumor) to form new tumors in other organs.

Pancreatic cancer typically starts in the ducts of the pancreas. Small changes in the cellular DNA result in uncontrolled multiplication and accumulation of cells in clusters called tumors. These cancer cells can spread outside the pancreas to other body parts if untreated.

When cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary tumor. For example, if cancer of the pancreas spreads to the liver, the cancer cells in the liver are pancreatic cancer cells. The disease is metastatic pancreatic cancer, not liver cancer. It is treated as pancreatic cancer, not liver cancer.

Islet cell cancer is another name for pancreatic neuroendocrine tumors (NETs) that are malignant or cancerous. NETs are rare tumors originating in the pancreas or nearby from hormone-producing cells called islet cells. Some NETs are functional, producing excess hormones that can cause various symptoms related to hormones.

No one knows the exact causes of pancreatic cancer though research has shown that people with certain risk factors are more likely to develop pancreatic cancer. Risk factors include:

•Cigarette smoking – Cigarette smoke contains a large number of carcinogens (cancer causing chemicals.) Therefore, it is not surprising that cigarette smoking is one of the biggest risk factors for developing pancreatic cancer. According to some reports smokers have a 2-3 fold increased risk of developing pancreatic cancer.

•Diabetes – There have been a number of reports which suggest that diabetics have an increased risk of developing pancreatic cancer.

•Family History – Having a mother, father, sister, or brother with pancreatic cancer increases the risk of developing the disease by 2-3 times.

•Chronic pancreatitis – Long-term inflammation of the pancreas (pancreatitis) has been linked to cancer of the pancreas.

•Ethnicity – Studies in the United States have shown that pancreatic cancer is more common in the African-American population than it is in the white population. Some of this increased risk may be due to socioeconomic factors and to cigarette smoking.

•Religious Background – Pancreatic cancer is proportionally more common in Ashkenazi Jews than the rest of the population. This may be because of a particular inherited mutation in the breast cancer gene (BRCA2) which runs in some Jewish families.

• Diet – Diets high in meats, cholesterol, fried foods and nitrosamines may increase the risk, while diets high in fruits and vegetables may reduce the risk of pancreatic cancer.

If you have a family history of pancreatic cancer or are concerned you may be at risk, discuss it with a health care professional. The health professional can review your family history and help you understand whether genetic testing might be right for you. Genetic testing can find DNA changes that run in families and increase the risk of cancer.

In the early stages, pancreatic cancer is extremely difficult to detect because often there are no symptoms. But, as the cancer grows, symptoms may include:

•Pain in the upper abdomen or upper back
•Yellow skin and eyes, and dark urine from jaundice
•Weakness
•Loss of appetite
•Nausea and vomiting
•Weight loss

These symptoms are not sure signs of pancreatic cancer. An infection or other problem could also cause these symptoms. Only a doctor can diagnose the cause of a person’s symptoms. Anyone with these symptoms should see a doctor so that the doctor can treat any problem as early as possible.

When pancreatic cancer is diagnosed, the doctor needs to know the stage, or extent, of the disease to plan the best treatment. Staging is a careful attempt to find out the size of the tumor in the pancreas, whether the cancer has spread, and if so, to what parts of the body. The results of various diagnostic tests will indicate how far the cancer has progressed and determine the stage. Subsequent decisions about treatment will be based upon the stage assigned.

The NCCN Guidelines for Pancreatic Cancer Patients includes a detailed list of questions to ask your care team.

Doctors in clinics and hospitals are searching for a cure. In their efforts, they often conduct clinical trials. These are research studies in which people take part voluntarily. In these trials, researchers are studying ways to treat pancreatic cancer. Research already has led to advances in treatment methods, and researchers continue to search for more effective approaches to treat this disease.

Patients who join clinical trials have the first chance to benefit from new treatments that have shown promise in earlier research. They also make an important contribution to medical science by helping doctors learn more about the disease.

Although clinical trials may pose some risks, researchers take very careful steps to protect their patients.

In trials with people who have pancreatic cancer, doctors are studying new drugs, new combinations of chemotherapy, and combinations of chemotherapy and radiation before and after surgery. For more information on clinical trials, click here.

Participating in a clinical trial for pancreatic cancer can be a good option at diagnosis and during every treatment decision. Clinical trials are research studies that test new treatments, procedures, or devices to see how well they work. They are important in helping prevent, treat, and cure cancer; every treatment available today was approved through a clinical trial.

Palliative care is a specialized form of care that provides symptom relief, comfort, and support to individuals living with serious illnesses.

An oncologist is a doctor who specializes in treating cancer. Specialists who treat pancreatic cancer include surgeons, medical oncologists, and radiation oncologists.

Getting a second opinion for pancreatic cancer care is generally recommended, regardless of when you are in the treatment process. A second opinion can help you confirm your diagnosis, decide on a treatment plan, and find a doctor and team you feel comfortable with. It can also help you and your family learn about your options and consider the benefits and disadvantages of treatment. When choosing your medical team, it’s important to seek treatment at a center with extensive experience in managing pancreatic cancer.

