CanCer-666: Pancreatic Cancer

Risk Factors For Pancreatic Cancer

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A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors often influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. However, knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices. However, the following factors may raise a person’s risk of developing pancreatic cancer: Risk Factors For Pancreatic Cancer 
 
• Age 
The risk of developing pancreatic cancer increases with age. Most people who develop pancreatic cancer are older than 45; in fact, 90% are older than 55 and 70% are older than 65. However, adults of any age can be diagnosed with pancreatic cancer. 
 
• Alcohol 
Chronic heavy alcohol use is a risk factor for chronic pancreatitis which is a risk factor for pancreatic cancer. However, research evidence on a direct link between alcohol and risk of pancreatic cancer is mixed. There does not appear to be an increased risk of developing pancreatic cancer from moderate alcohol consumption. However, some studies suggest that heavy drinking (more than 3 drinks a day) may lead to an increased risk of developing the disease. 
 
• Allergies 
Some research studies have found that having certain types of allergy including ones that affect the skin (such as eczema or hives), a reaction to insect bites, hay fever and respiratory allergies may reduce the risk of developing pancreatic cancer. The risk is further reduced with an increased number and severity of allergies. However there is no evidence that having asthma or allergies related to food or drugs lead to a reduction in risk. 
 
• Bacteria 
A common bacterium called Helicobacter pylori, also called H. pylori, causes inflammation and ulcers in the stomach and increases the risk of stomach cancer. H. pylori also increases the risk of pancreatic cancer, although the risk is not as high as the risk of developing stomach cancer. 
 
• Body Mass Index (BMI) and Weight 
A review of the evidence on weight and BMI (Body Mass index) suggests that a higher BMI and increased abdominal fatness increase the risk of developing pancreatic cancer. The review found that there was a 10% increase in risk for a five point increase in BMI. 
 
A UK study published in 2011 suggested that 12% (around 1000) of cases of pancreatic cancer were related to being overweight or obesity. (Overweight was classed as a BMI of over 25 and obesity as a BMI of over 30). 
 
• Chemicals 
Exposure to certain chemicals (such as pesticides, benzene, certain dyes, and petrochemicals) may increase the risk of developing pancreatic cancer. 
 
• Chronic Pancreatitis 
Chronic pancreatitis is a long-term inflammation of the pancreas. This condition is linked with an increased risk of pancreatic cancer (especially in smokers), but most people with pancreatitis never develop pancreatic cancer. A small number of cases of chronic pancreatitis are due to an inherited gene mutation. People with this inherited (familial) form of pancreatitis have a high lifetime risk for developing pancreatic cancer. 
 
• Cirrhosis 
Cirrhosis develops when liver cells are damaged and are replaced by scar tissue. Most cirrhosis in the United State is caused by alcohol abuse. Other causes are viral hepatitis (see above), too much iron in the liver from a disease called hemochromatosis, and some other rare types of chronic liver disease. 
 
• Coffee 
Some older studies have suggested that drinking coffee might increase the risk of pancreatic cancer, but more recent studies have not confirmed this. 
 
• Diabetes 
Many studies have indicated that diabetes, especially when a person has had it for many years, does increase his or her risk of developing pancreatic cancer. In addition, suddenly developing diabetes later in adulthood can be an early symptom of pancreatic cancer. However, it is important to remember that not all people who have diabetes or who develop diabetes as adults develop pancreatic cancer. 
 
• Diet 
Some studies linked pancreatic cancer and diets that include a lot of red meat, pork, and processed meat (such as sausage and bacon). Others have found that diets high in fruits and vegetables may help reduce the risk of pancreatic cancer. But not all studies have found such links, and the exact role of diet in relation to pancreatic cancer is still being studied. Risk Factors For Pancreatic Cancer 
 
• Ethnicity 
African Americans are more likely to develop pancreatic cancer than whites. The reasons for this are not clear, but it may be due in part to having higher rates of other risk factors for pancreatic cancer, such as diabetes, smoking in men, and being overweight in women. 
 
• Family History 
Pancreatic cancer may run in the family, called familial pancreatic cancer, if two or more first-degree relatives (parents, brothers, sisters, children) are diagnosed with pancreatic cancer. Families with three or more close relatives (grandparents, aunts, uncles, nieces, nephews, grandchildren, cousins) diagnosed with pancreatic cancer and with one relative diagnosed before age 50 are also considered to have familial pancreatic cancer. The National Institutes of Health (NIH) estimates that the risk of developing pancreatic cancer is increased four to five times for a person with one first-degree relative with pancreatic cancer, six to seven times for a person with two first-degree relatives, and 32 times for a person with three first-degree relatives with the disease. 
 
It is important to talk with your family members about your family’s history of pancreatic cancer. If you think you may have a family history of pancreatic cancer, talk with a genetic counselor before you have any genetic testing. Only genetic testing can determine if you have a genetic mutation and genetic counselors are trained to explain the risks and benefits of genetic testing. There are specific registries for families with inherited pancreatic cancer syndromes and a genetic counselor can help you learn more about these. 
 
• Gastric (Stomach) Ulcer 
Having a gastric ulcer increases the risk of developing pancreatic cancer. Having surgery for the gastric ulcer further increases the risk to double that of the general population. This may be because bacteria which populate the stomach after the operation lead to the formation of carcinogenic nitrosamines. 
 
• Gender 
Men are about 30% more likely to develop pancreatic cancer than women. This may be due, at least in part, to higher tobacco use in men, which raises pancreatic cancer risk (see above). The difference in pancreatic cancer risk was more pronounced in the past (when tobacco use was much more common among men than women), but the gap has closed in recent years. 
 
• Hepatitis B Infection 
Hepatitis viruses are viruses that infect the liver. One study has shown that a previous hepatitis B infection was twice as common in people with pancreatic cancer than in people without the cancer. More research is needed to learn more about this link. 
 
