Updated March 24, 2020
Many people understand the basics of how the heart, lungs, and other organs work, but the pancreas is not as well known. This organ, however, is one of the most important parts of the digestive system. Without it, our GI system would not function in an optimal way.
The pancreas produces insulin, a hormone that regulates blood glucose (sugar) levels. It also generates digestive juices that help the body break down food and absorb nutrients. Cancer of the pancreas, therefore, can be a devastating diagnosis.
The incidence rate of pancreatic cancer is increasing; there are now about 55,000 cases annually in the United States. Whether you’ve received a pancreatic cancer diagnosis or want to learn how to help prevent one, we’ll tell you what you should know about the risk factors, symptoms, and treatment for pancreatic cancer.
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Facts About Pancreatic Cancer
The pancreas sits deep in the abdomen behind the stomach and intestines. “Because it’s nestled behind other organs far inside the abdomen, doctors usually can’t feel a growing tumor, so when symptoms do appear, the cancer is often advanced,” says Amer Zureikat, MD, co-director of the UPMC Hillman Cancer Center Pancreatic Cancer Program.
That’s the bad news. The good news? “Finding pancreatic cancer in the advanced stages does not mean that it can’t be treated,” Dr. Zureikat says. “It can.”
First, though, your doctor may recommend some tests to confirm the diagnosis. “These can include simple tests such as a physical exam or a blood test, but eventually will include radiologic tests such as an ultrasound, CT scan, or MRI,” Dr. Zureikat says. “Often, we need to biopsy the tumor to confirm the diagnosis. That involves a minimally invasive test where we put a scope into the stomach and take a sample from the pancreatic mass.”
Once your doctor’s suspicion is confirmed, it’s time to discuss your options and treatment for pancreatic cancer.
Treatment for Pancreatic Cancer
Pancreatic cancer treatment could involve surgery, radiation, chemotherapy, or a combination of the three.
Pancreatic cancer surgery
The most common surgical operation to remove a pancreatic tumor is called the Whipple procedure. It involves removing the right side of the pancreas, or approximately 40-50 percent of the organ. This also involves removal of the gall bladder, first portion of the intestine (duodenum), bile duct, and often the tail end of the stomach, in addition to all the cancerous lymph nodes around the tumor.
This procedure can be performed with the assistance of a robot that magnifies the optics and stabilizes the surgeon’s movements.
The American Cancer Society recommends patients get a Whipple at a hospital that performs at least 15 a year. UPMC performed 120 in 2018, of which over half were using robotic technology.
“UPMC was one of the pioneers in this type of robotic surgery and is the leading center nationwide in the number of robotic Whipples performed,” Dr. Zureikat says. “It is the same as a more invasive open operation; the only difference is that it’s done with smaller incisions, which can lead to less blood loss and pain, earlier discharge to home, and faster recovery.”
In a study that compared robotic Whipples performed at UPMC to open Whipples performed at several other centers, the robotic Whipples were associated with a lower complication rate.
Other surgical options for pancreatic cancer include:
- Distal pancreatectomy: Removal of the pancreas tail and part of the body. It also often includes removal of the spleen. This can also be done with robotic technology. UPMC performs nearly 50 such operations per year, the majority of which were robotic.
- Laparoscopic pancreatectomy — Minimally invasive procedure that uses small cuts to remove the body and tail of the pancreas, similar to robotic surgery.
- Limited resection (enucleation): This procedure removes the tumor while sparing the pancreas. This potentially can be used if the tumor hasn’t spread or for less aggressive cancers like pancreatic neuroendocrine tumors.
- Portal vein resection and reconstruction: This can be performed if a pancreatic tumor is larger, more aggressive, and invades the portal vein, which sends blood to the liver. This operation is usually done at the time of the Whipple or distal pancreatectomy.
- Appleby operation (also known as DP-CAR: Distal Pancreatectomy with Celiac Axis Resection) — Doctors remove pancreas tumors that have advanced into the celiac or hepatic artery.
- Small bowel (duodenum) resection: If a pancreas tumor spreads to the small intestine close to the pancreas (known as duodenum), doctors can remove the tumor and part of the bowel.
Chemotherapy involves the use of anti-cancer drugs for treatment. The treatment can help shrink tumors to allow for surgical removal, prevent them from growing, destroy microscopic cancer cells, or relieve pain. Doctors can give chemotherapy before or after surgery, or they can use it without surgery.
In radiation therapy, doctors use x-rays to kill cancer cells. It can help shrink the tumor, stop it from spreading, or relieve pain.
The most common type is external beam radiation therapy. A machine outside the body delivers the beams of x-rays through the skin to the tumor.
A recent advance in radiation therapy called SBRT (Stereotactic Body Radiation Therapy) is also available at UPMC. This technique delivers a focused boost of radiation to the tumor with minimal exposure of nearby organs, thereby limiting the side effects and shortening the radiation time from a month to one week.
Pancreatic Cancer Symptoms and Risk Factors
As with many cancers, the earlier a pancreatic tumor is detected, the higher the probability of successful treatment. Here are several pancreatic cancer symptoms:
- Abdominal pain
- Back pain
- Weight loss
- New onset diabetes
To reduce the risk of pancreatic cancer, know your risk factors and control the ones you can: your weight and your alcohol and tobacco use. People with diabetes should manage their condition carefully.
Age, sex, and genetics may also affect your risk, but these factors are out of your control.
“Approximately 90 percent of people who are diagnosed with pancreatic cancer are older than 55,” Dr. Zureikat says. “Men are more likely to be afflicted than women. ”Family history can play a role, so make sure to ask your doctor about the need for genetic screening if you have a family history of breast, pancreas, small intestine, and melanoma cancers at the time of your visit.
For more helpful facts about pancreatic cancer, and for answers to your specific questions about a pancreatic cancer diagnosis, call the experts at UPMC Hillman Cancer Center at 412-647-2811
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About UPMC Hillman Cancer Center
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