What is pancreatic cancer?
Pancreatic cancer begins when abnormal cells in the pancreas grow and divide out of control and form a tumor. The pancreas is an organ that secretes enzymes that aid digestion by breaking down food. Certain pancreatic glands also produce insulin, which helps control the amount of sugar in the blood, along with other hormones that help the body store and use energy from food. For reasons that are still being explored by the scientific community, new cells can grow within the pancreas before the body needs them, or old cells might live longer than they should.
The resulting accumulation of excess cells can form a tissue mass, or tumor. A tumor in the pancreas can be either benign or malignant. A benign tumor typically does not spread beyond the pancreas or invade other tissues, and usually will not grow back after removal. A pancreatic cyst, or a benign buildup of fluid that may eventually become cancerous, can also develop. Malignant pancreatic tumors can spread to and damage other tissues and organs throughout the body, such as the lymph nodes, liver, peritoneum and lungs. Although a malignant tumor can sometimes be removed, it can potentially grow back.
Types of pancreatic cancer
Pancreatic cancers can be categorized by the type of cell they originate in. The most common type is pancreatic adenocarcinoma, which accounts for about 95% of all cases. This cancer develops when the exocrine cells that form glands and ducts begin to grow uncontrollably. The majority of cells in the pancreas are exocrine cells. Pancreatic adenocarcinoma may also develop from the cells that produce pancreatic enzymes, in which case it is referred to as acinar cell carcinoma.
Less commonly, pancreatic cancer can form in the endocrine cells that create insulin and other vital hormones and release them into the bloodstream. Pancreatic neuroendocrine tumors—also referred to as islet cell tumors—begin in the endocrine cells.
Other types of this cancer include intraductal papillary-mucinous neoplasm—a benign tumor that can sometimes become cancerous—and mucinous cystadenocarcinoma—a rare cystic tumor that can develop in the tail of the pancreas.
Causes & risk factors of pancreatic cancer
Research shows that pancreatic cancer is caused by mutations, or changes, in a cell’s DNA. What exactly triggers these cellular changes is unclear. While the scientific community still has much to learn about the root causes of this cancer, researchers have identified several risk factors. A risk factor is something that may increase the likelihood of being diagnosed with a medical condition. Risk factors for pancreatic cancer include:
- Advanced age, as most patients are older than 60
- Chronic pancreatitis
- A family history pancreatic cancer
- Certain genetic syndromes, including Lynch syndrome and BRCA2 gene mutation
Pancreatic cancer is an uncommon condition, and having one or more of these risk factors does not mean that a diagnosis is inevitable. On the other hand, some patients with this cancer don’t have any known risk factors. Individuals who have multiple risk factors should be mindful of changes in their health and watch for potential pancreatic cancer symptoms.
Pancreatic cancer symptoms
Pancreatic cancer typically does not cause obvious symptoms in its early stages. As the disease progresses, symptoms may include:
- Unexplained weight loss
- Loss of appetite or a feeling of fullness
- Jaundice, or yellowing of the skin or eyes
- Dark-colored urine
- Light-colored stools
- Abdominal pain that travels toward the spine
- Worsening of existing diabetes or a new diabetes diagnosis
- Itchy skin
- Blood clots
- Indigestion, diarrhea and other digestive problems
Symptoms can also vary according to the specific type of cancer and its location within the pancreas. Possible symptoms of advanced-stage cancer include liver and gallbladder enlargement, fluid build-up in the belly and deep vein thrombosis (DVT).
Diagnosing pancreatic cancer
Pancreatic cancer can be difficult to diagnose as symptoms are often vague or subtle. To confirm a suspected case, a physician may perform one or more of the following tests:
- Computed tomography (CT) scan. An imaging technique that produces pictures of the chest, stomach and pelvic area to identify masses in the pancreas and nearby organs
- Endoscopic ultrasound (EUS). A procedure that involves passing a thin, flexible ultrasound device down the esophagus and into the abdomen to obtain detailed images of the pancreas
- Blood tests. Bloodwork taken to screen for certain proteins (CA19-9) produced by pancreatic cancer cells or to gauge liver function (liver function tests and bilirubin)
- A small amount of tissue is taken from the pancreas, usually through an endoscopic procedure or fine-needle aspiration (FNA)
Once a pancreatic cancer diagnosis is confirmed, the next step is to stage the cancer and develop an appropriate course of treatment.
Pancreatic cancer stages
Cancer staging is performed to determine the extent of the cancer, whether it has metastasized (spread) to other parts of the body, and if so, how far. This information plays a crucial role in determining a patient’s prognosis and treatment plan.
Multiple factors are taken into account when staging cancer, including whether or not the tumor is resectable (surgically removable) and what nearby structures are affected. The following criteria are used to stage pancreatic cancer from 1 through 4, with 4 being the most advanced:
- Stage 1A. Resectable tumors that are 2 centimeters or smaller and have not spread beyond the pancreas
- Stage 1B. Resectable tumors that are larger than 2 centimeters and have not spread beyond the pancreas
- Stage 2A. Potentially resectable tumors that extend directly outside of the pancreas but have not reached surrounding lymph nodes or major arteries
- Stage 2B. Potentially resectable tumors that have reached surrounding lymph nodes but not major arteries
- Stage 3. Unresectable tumors that have reached major arteries
- Stage 4. Unresectable tumors that have spread to other organs
Around half of all pancreatic cancers are diagnosed in stage 4. While stage 4 pancreatic cancer is not yet considered curative, there are multiple treatment options available to help reduce symptoms, slow the cancer’s progression and enhance quality of life.
Moffitt Cancer Center’s approach to treating pancreatic cancer
Within Moffitt Cancer Center’s Gastrointestinal Oncology Program, we take a multispecialty approach to pancreatic cancer care. In a single location, our patients have access to a comprehensive range of treatments provided by a collaborative team of highly experienced and specialized professionals, including:
- Board-certified surgeons
- Medical oncologists
- Radiation oncologists
These experts meet weekly as a tumor board to review patient cases and work together to deliver comprehensive, individualized care. As a result, each Moffitt patient receives the benefit of having multiple expert opinions at each phase of his or her evaluation and treatment. Additionally, our compassionate oncology nurses, social workers and dietitians provide a full range of supportive care to our patients.
As the only National Cancer Institute-designated Comprehensive Cancer Center based in Florida, Moffitt continues to blaze new trails that advance cancer research. In addition to our extensive portfolio of clinical trials, Moffitt administers several molecular therapy, immunotherapy and chemotherapy drugs that are not readily available elsewhere, allowing us to provide our patients with opportunities to be among the first to receive highly advanced therapies