• Heredity Pancreatitis 
Hereditary pancreatitis is a rare type of pancreatitis which causes earlier onset pancreatitis, usually before the age of 30 years. About 40% of people with hereditary pancreatitis will develop pancreatic cancer by age 80, with smoking and diabetes thought to increase the risk. 
 
• History of Cancer 
People are at an increased risk of developing pancreatic cancer within 10 years of a diagnosis of cancers of the pharynx, stomach, gallbladder, larynx, lung, cervix, corpus uteri, bladder, and eye and 10 years or later after a diagnosis of cancers of the stomach, colon, gallbladder, breast, cervix, placenta, corpus uteri, ovary, testis, bladder, kidney, and eye, as well as Hodgkin's and non-Hodgkin's lymphomas. In some cases this may be because of the shared risk factor of smoking. In other cases there may be a genetic link or an effect from previous radiotherapy treatment. 
 
• NSAIDs (Nonsteroidal anti-inflammatory drugs) (including Aspirin) 
NSAIDs have been shown to have a beneficial effect in reducing the risk of some cancers, but the available research evidence does not show any association between NSAIDS and risk of pancreatic cancer. 
 
• Physical Activity 
Reviews of the available evidence suggest that occupational physical activity may have a protective effect and lower the risk of developing pancreatic cancer. However, no relationship has been found between recreational physical activity and pancreatic cancer. 
 
• Physical Inactivity 
Some research has suggested that lack of physical activity might increase pancreatic cancer risk. But not all studies have found this. 
 
• Rare Inherited Conditions 
Members of families with certain uncommon inherited conditions also have a significantly increased risk of pancreatic cancer, as well as other types of cancer; these include hereditary pancreatitis (see below), Peutz-Jeghers syndrome (PJS), familial malignant melanoma and pancreatic cancer (FAMM-PC), hereditary breast and ovarian cancer (HBOC) syndrome, and Lynch syndrome. In addition, people who have Li-Fraumeni syndrome (LFS) and familial adenomatous polyposis (FAP) may have an increased risk of pancreatic cancer. 
 
• Smoking 
Smoking is one of the most important risk factors for pancreatic cancer. The risk of getting pancreatic cancer is about twice as high among smokers compared to those who have never smoked. Scientists think this may be due to cancer-causing chemicals in cigarette smoke that enter the blood and damage the pancreas. About 20% to 30% of exocrine pancreatic cancer cases are thought to be caused by cigarette smoking. Cigar and pipe smoking also increase risk, as does the use of smokeless tobacco products. 
 
• Tooth or Gum Disease 
Some research has suggested that tooth or gum disease can increase the risk of developing pancreatic cancer. It is not yet clear why it increases risk. 
 
• Ulcerative Colitis and Chrohns Disease 
People who are hospitalised for ulcerative colitis for the first time before the age of 25 have seven times the risk of developing pancreatic cancer as the general population. This risk reduces if people are first hospitalised at an older age. People with Crohn's disease have a 75% increased risk of developing pancreatic cancer. Risk Factors For Pancreatic Cancer</div>
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Risk Factors For Pancreatic Cancer

A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors often influence the development o...

Pancreatic Cancer Staging

ancorez Pancreatic Cancer 3:05 PM

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Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting other parts of the body. Doctors use diagnostic tests to determine the cancer's stage, so staging may not be complete until all the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient's prognosis (chance of recovery). As with Diagnosis, it is important for the staging of pancreatic cancer to be done at a center with experience in staging pancreatic cancer. There are different stage descriptions for different types of cancer. Pancreatic Cancer Staging 
 
Doctors use several systems to stage pancreatic cancer. The method used to stage other cancers, called the TNM classification, is not often used for pancreatic cancer; however, for completeness, it is discussed below. The more common way to classify pancreatic cancer is to divide it into four categories based on whether it can be removed with surgery and where it has spread: 
 
• Borderline resectable 
 
This category is being increasingly used. It refers to a tumor that cannot be removed surgically when it is first diagnosed, but if chemotherapy and/or radiation therapy is able to shrink the tumor first, it may be able to be removed at a later time. 
 
• Resectable 
 
If the cancer is only in the pancreas (or has spread just beyond it) and the surgeon believes the entire tumor can be removed, it is called resectable. (In general, this would include most stage IA, IB, and IIA cancers in the TNM system.) 
 
It’s important to note that some cancers might appear to be resectable based on imaging tests such as CT scans, but once the surgeon starts the operation it might become clear that not all of the cancer can be removed. If this happens, only a sample of the cancer may be removed to confirm the diagnosis (if a biopsy hasn’t been done already), and the rest of the planned operation will be stopped to help avoid the risk of major side effects. 
 
• Unresectable 
 
These cancers can’t be removed entirely by surgery. 
 
Locally advanced: If the cancer has not yet spread to distant organs but it still can’t be removed completely with surgery, it is called locally advanced. Often the reason the cancer can’t be removed is because it has grown into or surrounded nearby major blood vessels. (In general, this would include stage IIB and most III cancers in the TNM system.) 
 
Surgery to try to remove these tumors would be very unlikely to be helpful and could still have major side effects. Some type of surgery might still be done, but it would be a less involved operation with the goal of relieving symptoms or problems like a blocked bile duct or intestinal tract, not of curing the cancer. 
 
Metastatic: If the cancer has spread to distant organs, it is called metastatic. These cancers can’t be removed completely. Surgery might still be done, but the goal would be to relieve symptoms, not to cure the cancer. Pancreatic Cancer Staging 
 
• TNM Staging System 
 
A staging system is a standard way for doctors to sum up how far a cancer has spread. The main system used stage cancers of the pancreas is the American Joint Committee on Cancer (AJCC) TNM system. The TNM system is based on 3 key pieces of information: 
<ul>
<li>T describes the size of the main (primary) tumor and whether it has grown outside the pancreas and into nearby organs.</li>
<li>N describes the spread to nearby (regional) lymph nodes.</li>
<li>M indicates whether the cancer has metastasized (spread) to other organs of the body. (The most common sites of pancreatic cancer spread are the liver, lungs, and the peritoneum — the space around the digestive organs.)</li>
</ul>
Numbers or letters appear after T, N, and M to provide more details about each of these factors. 
 
