Definition of Pancreatic cancer
Pancreatic cancer: Malignancy of the pancreas. Pancreatic cancer has been
called a "silent" disease because early pancreatic cancer
usually does not cause symptoms. If the tumor blocks the common bile
duct and bile cannot pass into the digestive system, the skin and
whites of the eyes may become yellow (jaundiced), and the urine
darker as a result of accumulated bile pigment called bilirubin.
The pancreas is a spongy, tube-shaped organ about
6 inches long. It is located in the back of the abdomen, behind the
stomach. The head of the pancreas is on the right side of the
abdomen. It is connected to the duodenum, the upper end of the small
intestine. The narrow end of the pancreas, called the tail, extends
to the left side of the body.
The pancreas makes pancreatic juices and hormones, including
insulin. Pancreatic juices, also called enzymes, help digest food in
the small intestine. Insulin controls the amount of sugar in the
blood.
As pancreatic juices are made, they flow into the main pancreatic
duct. This duct joins the common bile duct, which connects the
pancreas to the liver and the gallbladder. The common bile duct,
which carries bile (a fluid that helps digest fat), connects to the
small intestine near the stomach.
The pancreas is divided functionally into the endocrine pancreas (that makes insulin and other hormones) and the exocrine pancreas (that makes pancreatic enzymes to aid the digestion). This information is limited to cancer of the exocrine pancreas, which is far and away the most common type of pancreatic cancer.
Cancer of the pancreas has markedly increased in incidence over the decades and now ranks as the fourth leading cause of cancer death in the US. Despite the high mortality rate associated with pancreatic cancer, its causation is poorly understood. Smoking is known to be a major risk factor. Cigarette smokers develop cancer of the pancreas two to three times more often than do nonsmokers. Quitting smoking reduces the risk of pancreatic cancer.
Cancer of the pancreas is rarely curable. The overall survival rate is less than 4%. The cure rates are highest (although still usually under 25%) if the tumor is small (less than 2 cm in diameter) and is truly localized to the pancreas but, unfortunately, such cases account for fewer than 20% of all cases of pancreatic cancer. For patients with advanced cancers, the overall survival rate of all stages is less than 1% at 5 years with most patients dying within 1 year.
Staging of the tumor is important to the diagnosis and to the identification of patients with disease that cannot be resected (removed by surgery). Staging has been aided by advances in imaging technology, including the spiral computed tomographic (CT) scan, magnetic resonance imaging (MRI) scan, positron emission tomographic (PET) scan, endoscopic ultrasound, and laparoscopic staging.
There are no specific tumor markers for pancreatic cancer. Markers such as serum CA 19-9 have low specificity. Most patients with pancreatic cancer have an elevated CA 19-9 at diagnosis. Following or during definitive therapy, the increase of CA 19-9 levels may identify patients with progressive tumor growth. However, the presence of a normal CA 19-9 does not rule out recurrence of the tumor.
Patients with any stage of pancreatic cancer are candidates for clinical trials because of the poor response to chemotherapy, radiation therapy, and surgery as conventionally used.
However, palliation to ease or relieve symptoms may be achieved with conventional treatment. Palliative measures may include surgical or radiologic biliary decompression, relief of gastric outlet obstruction, and pain control. These and other measures may significantly improve the quality of life.
It is essential to address the potentially disabling psychological events associated with the diagnosis and treatment of pancreatic cancer. The impact of this disease can weigh heavily upon the patient and all those close to him or her.
Last Editorial Review: 10/10/2004Common Misspellings: pancreatic canser
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