People with pancreatic cancer may have several treatment options. Depending on the type and stage, pancreatic cancer may be treated with surgery, radiation therapy, targeted therapy or chemotherapy. Some patients have a combination of therapies. For more information, click here.

Generally if the cancer is localized, surgical treatment, via resection or removal of the tumor, can be pursued. This means that the cancer has not spread to any blood vessels, distant lymph nodes or other organs, such as the liver or lung. These characteristics are determined through various diagnostic techniques.

This depends where the tumor is located within the pancreas.

Cancer in the Head, Neck or Uncinate Process of the Pancreas: The Whipple Procedure

Cancer in the Body or Tail of the Pancreas: Distal Pancreatectomy and Splenectomy

Questions to ask the doctor before surgery, click here.

Radiation therapy (also referred to as radiotherapy) uses high-energy rays to kill cancer cells. Radiation therapy may be administered alone, or in combination with surgery, chemotherapy, or both.

Questions to ask the doctor before radiation therapy:
•Why do I need this treatment?
•When will the treatments begin? When will they end?
•How will I feel during therapy? Are there side effects?
•What can I do to take care of myself during therapy? Are there certain foods that I should eat or avoid?
•How will we know if the radiation is working?
•Will I be able to continue my normal activities during treatment?

Chemotherapy is the use of drugs to kill cancer cells. Doctors also give chemotherapy to help reduce pain and other problems caused by pancreatic cancer. It may be given alone, with radiation, or in combination with surgery and radiation.
Chemotherapy is systemic therapy and is most often delivered intravenuously. Once in the bloodstream, the drugs travel throughout the body.

Usually chemotherapy is an outpatient treatment. However, depending on which drugs are given and the patient’s general health, the patient may need to stay in the hospital.

Questions to ask before chemotherapy:
•Why do I need this treatment?
•What will it do?
•What drugs will I be taking? How will they be given? Will I need to stay in the hospital?
•Will the treatment cause side effects? What can I do about them?
•How long will I be on this treatment?

Because cancer treatment may damage healthy cells and tissues, unwanted side effects are common. These side effects depend on many factors, including the type and extent of the treatment. Side effects may not be the same for each person, and they may even change from one treatment session to the next. The health care team will explain possible side effects and how they will help the patient manage them.

Surgery
The side effects of surgery depend on the extent of the operation, the person’s general health, and other factors. Most patients have pain for the first few days after surgery. Pain can be controlled with medicine, and patients should discuss pain relief with the doctor or nurse.

Removal of part or all of the pancreas may make it hard for a patient to digest foods. The health care team can suggest a diet plan and medicines to help relieve diarrhea, pain, cramping, or feelings of fullness. During the recovery from surgery, the doctor will carefully monitor the patient’s diet and weight. At first, a patient may have only liquids and may receive extra nourishment intravenously or by feeding tube into the intestine. Solid foods are added to the diet gradually.

Patients may not have enough pancreatic enzymes or hormones after surgery. Those who do not have enough insulin may develop diabetes. The doctor can give the patient insulin, other hormones, and enzymes.

Radiation Therapy
Radiation therapy may cause patients to become very tired as treatment continues. Rest is important, but doctors usually advise patients to try to stay as active as possible. In addition, when patients receive radiation therapy, the skin in the treated area may sometimes become red, dry, and tender.

Radiation therapy to the abdomen may cause nausea, vomiting, diarrhea, or other problems with digestion. The health care team can offer medicine or suggest diet changes to control these problems. For most patients, the side effects of radiation therapy go away when treatment is over.

Chemotherapy
The side effects of chemotherapy depend on the drugs and the doses the patient receives as well as how the drugs are administered. As with other types of treatment, side effects vary from patient to patient.

Patients who undergo chemotherapy may also be more likely to get infections, bruise or bleed easily, and may have less energy. Since systemic therapy affects rapidly dividing cells, patients may lose their hair and may have other side effects such as poor appetite, nausea and vomiting, diarrhea, or mouth sores. Usually, these side effects go away gradually during the recovery periods between treatments or after treatment is over. The health care team can suggest ways to relieve side effects.

Pain can be successfully controlled through aggressive therapy and constant assessment. If you are experiencing pain, it is important to speak with your doctor as soon as possible as early treatment can make it easier to control. Your oncologist, pain specialist, or palliative care doctor can provide the best prescription, which may include non-opioid drugs, opioid drugs, nerve blocks, or even medical marijuana if it is legal in your state.

Alternative treatments such as acupuncture, massage, meditation, physical and occupational therapy may also help to manage the pain. Click here for more information about pain control

Living with a serious disease such as pancreatic cancer is not easy. Some people find they need help coping with the emotional and practical aspects of their disease. Support groups can help. In these groups, patients or their family members get together to share what they have learned about coping with their disease and the effects of treatment. To find a support group, click here.