T categories 
 
Using the TNM system, the "T" plus a letter or number (0 to 4) is used to describe the size and location of the tumor. This helps the doctor develop the best treatment plan for each patient. Specific tumor stage information listed below. 
<ul>
<li>TX: The primary tumor cannot be evaluated.</li>
<li>T0: No evidence of cancer was found in the pancreas.</li>
<li>Tis: Refers to carcinoma in situ (which is very early cancer that has not spread.)</li>
<li>T1: The tumor is in the pancreas only, and it is 2 centimeters (cm) or smaller in size.</li>
<li>T2: The tumor is in the pancreas only, and it is larger than 2 cm.</li>
<li>T3: The tumor extends beyond the pancreas, but the tumor does not involve the major arteries or veins near the pancreas.</li>
<li>T4: The tumor extends beyond the pancreas into major arteries or veins near the pancreas. A T4 tumor is unresectable (unable to be completely removed during surgery).</li>
</ul>
 
N categories 
 
The "N" in the TNM staging system is for lymph nodes. Lymph nodes are tiny, bean-shaped organs located throughout the body that normally help fight infection and disease as part of the body's immune system. In pancreatic cancer, regional lymph nodes are those lymph nodes near the pancreas and distant lymph nodes are those lymph nodes in other parts of the body. 
<ul>
<li>NX: The regional lymph nodes cannot be evaluated.</li>
<li>N0: Cancer was not found in the regional lymph nodes.</li>
<li>N1: Cancer has spread to regional lymph nodes.</li>
</ul>
 
M categories 
 
The "M" in the TNM system indicates whether the cancer has spread to other parts of the body. 
<ul>
<li>MX: Distant metastasis cannot be evaluated.</li>
<li>M0: The disease has not spread to other parts of the body.</li>
<li>M1: Cancer has spread to another part of the body, including distant lymph nodes. Pancreatic cancer most commonly spreads to the liver, peritoneum (lining of the abdominal cavity), and lungs.</li>
</ul>
 
<h3>
Stage Grouping for Pancreatic Cancer</h3>
 
Once the T, N, and M categories have been determined, this information is combined to assign an overall stage of 0, I, II, III, or IV (sometimes followed by a letter). This process is called stage grouping. 
<ul>
<li>Stage 0 (Tis, N0, M0): The tumor is confined to the top layers of pancreatic duct cells and has not invaded deeper tissues. It has not spread outside of the pancreas. These tumors are sometimes referred to as pancreatic carcinoma in situ or pancreatic intraepithelial neoplasia III (PanIn III).</li>
<li>Stage IA (T1, N0, M0): The tumor is confined to the pancreas and is 2 cm across or smaller (T1). It has not spread to nearby lymph nodes (N0) or distant sites (M0).</li>
<li>Stage IB (T2, N0, M0): The tumor is confined to the pancreas and is larger than 2 cm across (T2). It has not spread to nearby lymph nodes (N0) or distant sites (M0).</li>
<li>Stage IIA (T3, N0, M0): The tumor is growing outside the pancreas but not into major blood vessels or nerves (T3). It has not spread to nearby lymph nodes (N0) or distant sites (M0).</li>
<li>Stage IIB (T1-3, N1, M0): The tumor is either confined to the pancreas or growing outside the pancreas but not into major blood vessels or nerves (T1-T3). It has spread to nearby lymph nodes (N1) but not to distant sites (M0).</li>
<li>Stage III (T4, Any N, M0): The tumor is growing outside the pancreas into nearby major blood vessels or nerves (T4). It may or may not have spread to nearby lymph nodes (Any N). It has not spread to distant sites (M0).</li>
<li>Stage IV (Any T, Any N, M1): The cancer has spread to distant sites (M1). Pancreatic Cancer Staging</li>
</ul>
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Pancreatic Cancer Staging

Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting other parts of the bo...

Diagnosis of Pancreatic Cancer

ancorez Pancreatic Cancer 8:17 AM

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Reaching a diagnosis of pancreatic cancer can be a lengthy and complex process due to the tests and investigations involved. When the disease first develops it often doesn't cause many symptoms so people can have pancreatic cancer for some time without knowing. This means a diagnosis of pancreatic cancer can come as a shock. Diagnosis of Pancreatic Cancer 
 
Any symptoms people do have can be quite vague and may also be a sign of other more common illnesses that affect the gastro-intestinal system (gut) such as heartburn, pancreatitis, gallstones, irritable bowel syndrome or even stress. So it can be particularly difficult for GPs to detect and diagnose pancreatic cancer, especially in its early stages. As there is currently no easy way of detecting pancreatic cancer, diagnosis may sometimes be delayed while GPs or specialists spend time ruling out all the different possible causes for people's symptoms. 
 
If a doctor suspects that a person has pancreatic cancer, he or she will first ask about the person's medical history and examine the person to look for signs of the disease. An appropriate and timely diagnosis is very important, ideally performed at a center that has experience with the disease. The tests listed below may be used to diagnose pancreatic cancer. 
 
Biopsy 
 
A person’s medical history, physical exam, and imaging test results may strongly suggest pancreatic cancer, but usually the only way to be sure is to remove a small sample of tumor and look at it under the microscope. This procedure is called a biopsy. Biopsies can be done in different ways. 
 
