Pancreatic Cancer (Exocrine Cancer)
The pancreas is an oblong, pear-shaped organ, about six inches long, that ties within a loop of the small intestine behind the stomach. The exocrine portion of the pancreas, the tissue in which digestive juices and enzymes are produced, is the site of 95 percent of all pancreatic cancers. These cancers typically originate in the ductal cells in the head of the pancreas.
After decades of steadily increasing, the incidence of pancreatic cancer is dropping somewhat, with about 24,000 new cases a year. The higher death toil of 27,000 a year reflects the incidence of the recent past.
Men, especially African-Americans, are the most common victims of the disease, although there has been a recent slight rise in cases among African-American women.
The cause is unknown, but smoking has been strongly implicated as a factor because the occurrence among smokers is more than double that of non-smokers. A high-meat, high-fat diet also has been linked to increased risk of pancreatic cancer, and so has working with dry cleaning agents, benzene, and certain other chemicals.
At one time, chronic pancreatitis, diabetes, and cirrhosis of the liver were considered risk factors, but recent data has rendered these relationships invalid. However, the sudden onset of diabetes in an individual who is not overweight and has no family history of the disease suggests the possibility of pancreatic cancer.
The disease has been called a silent cancer because it develops very slowly and does not produce symptoms in its early stages. As the tumor grows, it often blocks the bile duct, resulting in itchiness and jaundice, a yellowing of the skin and the whites of the eyes. Nausea, pain in the middle of the abdomen, lack of appetite, unexplained weight loss, indigestion, and fatty stools (steatorrhea) are other symptoms of pancreatic cancer.
Diagnostic Studies and Procedures
Unfortunately, because there are no effective screening tests, very few pancreatic tumors are being diagnosed in an early, treatable stage. This may change if the current search for a chemical marker for the cancer yields a screening blood test.
Ultrasound or CT scans may be ordered, but normal findings do not necessarily rule out a pancreatic tumor, which may not show up on imaging studies. If a doctor suspects pancreatic cancer, an ERCP, or endoscopic retrograde cholangiopancreatogram, may be performed. For this test, a flexible tube is inserted into the throat and passed through the stomach and small intestine. Dye is then injected into the drainage duct of the pancreas to make its structure show up on X-ray film. During this procedure, samples of pancreatic juice can be obtained and studied for the presence of cancer cells. In some cases, however, a definitive diagnosis of cancer will require laparoscopy. This surgical procedure involves the use of a viewing instrument that is inserted through an incision near the navel, allowing a doctor to examine the pancreas and take multiple biopsy samples.
Medical Treatments
If the cancer is confined to the head of the pancreas, surgical removal of this portion can sometimes cure the disease, but according to statistics of the American Cancer Society, only 3 percent of patients survive five or more years after such treatment.
In addition to surgery, chemotherapy and radiation treatments may be employed. New ways of delivering radiation are under study, in one experimental approach, pellets of iridium are implanted temporarily in the pancreas to deliver large doses of radiation directly into the tumor. Administering high-dose radiation at the time of surgery is another experimental technique currently in use.
Palliative surgery -- a procedure performed to alleviate symptoms even if a cure is unlikely -- may be recommended to relieve obstruction and other complications of advanced cancer.
Alternative Therapies
The use of alternative therapies is generally limited to managing pain and other symptoms.
Self-hypnosis, biofeedback, meditation, and visualization may be helpful.
Hydrotherapy in the form of contrast baths may be beneficial as well. It consists of 5 to 10 minutes In a hot bath followed by a cold shower for two to five minutes, which may relieve the itchiness that often accompanies chronic jaundice.
Self-Treatment
Because pancreatic cancer often causes severe digestive problems, especially of fats, it's wise to keep a food diary to identify those foods that seem to provoke special problems.
Many patients with advanced cancer and their family members find comfort from joining a support group. Information about such groups can be obtained from a hospital social service office or from the local chapter of the American Cancer Society.
Other Causes of Pancreatic Symptoms
Chronic pancreatitis can cause pain and symptoms similar to those of pancreatic cancer, as can gallbladder disease, an obstructed bile duct, or a liver disorder.