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Pancreatic Cancer

Pancreatic cancer symptoms are typically vague, making it difficult to diagnose early. Because these cancers are often caught at a late stage, they have been hard to treat in the past.

Today, UCSF Medical Center is using new technology that's resulting in earlier diagnosis of pancreatic cancer as well as earlier diagnosis of benign cysts, lesions and tumors that could lead to cancer if not treated. In addition, we're providing new customized treatments and follow-up care that are saving more lives.

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The Pancreas

The pancreas is an oblong organ, about six inches long, located in the upper abdomen. It has two major functions: The first is to produce digestive enzymes — proteins that help digest food into the small intestine. Cells that perform this function make up the exocrine pancreas.

The second major function is to produce hormones that are secreted into the blood. These cells make up the endocrine pancreas.

Endocrine Pancreas

The endocrine pancreas is made up of specialized cells, referred to as islets of Langerhans, that produce hormones. The most important hormone produced is insulin that helps control sugar in the blood.

Cancers that begin in islet cells are called islet cell tumors or pancreatic neuroendocrine tumors. These tumors are rare and may produce hormones that cause very low or very high blood sugars or symptoms such as stomach pain and severe diarrhea.

Exocrine Pancreas

The exocrine pancreas is made up of ducts and acini, which are small pockets at the end of the ducts. Cells lining the ducts are the most likely to develop cancer, called ductal adenocarcinomas, the most common type of pancreatic cancer.

These two types of tumors are treated very differently.

At UCSF, we have specialists who conduct research on both types of pancreatic cancers. We have one of the few pancreas cancer research programs in the nation with a team dedicated to learning more about these tumors and developing better treatments.

Risk Factors

Although the cause of pancreatic cancer is unknown, risk factors have been identified that increase a person's chance of developing the disease. These include:

  • Smoking — People who smoke cigarettes are two to three times more likely to develop pancreatic cancer than non-smokers.
  • Age — The risk of pancreatic cancer increases with age. People over the age of 60 are more commonly diagnosed with the disease.
  • Race — African Americans are more likely than Asians, Hispanics and whites to develop pancreatic cancer.
  • Chronic Pancreatitis — A history of chronic pancreatitis may increase the likelihood of developing pancreatic cancer.
  • Diabetes — Some people with diabetes are more commonly affected by pancreatic cancer. Diabetes may also be a complication or an early sign of pancreatic cancer.
  • Diet — A diet high in fats, especially processed red meats, may increase the chance of developing pancreatic cancer.
  • Weight — Overweight people are more likely than others to develop pancreatic cancer.

Genetics

While most cases of pancreatic cancer don't run in families, inherited conditions may increase the chance of developing pancreatic cancer.

About 5 percent to 10 percent of pancreatic cancers are considered hereditary, or related to a specific genetic mutation. Pancreatic cancer is considered to run in a family when two or more first-degree relatives — such as parents, siblings or children — have the condition. This is sometimes referred to as familial pancreatic cancer (FPC). If a person has a first-degree relative with pancreatic cancer, his or her risk is significantly greater than the average person's.

An increased risk also has been associated with a number of genetic syndromes including hereditary breast, ovarian and colon cancer and a serious type of skin cancer called familial atypical multiple mole syndrome (FAMMM).

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Pancreatic cancer often is called a "silent" disease because it typically doesn't cause symptoms early on. The cancer may grow and spread for some time before symptoms develop, which may be so vague that they are initially ignored. For these reasons, pancreatic cancer is hard to detect early. In many cases, the cancer has spread outside the pancreas by the time it is found.

When symptoms appear, their type and severity depend on the location and size of the tumor.

Common symptoms may include:

  • Jaundice — If the tumor blocks the bile duct so bile can't flow into the intestines, jaundice may occur, causing the skin and whites of the eyes to turn yellow, the urine to become dark and the stool to turn clay-colored.
  • Pain — As the cancer grows and spreads, pain often develops in the upper abdomen and the back. The pain may increase after a person eats or lies down.
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It is important to note that pancreatic cancer is not just one disease. There are many types of pancreatic tumors, each with its own unique prognosis and treatment recommendations. Currently, there is no screening exam of proven value for detecting pancreatic cancer in the general population.

In making a diagnosis of pancreatic cancer, your doctor may conduct the following tests.

Medical History and Physical Examination

A series of tests may be necessary to make a definite diagnosis. Your doctor will first start by asking about your medical history and any physical complaints or symptoms, specifically recent weight loss, pain and changes in appetite, bowel patterns or skin color. The doctor will then complete a thorough physical exam, which will include palpation and observation of the chest and abdomen.

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There are different treatments available for patients with pancreatic cancer, including surgery, radiation therapy and drug therapy. Your doctor will use the following criteria to develop a treatment plan:

  • Your overall health and well being and preferences regarding treatment
  • Whether or not the cancer can be removed by surgery
  • Whether the cancer has just been diagnosed or has recurred, which means that it has come back

Surgery

About 15 percent to 20 percent of patients with pancreatic cancer are diagnosed early enough that their tumor can be removed surgically. Typically, however, only smaller tumors are surgically removed and even then, cancer often returns.

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Reviewed by health care specialists at UCSF Medical Center.