• Endoscopic biopsy 
 
Doctors can also biopsy a tumor during an endoscopy. The doctor passes an endoscope (a thin, flexible, tube with a small video camera on the end) down the throat and into the small intestine near the pancreas. At this point, the doctor can either use endoscopic ultrasound (EUS) to pass a needle into the tumor or endoscopic retrograde cholangiopancreatography (ERCP) to remove cells from the bile or pancreatic ducts. These tests are described in more detail above. You will be sedated (made sleepy) for these tests, but general anesthesia (being put into a deep sleep) is not usually needed. Major side effects from these types of biopsies are rare. 
 
• Percutaneous (through the skin) biopsy 
 
For this test, a doctor inserts a thin, hollow needle through the skin over the abdomen and into the pancreas to remove a small piece of a tumor. This is known as a fine needle aspiration (FNA). The doctor guides the needle into place using images from ultrasound or CT scans. 
 
• Surgical biopsy 
 
Surgical biopsies are now done less often than in the past. They can be useful if the surgeon is concerned the cancer has spread beyond the pancreas and wants to look at (and possibly biopsy) other organs in the abdomen. The most common way to do a surgical biopsy is to use laparoscopy (sometimes called keyhole surgery). You will be sedated or asleep for this procedure. The surgeon makes several small incisions (cuts) in the abdomen and inserts small telescope-like instruments. One of these has a small video camera on the end to let the surgeon see inside the abdomen. The surgeon can look at the pancreas and other organs for tumors and take biopsy samples of abnormal areas. In the past, surgeons often used a laparotomy (a large incision through the skin into the wall of the abdomen) to examine internal organs and take biopsies. But this type of surgery requires a longer recovery and is now rarely used. 
<hr />
 
Blood Tests 
 
Several types of blood tests can be used to help diagnose pancreatic cancer or to help determine treatment options if it is found. 
 
• Blood tests for pancreatic neuroendocrine tumors 
 
Blood tests looking at the levels of certain pancreatic hormones can often help diagnose pancreatic neuroendocrine tumors (NETs). For insulinomas, insulin, glucose, and C-peptide levels are measured while the patient is fasting (not eating or drinking). (C peptide is a by-product of insulin production). Blood is drawn every 6 to 8 hours until the patient starts having symptoms of low blood sugar. The diagnosis of an insulinoma is made when there is low blood glucose with high levels of insulin and C-peptide. 
 
Other pancreatic hormones, such as gastrin, glucagon, somatostatin, pancreatic polypeptide, and VIP (vasoactive intestinal peptide) can be measured in blood to help diagnose pancreatic NETs. Measuring the level of a substance called chromogranin A (CgA) can be very helpful. This level goes up in most cases of pancreatic NETs — even tumors that don’t make excess hormones (non-functioning tumors). 
 
People with heartburn or ulcers who are taking medicines known as proton pump inhibitors, such as omeprazole (Prilosec®), esomeprazole (Nexium®), lansoprazole (Prevacid®), often need to stop taking them for a week before having these tests. This is because these medicines can falsely raise gastrin and CgA levels. Measurement of gastrin levels is most useful when combined with a test that measures the amount of acid in the stomach. This is because low acid levels can lead to high gastrin levels. When a gastrinoma is present, high gastrin levels are seen along with high acid levels. 
 
Carcinoid tumors: For carcinoids, a blood test may be done to look for serotonin, which is made by many of these tumors. The body breaks serotonin down into 5-hydroxyindoleactic acid (5-HIAA) and releases it into the urine. A test commonly used to look for carcinoid syndrome measures the levels of 5-HIAA in a urine sample collected over 24 hours. This test can help diagnose many (but not all) carcinoid tumors. 
 
Sometimes, the tumors do not make much serotonin, but they do make its precursor, 5-HTP, which can be converted to serotonin in the urine. In patients with these tumors, the blood serotonin level may be normal, but the urine levels of serotonin and 5-HTP are high. Eating foods that contain a lot of serotonin can raise 5-HIAA levels in the urine. Such foods include bananas, plantains, kiwi, certain nuts, avocado, tomatoes, and eggplant. Medicines, including cough syrup and acetaminophen (Tylenol), can also affect the results. These substances should be avoided before urine and blood testing for carcinoids. 
 
Other common tests to look for carcinoids include blood tests for chromogranin A (CgA), neuron-specific enolase (NSE), substance P, and gastrin. As noted above, medicines called proton-pump inhibitors, which lower stomach acid, can raise CgA and gastrin levels even in people without carcinoid tumors. If you take one of these medicines, talk to your doctor about what you need to avoid before having these blood tests. 
 
• Blood tests for exocrine pancreatic cancers 
 
Liver function tests: Jaundice (yellowing of the skin and eyes) is often one of the first signs of pancreatic cancer, but it can have many causes other than cancer. Doctors often get blood tests to assess liver function in people with jaundice to help determine its cause. 
 
Tumor markers: Tumor markers are substances that can sometimes be found in the blood when cancer is present. Two tumor markers may be helpful in pancreatic cancer: 
<ul>
<li>CA 19-9 is a substance often released into the blood by exocrine pancreatic cancer cells, although it often can’t be detected until the cancer is already advanced.</li>
<li>Carcinoembryonic antigen (CEA) is another tumor marker that might help find advanced pancreatic cancer in some people, but it is not used as often as CA 19-9.</li>
</ul>
Neither of these tumor marker tests is accurate enough to tell for sure whether or not someone has pancreatic cancer. Levels of these tumor markers are not high in all people with pancreatic cancer, and some people who don’t have pancreatic cancer might have high levels of these markers for other reasons. Still, these tests can sometimes be helpful, along with other tests, in figuring out if someone has cancer. 
 
