Pancreatic Cancer

Pancreatic Cancer

WHAT IS PANCREATIC CANCER?

Pancreatic cancer is both aggressive and deadly. It is the fourth leading cause of cancer-related deaths in the United States, second only to colorectal cancer as a cause of digestive cancer related death.

Pancreatic cancer is seldom detected in its early stages and typically spreads rapidly to nearby organs. But for people with pancreatic cysts or a family history of pancreatic cancer, some screening steps might help detect a problem early.

At Loma Linda University Health, our board-certified gastroenterologists and digestive disease specialists are leaders in the treatment of pancreatic conditions. This includes pancreatic cysts and pancreatic cancer.

WHAT ARE THE SYMPTOMS OF PANCREATIC CANCER?

Pancreatic cancer often does not cause any symptoms at first. Even when it does cause symptoms, they can often be similar to those caused by other conditions. Symptoms of pancreatic cancer include:

• Yellowing of your eyes or skin (jaundice)
• Itchy skin
• Dark yellow or brown urine
• Pale, greasy, foul-smelling stools that may float in the toilet
• Pain in your stomach or back
• Indigestion or discomfort after eating fatty foods
• Loss of appetite or unexplained weight loss
• Nausea and vomiting
• Extreme tiredness
• Gallbladder enlargement. You may feel a lump under your right ribs.
• Blood clots in your leg. This can cause pain, redness, or swelling in the leg.
• Blood clots in your lung. This can cause shortness of breath or chest pain.
• Uneven, lumpy fatty tissue under your skin
• New onset diabetes

Pancreatic cancer is not the most common cause of jaundice. Causes such as gallstones, hepatitis and other liver and bile duct diseases are much more common.

WHAT CAUSES PANCREATIC CANCER?

Although the cause of pancreatic cancer isn’t always clear, researchers have identified some factors that increase your risk of developing it. These include:

• Being overweight
• Smoking
• Alcohol abuse
• Inherited gene mutations

HOW IS PANCREATIC CANCER DIAGNOSED?

When a doctor suspects a patient may have pancreatic cancer, a variety of diagnostic tests may be used to explore the patient’s condition. These may include:

• Blood tests
• Ultrasound
• CT scan
• MRI
• PET scans
• Biopsy

At Loma Linda University Health, we offer the full range of diagnostic and treatment services for pancreatic cysts and pancreatic cancer. These include interventional endoscopic ultrasound, Magnetic Resonance Cholangiopancreatography (MRCP) and Endoscopic Retrograde Cholangio-Pancreatography (ERCP).

HOW IS PANCREATIC CANCER TREATED?

Treatment options for pancreatic cancer depend on the type and stage of cancer you have.

Palliative (pain relieving) treatment options include:

• Placing a stent in the obstructed biliary tree
• Surgical biliary bypass (especially in younger patients)
• Complex pain-relief options
• Pancreatic enzyme supplements
• Subcutaneous injections of octreotide
• Other alternative treatments
• Some surgeries

Life-extending treatments for for pancreatic cancer include:

• Chemotherapy
• Radiation
• Partial or total removal of the pancreas
• Some surgeries, depending on where the tumor is located as well as the type and the stage of cancer

Patients who undergo treatment for pancreatic cancer can experience different symptoms, such as significant pain, jaundice and itching, digestion problems, and depression. Your physician will treat these symptoms, if they occur, on a case-by-case basis. In addition, your physician may also bring in other team members, such as pain management specialists, nutritional counseling, occupational therapy, and psychological counseling/therapy.

Surgery for Localized Pancreatic Tumors

If a tumor of the pancreas is in a small confined (localized) area, and blood vessels are not affected by the tumor, surgery is often recommended to remove it. In many cases after surgery, the physician will recommend additional therapy to prevent the cancer from growing back, such as chemotherapy, radiation therapy, or both.

Types of Pancreatic Surgeries

There are several different types of surgeries used to remove a localized pancreatic tumor. As technology has advanced, options for surgical intervention have advanced, but the type of surgery recommended depends on the stage of cancer and location of the tumor. These surgeries include:

Whipple procedure – This is often used to remove tumors in the head of the pancreas

Distal pancreatectomy – This is often used to remove tumors in the tail of the pancreas.

Total pancreatectomy – Removal of the entire pancreas, and often removal of gallbladder, spleen, and other areas as deemed necessary by the surgeon

Central pancreatectomy – To remove of the middle of the pancreas

Surgery for Advanced Tumors

If a tumor affects blood vessels, surgery is not usually recommended because of potential complications.

Other Treatments

Surgery should only be considered for cancer that has not spread outside the pancreas. After surgery, radiation or chemotherapy to try to prevent disease recurrence is often recommended.

If the cancer is limited to the pancreas, but surgery is not an option, standard treatment often includes radiation therapy with chemotherapy or chemotherapy alone.

If the cancer has spread to other organs, systemic therapy, such as chemotherapy on or off a clinical trial may be considered.

Various procedures include:

• Endoscopic, minimally invasive and radiographic diagnostic imaging
• Islet auto-transplantation (TP-IAT)
• Robotic surgery for pancreatic cancer
• Robotic pancreaticoduodenectomy

Loma Linda University Health specializes in a wide range of treatments, including:

• Gallstone removal
• Stent placement for biliary obstruction
• Balloon dilation of duct strictures
• Sphincterotomy
• Diagnosis and treatment of pancreatic lesions
• Tissue sampling to diagnose biliary duct or pancreatic cancer
• Pancreatic pseudocyst drainage

As the first hospital in the Inland Empire to introduce the state-of-the-art and minimally invasive da Vinci® Surgical System, Loma Linda University Health is home to the most experienced surgeons in the region.

Our surgeons do more robotic surgeries each year than any other teaching hospital west of the Mississippi. We specialize in caring for the whole person, not just a diagnosis.

WHAT ARE THE COMPLICATIONS OF PANCREATIC CANCER? (Optional)

Complications during the treatment of pancreatic cancer can include:

• Weight loss
• Bowel obstruction
• Abdominal (belly) pain
• Liver failure

WHO IS AT RISK FOR PANCREATIC CANCER?

Although the exact cause of pancreatic cancer remains relatively unknown, there are some factors thought to contribute. These include:

• Smoking
• Being overweight
• Alcohol abuse
• Hereditary factors causing specific genetic mutations

NEXT STEPS

Seek medical intervention. Although many medical conditions can cause the same symptoms as pancreatic cancer, it’s important to seek medical attention right away if you experience symptoms of pancreatic cancer. This starts with a medical evaluation. To request an evaluation at Loma Linda University Health, contact this department or schedule the appointment through MyChart.