In people already known to have pancreatic cancer and who have high CA19-9 or CEA levels, these levels can be followed over time to help tell how well treatment is working. If all of the cancer has been removed, these tests can also be done to look for the cancer coming back. 
<hr />
 
Imaging Tests 
 
Imaging tests use x-rays, magnetic fields, sound waves, or radioactive substances to create pictures of the inside of your body. Imaging tests might be done for a number of reasons both before and after a diagnosis of pancreatic cancer, including: 
<ul>
<li>To help determine if treatment is working</li>
<li>To learn if and how far cancer has spread</li>
<li>To look for signs of cancer coming back after treatment</li>
<li>To look for suspicious areas that might be cancer</li>
</ul>
 
• Angiography 
 
This is an x-ray test that looks at blood vessels. A small amount of contrast material is injected into an artery to outline the blood vessels, and then x-rays are taken. 
 
Angiography can show if blood flow in a particular area is blocked or compressed by a tumor. It can also show any abnormal blood vessels (feeding the cancer) in the area. This test can be useful in finding out if a pancreatic cancer has grown through the walls of certain blood vessels. Mainly, it helps surgeons decide if the cancer can be removed completely without damaging vital blood vessels and helps them plan the operation. 
 
Angiography can also be used to look for pancreatic NETs that are too small to be seen on other imaging tests. These tumors cause the body to make more blood vessels to “feed” the tumor. These extra blood vessels can be seen on angiography. Diagnosis of Pancreatic Cancer 
 
X-ray angiography can be an uncomfortable procedure because the doctor has to put a small catheter into the artery leading to the pancreas. Usually the catheter is put into an artery in your inner thigh and threaded up to the pancreas. A local anesthetic is often used to numb the area before inserting the catheter. Then the dye is injected quickly to outline all the vessels while the x-rays are being taken. 
 
Angiography can also be done with a CT scanner (CT angiography) or an MRI scanner (MR angiography). These techniques are now used more often because they can give information about the blood vessels in or near the pancreas without the need for a catheter in the artery. You might still need an IV line so that a contrast dye can be injected into the bloodstream during the imaging. 
 
• Cholangiopancreatography 
 
A cholangiopancreatogram is an imaging test that looks at the pancreatic and bile ducts to see if they are blocked, narrowed, or dilated. These tests can help show if someone might have a pancreatic tumor that is blocking a duct. They can also be used to help plan surgery. The test can be done in different ways, each of which has pros and cons. 
<ul>
<li>Endoscopic retrograde cholangiopancreatography (ERCP): In this procedure performed by a gastroenterologist, an endoscope (a thin, lighted tube) is passed into the small intestine through the mouth and stomach. A catheter (smaller tube) is passed through the endoscope and into the bile ducts and pancreatic ducts. Dye is injected into the ducts, and the doctor then takes x-rays that can show whether a duct is compressed or narrowed. Often, a plastic or metal stent can be placed across the obstructed bile duct during ERCP to help relieve any jaundice. Samples of the tissue can be taken during this procedure and can sometimes help confirm the diagnosis of cancer. The patient is lightly sedated during this procedure. ERCP is generally used to place bile duct stents and not as commonly used for diagnosis.</li>
<li>Magnetic resonance cholangiopancreatography (MRCP): This is a different type of MRI scan that is sometimes used to give clearer pictures of the bile and pancreatic ducts and any blockages in them. The pictures are similar to those from an ERCP but it is less invasive if no other procedures (such as inserting a stent) need to be done. You will usually be asked not to eat or drink anything for two to three hours before the scan. This scan is usually done as an inpatient, though you may still wait up to two weeks for it to be done.</li>
<li>Percutaneous transhepatic cholangiography (PTC): In this x-ray procedure, a thin needle is inserted through the skin and into the liver. A dye is injected through the needle, so the bile ducts show up on x-rays. By looking at the x-rays, the doctor can tell whether there is a blockage of the bile ducts.</li>
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• Computed Tomography (CT) Scan 
 
A CT scan uses x-rays to build up a three-dimensional picture of the pancreas and the other organs around it. It is also usual to scan your chest and pelvic area to check for any signs of cancer outside the pancreas. It is more complex than an ultrasound and takes longer. A CT scan can also be used to guide the needle during a biopsy, a procedure where a tissue sample is taken for examination under a microscope. 
 
The CT scan is done in the x-ray department at the hospital. It usually lasts approximately 30 minutes, depending on the exact area to be scanned. The scan is not painful but the couch you lie on is quite hard and can be uncomfortable. You will probably be able to go home straight afterwards. 
 
As with an ultrasound scan you will be asked not to eat anything for six to eight hours beforehand and only drink clear fluids. You will be awake while the scan is done. You will lie on a couch attached to the scanner, which looks like a large ring. A computer moves the couch automatically through the scanner while a series of 360° x-rays are taken to build up a detailed picture. Before the scan you may be asked to swallow a liquid containing a dye, known as a contrast medium. This fills the stomach and intestines and provides a contrast to help identify the different organs. You may also be given an injection of contrast medium (providing you are not allergic to iodine) into a vein to help to show up the blood vessels in the area. 
 
• Magnetic Resonance Imaging (MRI) 
 
MRI scans use magnets and radio frequency waves to build up detailed cross-sectional images of the pancreas and surrounding areas. 
 
There is no special preparation for an MRI, but because it uses powerful magnets you have to fill in a safety questionnaire before your appointment. This asks you whether you have any metal implants in your body (such as pacemaker, eye or ear metallic fragments). You will need to wear loose clothing and make sure you have no metal objects on you, including zips and buttons. The scanner is shaped like a tunnel; you lie on a table that moves into the tunnel for the scan. The magnets make it quite noisy so you may be given earplugs or headphones. You will also be able to hear and talk to the radiographer who operates the scanner from outside the room. 
 
The scan usually takes 20-30 minutes, though it can be shorter or longer, and you will be able to go home straight afterwards. You may have to wait two to three weeks for an appointment. 
 
• Positron Emission Tomography (PET) Scan 
 
A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body. A PET scan is often done in combination with a CT scan, with the images placed over each other (called a fusion or integrated CT-PET scan). The combination can provide a more complete picture of the area being evaluated. PET scans are done regularly at some but not all cancer centers for the diagnosis and staging of pancreatic cancer. However, they are not yet considered a standard test to diagnose pancreatic cancer. A PET scan alone should never be used instead of a high-quality CT scan. 
 
• Somatostatin Receptor Scintigraphy (SRS) 
 
This test, also known as OctreoScan, can be very helpful in diagnosing pancreatic neuroendocrine tumors (NETs). It uses a hormone-like substance called octreotide that is bound to a radioactive substance (indium-111). Octreotide attaches to proteins on the tumor cells of many NETs, but it is less helpful in finding insulinomas. 
 
A small amount of this substance is injected into a vein. It travels through the blood and attaches to NETs. About 4 hours after the injection, a special camera can be used to show where the radioactivity has collected in the body. More scans may be done on the following few days as well. This scan can help diagnose NETs, but it can also help decide on treatment. NETs that show up on SRS scans will often stop growing if treated with octreotide. 
 
• Ultrasound 
 
An ultrasound uses sound waves to create a picture of the internal organs. There are two types of ultrasound devices: abdominal and endoscopic. 
 
Abdominal ultrasound: For this test, a wand-shaped probe called a transducer is moved over the skin of the abdomen. It gives off sound waves and detects the echoes as they bounce off organs. The pattern of echoes is processed by a computer to produce an image on a screen. The echoes made by most pancreatic tumors differ from those of normal pancreas tissue. Different echo patterns can help doctors tell some types of pancreatic tumors from one another. 
 
If it’s not clear what might be causing a person’s abdominal symptoms, an ultrasound might be the first test done because it is easy to do and it doesn’t expose a person to radiation. But if signs and symptoms are more likely to be caused by pancreatic cancer, a CT scan is often more useful for looking at the pancreas than an ultrasound. 
 
Ultrasound is also commonly used to look at the liver, and may be used if someone has symptoms (like jaundice) that point to a liver problem. 
 
Endoscopic Ultrasound (EUS): In this test a thin, flexible tube (endoscope) with an ultrasound probe at the end is passed through your mouth into your stomach. The ultrasound creates detailed pictures of the area that help show where the cancer is in the pancreas, how big it is and whether it has spread beyond the pancreas. A needle can also be passed through the tube to take tissue samples; this is a type of biopsy called fine-needle aspiration (FNA). 
 
To prepare for the test you won't be able to eat or drink for six to eight hours beforehand. The test takes between 30-60 minutes. You will be asked to lie down on your left side. You will be given a throat spray of local anaesthetic that helps to stop you coughing during the investigation. Then you will be given a sedative by an injection in your arm or the back of your hand. Although this won't put you to sleep it will make you very drowsy and relaxed; most people don't remember much about the procedure afterwards. It means the doctor can pass the endoscope easily into your stomach. During the procedure the doctor may see areas that need further investigation, in which case they will collect a small number of cells (an EUS FNA). 
 
This test is usually done in specialist centres. You may have to wait two to three weeks for the test to be arranged. 
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Medical History and Physical Exam 
 
A thorough physical exam will focus mostly on your abdomen (belly) to check for any masses or fluid buildup. Cancers that block the bile duct may cause the gallbladder to enlarge, which can sometimes be felt on physical exam. Pancreatic cancer may spread to the liver, causing it to enlarge. Your skin and the whites of your eyes will be checked for jaundice (yellowing). 
 
Pancreatic cancer can also spread to lymph nodes above the collarbone and other locations. These areas will be looked at carefully for lumps or swelling that might mean cancer spread. 
 
If the results of the exam are abnormal, your doctor will probably order tests to help find the problem. You might also be referred to a gastroenterologist (a doctor who treats digestive system diseases) for further tests and treatment.Diagnosis of Pancreatic Cancer</div>
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Diagnosis of Pancreatic Cancer

Reaching a diagnosis of pancreatic cancer can be a lengthy and complex process due to the tests and investigations involved. When the di...

Signs and Symptoms of Pancreatic Cancer

ancorez Pancreatic Cancer 6:09 PM

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People with pancreatic cancer may experience the following symptoms or signs. Sometimes, people with pancreatic cancer do not show any of these symptoms. Or, these symptoms may be caused by a medical condition that is not cancer. If you are concerned about a symptom or sign on this list, please talk with your doctor. Signs and Symptoms of Pancreatic Cancer. 
 
<h3>
Signs and symptoms of exocrine pancreatic cancer</h3>
Early pancreatic cancers often do not cause any signs or symptoms. By the time they do cause symptoms, they have often already grown through the pancreas or spread beyond it. 
 
• Abdominal or back pain 
 
Pain in the abdomen (belly) or back is common in pancreatic cancer. Cancers that start in the body or tail of the pancreas can grow fairly large and start to press on other nearby organs, causing pain. The cancer may also spread to the nerves surrounding the pancreas, which often causes back pain. Of course, pain in the abdomen or back is fairly common and is most often caused by something other than pancreatic cancer. 
 
• Blood clots 
 
Sometimes, the first clue that someone has pancreatic cancer is the development of a blood clot in a large vein, often in the leg. This is called a deep venous thrombosis or DVT. Symptoms can include pain, swelling, redness, and warmth in the affected leg. Sometimes a piece of the clot can break off and travel to the lungs, which might make it hard to breathe or cause chest pain. A blood clot in the lungs is called a pulmonary embolism or PE. 
 
• Bowel problems 
 
A condition called steatorrhoea (stools that are large, pale, oily, floating and smelly) is a common symptom of diseases of the pancreas. It happens because the cancer affects the production of the enzymes needed to digest food, particularly high fat food. Undigested food passing quickly through the body can also cause diarrhoea and subsequent weight loss. 
 
• Diabetes 
 
Diabetes can develop if a tumour interferes with the pancreas working properly. This is because the pancreas produces the hormone insulin which the body needs to regulate the amount of sugar in the blood. People with diabetes often feel extremely thirsty, pass more urine than normal, lose weight and feel weak and lacking in energy. 
 
Diabetes is particularly associated with pancreatic cancer in older people. If someone over 50 has developed type 2 diabetes within the past two years, with no other explanation, their GP should consider the possibility of pancreatic cancer. 
 
• Digestive problems 
 
Pale, greasy stools: If cancer blocks the release of the pancreatic juice into the intestine, a person might not be able to digest fatty foods. The undigested fat can cause stools to be unusually pale, bulky, greasy, and to float in the toilet. 
 
Nausea and vomiting: Nausea (feeling sick) and sickness can occur for several different reasons. A tumour can block the bile duct or press on the duodenum, which obstructs digestion. It may also cause inflammation around it in the pancreas, or jaundice. Both of these can lead to a chemical imbalance in the body which can make people feel sick. 
 
• Fatty tissue abnormalities 
 
Some people with pancreatic cancer develop an uneven texture of the fatty tissue underneath the skin. This is caused by the release of the pancreatic enzymes that digest fat. 
 
• Fever and shivering 
 
If the pancreas is inflamed or the ducts are blocked because of the tumour, this can cause a high temperature and shivering. 
 
• Gallbladder enlargement 
 
If the cancer blocks the bile duct, bile can build up in the gallbladder, which then becomes enlarged. This can sometimes be felt by a doctor (as a large lump under the right ribcage) during a physical exam. It can also be detected by imaging tests. 
 
• Indigestion/heartburn 
 
New, unexplained and persistent dyspepsia (indigestion/heartburn) can be a symptom of pancreatic cancer, particularly in older people. 
 
• Jaundice and related symptoms 
 
Jaundice is yellowing of the eyes and skin. Most people with pancreatic cancer (and virtually all people with ampullary cancer) will have jaundice as one of their first symptoms. Signs and Symptoms of Pancreatic Cancer. 
 
Jaundice is caused by the buildup of bilirubin, a dark yellow-brown substance made in the liver. Normally, the liver excretes bilirubin as part of a liquid called bile. Bile goes through the common bile duct into the intestines, eventually leaving the body in the stool. When the common bile duct becomes blocked, bile can’t reach the intestines, and the level of bilirubin in the body builds up. 
 
Cancers that start in the head of the pancreas are near the common bile duct. These cancers can press on the duct and cause jaundice while they are still fairly small, which may allow these tumors to be found at an early stage. But cancers that start in the body or tail of the pancreas don’t press on the duct until they have spread through the pancreas. By this time, the cancer has often spread beyond the pancreas as well. 
 
When pancreatic cancer spreads, it often goes to the liver. This can also lead to jaundice. 
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<li>Dark urine: Sometimes, the first sign of jaundice is darkening of the urine from bilirubin. As bilirubin levels in the blood increase, the urine becomes brown in color.</li>
<li>Light-colored stools: If the bile duct is blocked, bile (and bilirubin) can’t get through to the bowel. When this happens, a person might notice their stools becoming lighter in color.</li>
<li>Itchy skin: When bilirubin builds up in the skin, it can start to itch as well as turning yellow.</li>
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Pancreatic cancer is not the most common cause of jaundice. Other causes, such as gallstones, hepatitis, and other liver diseases, are much more common. 
 
• Weight loss and poor appetite 
 
Losing a lot of weight for no particular reason can be a sign that something is wrong. People may also notice a loss of appetite or changes in what they feel like eating. Pancreatic cancer can affect the ability of the pancreas to produce digestive enzymes that help to digest food, especially high fat food. This means that the body can't digest food properly or get the nutrients it needs, leading to weight loss. 
 
<h3>
Signs and symptoms of pancreatic neuroendocrine tumors</h3>
Pancreatic neuroendocrine tumors (NETs) often release excess hormones into the bloodstream. Different types of tumors make different hormones, which lead to different symptoms. 
 
 • Carcinoid tumors 
 
These tumors often make serotonin or its precursor, 5-HTP. When a pancreatic tumor makes these substances, they first travel to the liver. The liver breaks these substances down before they can reach the rest of the body and cause problems. Because of this, carcinoid tumors often don’t cause symptoms until they spread outside the pancreas. 
 
When these tumors do spread, it is most often to the liver. There, the cancer cells can release hormones directly into the blood leaving the liver. This can cause the carcinoid syndrome, with symptoms including flushing (skin turning red with a warm feeling), diarrhea, wheezing, and a rapid heart rate. These symptoms often occur in episodes, between which the person may feel fine. 
 
• Gastrinomas 
 
These tumours occur in the head of the pancreas and the duodenum. They overproduce a hormone called gastrin, which can cause peptic ulcers in the stomach or duodenum. This can result in severe pain, bleeding (causing black, tarry stools) and diarrhoea. Gastrinomas are the second most common of the different functioning endocrine tumours. 
 
Gastrinomas can be associated with a hereditary syndrome called Multiple Endocrine Neoplasia, type 1 (MEN-1) where several tumours develop in different endocrine glands, including the pancreas. 
 
• Glucagonomas 
 
These tumours overproduce a hormone called glucagon, which normally helps to regulate the amount of glucose (sugar) in the blood. Symptoms include a specific type of skin rash (redness, blistering and scabbing), anaemia (lack of red blood cells), weight loss and inflammation inside the cheeks and lips. Glucagonomas are most often found in the tail of the pancreas. The tumours often spread outside the pancreas (metastasise), commonly to the liver. Glucagonomas mostly affect post-menopausal women. 
 
• Insulinomas 
 
These tumours overproduce the hormone insulin, which can lead to symptoms of hypoglycaemia (low blood sugar), such as weakness, loss of energy, dizziness and drowsiness. They are the most common type of sporadic functioning endocrine tumours. Insulinomas tend to occur in middle age and are slightly more common in women than men. Insulinomas can occur in MEN-1 but less commonly than gastrinomas. 
 
• Non-functioning neuroendocrine tumors 
 
These tumors don’t make excess hormones, so they don’t cause symptoms in early stages and often grow quite large before they are found. Most of these are cancers and start to cause problems as they get larger or spread outside the pancreas. Symptoms can be like those from exocrine pancreas cancers, including jaundice (yellowing of the eyes and skin), belly pain, and weight loss. 
 
• PPomas 
 
These tumors make pancreatic polypeptide (PP), which helps regulate both the exocrine and endocrine pancreas. They can cause problems such as belly pain and an enlarged liver. Some patients also get watery diarrhea. 
 
• Somatostatinomas 
 
These tumors make somatostatin, which helps regulate other hormones. Symptoms of this type of tumor can include diarrhea, gallbladder problems, and symptoms of diabetes (feeling thirsty and hungry, and having to urinate often). The problems with the gallbladder can lead to belly pain, nausea, poor appetite, and jaundice (yellowing of the skin and eyes). 
 
The early symptoms of a somatostatinoma tend to be mild and are more often caused by other things, so these tumors tend to be diagnosed at an advanced stage. Often, they are not found until they spread to the liver, when they cause problems like jaundice and pain. 
 
• VIPomas 
 
These tumours overproduce a hormone called vasoactive intestinal polypeptide (VIP). This causes a great deal of watery diarrhoea and sometimes flushing of the face. This condition is also known as watery diarrhoea and hypokalaemia achlorhydria (WDHA) or Verner-Morrison Syndrome after the doctors who discovered it. VIPomas occur most frequently in the tail of the pancreas. They are more common in women than men. Signs and Symptoms of Pancreatic Cancer</div>
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Signs and Symptoms of Pancreatic Cancer

People with pancreatic cancer may experience the following symptoms or signs. Sometimes, people with pancreatic cancer do not show any o...

Definition and Description of Pancreatic Cancer

ancorez Pancreatic Cancer 12:09 PM

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<a href="http://cancer-666.blogspot.com/">Pancreatic cancer</a> is a disease in which malignant (cancer) cells are found in the tissues 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 may become darker as a result of accumulated bile pigment (bilirubin). Also called exocrine cancer.</div>
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Description</div>
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Pancreatic cancer is abnormal cell growth in the tissue of the pancreas. The pancreas is about 6 inches long, and is located next to the small intestine, behind the stomach. This organ serves two main functions in the body. It produces juices and enzymes to help with digesting and absorbing food. It also produces several hormones, such as insulin, that regulate the way your body stores and processes food.</div>
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About 95% of all pancreatic cancers begin in the part of the pancreas that produces digestive fluids (the exocrine pancreas). The remaining 5% begin in the part that produces hormones (the endocrine pancreas). These different types of tumors are vastly different. It is extremely important that doctors confirm the type of cancer in the pancreas because of differences in treatment. Since the overwhelming majority of pancreatic cancers are tumors in the exocrine pancreas (adenocarcinomas), this article will focus on this type of cancer.</div>
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Unless pancreatic cancer is detected in its very early stages, it is hard to control. Pancreatic cancer tends to occur in older people, and the incidence of the disease is rising as people live longer. Health professionals estimate that 32,180 people in the United States will be diagnosed with pancreatic cancer in 2005 and 31,800 will die of the disease.</div>
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The pancreas is a 6-8 in (15-20 cm) long, slipper-shaped gland located in the abdomen. It lies behind the stomach, within a loop formed by the small intestine. Other nearby organs include the gallbladder, spleen, and liver. The pancreas has a wide end (head), a narrow end (tail), and a middle section (body). A healthy pancreas is important for normal food digestion and also plays a critical role in the body's metabolic processes. The pancreas has two main functions, and each are performed by distinct types of tissue. The exocrine tissue makes up the vast majority of the gland and secretes fluids into the other organs of the digestive system. The endocrine tissue secretes hormones (like insulin) that are circulated in the bloodstream, and these substances control how the body stores and uses nutrients. The exocrine tissue of the pancreas, comprised mostly of acinar cells and ductal cells, produces pancreatic (digestive) juices. These juices contain several enzymes that help break down proteins and fatty foods. The exocrine pancreas forms an intricate system of channels or ducts, which are tubular structures that carry pancreatic juices to the small intestine where they are used for digestion.</div>
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Pancreatic cancer are classified as either exocrine or endocrine tumors depending on which type of tissue they arise from within the gland. Ninety-five percent of pancreatic cancers occur in the tissues of the exocrine pancreas. Ductal adenocarcinomas arise in the cells that line the ducts of the exocrine pancreas and account for 80% to 90% of all tumors of the pancreas. Unless specified, nearly all reports on pancreatic cancer refer to ductal adenocarcinomas. Less common types of pancreatic exocrine tumors include acinar cell carcinoma, cystic tumors that are typically benign but may become cancerous, and papillary tumors that grow within the pancreatic ducts. Pancreatoblastoma is a very rare disease that primarily affects young children. Two-thirds of pancreatic tumors occur in the head of the pancreas, and tumor growth in this area can lead to the obstruction of the nearby common bile duct that empties bile fluid into the small intestine. When bile cannot be passed into the intestine, patients may develop yellowing of the skin and eyes (jaundice) due to the buildup of bilirubin (a component of bile) in the bloodstream. Tumor blockage of bile or pancreatic ducts may also cause digestive problems since these fluids contain critical enzymes in the digestive process. Depending on their size, pancreatic tumors may cause abdominal pain by pressing on the surrounding nerves. Because of its location deep within the abdomen, pancreatic cancer often remains undetected until it has spread to other organs such as the liver or lung. Pancreatic cancer tends to rapidly spread to other organs, even when the primary (original) tumor is relatively small.</div>
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Definition and Description of Pancreatic Cancer

Definition Pancreatic cancer is a disease in which malignant (cancer) cells are found in the tissues of the pancreas. Pancreatic ca...

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