Jane Doe
What is Pancreatic Cancer?
Pancreatic cancer, also known as pancreatic carcinoma, is an aggressive type of cancer that invades the pancreas, an important organ near the stomach and the liver. While some pancreatic cancers can be caught and treated early, the prognosis for this disease is usually not good; the National Institutes of Health report that about 80% of people with pancreatic cancer already have advanced and incurable disease at the time of diagnosis. Most people with pancreatic cancer can try surgery, chemotherapy, radiation, or some combination of the three, based on a doctor’s recommendation; however, the average survival time for people diagnosed with pancreatic cancer is usually less than a year. The National Cancer Institute reports that less than 5% of patients with pancreatic cancer survive for more than five years.
Types of pancreatic cancer
Lifestyle changes after Pancreatic Cancer
You can't change the fact that you have had cancer. What you can change is how you live the rest of your life -- making choices to help you stay healthy and feel as well as you can. This can be a time to look at your life in new ways. Maybe you are thinking about how to improve your health over the long term. Some people even start during cancer treatment.
Making healthier choices
For many people, a diagnosis of cancer helps them focus on their health in ways they may not have thought much about in the past. Are there things you could do that might make you healthier? Maybe you could try to eat better or get more exercise. Maybe you could cut down on the alcohol, or give up tobacco. Even things like keeping your stress level under control may help. Now is a good time to think about making changes that can have positive effects for the rest of your life. You will feel better and you will also be healthier.
Eating better
If treatment caused weight changes or eating or taste problems, do the best you can and keep in mind that these problems usually get better over time. You may find it helps to eat small portions every 2 to 3 hours until you feel better. You may also want to ask your cancer team about seeing a dietitian, an expert in nutrition who can give you ideas on how to deal with these treatment side effects.
One of the best things you can do after cancer treatment is put healthy eating habits into place. You may be surprised at the long-term benefits of some simple changes, like increasing the variety of healthy foods you eat. Getting to and staying at a healthy weight, eating a healthy diet, and limiting your alcohol intake may lower your risk for a number of types of cancer, as well as having many other health benefits.
Rest, fatigue, and exercise
If you were sick and not very active during treatment, it is normal for your fitness, endurance, and muscle strength to decline. Any plan for physical activity should fit your own situation. An older person who has never exercised will not be able to take on the same amount of exercise as a 20-year-old who plays tennis twice a week. If you haven't exercised in a few years, you will have to start slowly – maybe just by taking short walks.
If you are very tired, you will need to balance activity with rest. It is OK to rest when you need to. Sometimes it's really hard for people to allow themselves to rest when they are used to working all day or taking care of a household, but this is not the time to push yourself too hard. Listen to your body and rest when you need to. (For more information on dealing with fatigue, please see Fatigue in People With Cancer and Anemia in People With Cancer.)
Keep in mind exercise can improve your physical and emotional health.
Pancreatic cancer, also known as pancreatic carcinoma, is an aggressive type of cancer that invades the pancreas, an important organ near the stomach and the liver. While some pancreatic cancers can be caught and treated early, the prognosis for this disease is usually not good; the National Institutes of Health report that about 80% of people with pancreatic cancer already have advanced and incurable disease at the time of diagnosis. Most people with pancreatic cancer can try surgery, chemotherapy, radiation, or some combination of the three, based on a doctor’s recommendation; however, the average survival time for people diagnosed with pancreatic cancer is usually less than a year. The National Cancer Institute reports that less than 5% of patients with pancreatic cancer survive for more than five years.
Types of pancreatic cancer
Cancer can occur in any part of the pancreas, but up to 8 out of 10 (80%) start in the head of the pancreas.
There are several different types of pancreatic cancer. The most common type is ductal adenocarcinoma, which starts from cells in the lining of the pancreatic ducts.
Other rare tumours of the pancreas include:
- cystic tumours these are fluid-filled sacs in the pancreas, some of which are cancerous
- acinar cell carcinomas which start from the cells that make pancreatic juice
- neuroendocrine tumours which begin in the endocrine cells where insulin and other hormones are made
- lymphoma a cancer of the lymphatic tissue in the pancreas.
The treatments for cancerous cystic tumours and acinar cell carcinomas are similar to treatments for adenocarcinoma. But the tests and treatments for neuroendocrine tumours and lymphoma of the pancreas may be very different.
Symtoms of Pancreatic Cancer
Initially, pancreatic cancer tends to be silent and painless as it grows. By the time it's large enough to cause symptoms, pancreatic cancer has generally grown outside the pancreas. At this point, symptoms depend on the cancer's location within the pancreas:
- Diabetes, especially if it comes on suddenly. Recently, the Mayo Clinic published startling research showing that 40 percent of pancreatic cancer patients had been diagnosed with diabetes one to two years before discovering they had a pancreatic tumor. Researchers believe the diabetes is caused by tumors that simply haven't been detected yet. The problem is, diabetes is very common, and the majority of diabetes isn't pancreatic cancer, so doctors are trying to develop screening tools to tell the difference. Right now, they say family history is an important clue. If you're diagnosed with diabetes that seems to come on suddenly and you have no family history of diabetes, bring this to your doctor's attention and ask for further screening for pancreatic cancer.
- Yellowing of the eyes or skin. Even a small pancreatic tumor can block the bile duct in the head of the pancreas, causing bile to build up. This causes jaundice.
- Itchy skin, palms, and soles of feet. A little-known side-effect of jaundice is itchy hands and feet. It's due to a skin reaction to the bilirubin, the yellowish brown liver chemical that causes jaundice.
- Lack of appetite. An Italian study found that six to eight months before being diagnosed with pancreatic tumors, patients reported a sudden drop in their appetite and a tendency to feel full after eating very little.
- Changes in taste. In the same Italian study, some of the patients surveyed said they'd suddenly lost their taste for coffee, wine, and smoking. In fact, they said, they felt "disgust" for the smell and taste of coffee and alcohol.
- Abdominal pain. Pancreatic cancer sufferers remember this pain as a gnawing pain, rather than a sharp cramp or ache, and it radiates toward the back. A characteristic clue: the pain goes away when you lean forward.
- An enlarged gall bladder. The same blockage of the bile duct that causes jaundice can also cause an enlarged gallbladder, as the bile builds up behind the duct. The good news is that an enlarged gallbladder can be seen on imaging tests, and it may even be possible for a doctor to feel it during a physical exam.
- Pale, floating, smelly stools. If a pancreatic tumor prevents digestive enzymes from reaching the intestine, the result is an inability to digest fatty foods. So you end up with loose, smelly "floaters" as a result of the excess fat. Doctors say this symptom, in particular, can be an early clue and is too often overlooked.
- Dark, tarry stools. Bleeding in the upper intestines causes this symptom.
Causes of Pancreatic Cancer
Pancreatic cancer is fundamentally a disease caused by damage to the DNA (mutations). These mutations can be inherited from mom or dad, or they can be acquired as we age. First, let us look at the inherited mutations. Remember that we have two copies of each gene - one copy we inherit from mom, the other copy we inherit from dad. Most individuals with an inherited cancer syndrome inherit one mutant copy (let us say from dad) and one intact (normal) copy (let us say from mom) of a cancer associated gene.
To summarize, pancreatic cancer is caused by DNA mutations, and there are three ways that we can damage our DNA. We can be born with a DNA mutation inherited from mom or dad, we can do something, like smoke, that damages our DNA, or our DNA can be damaged by chance.
Cigarette smoking
Smoking doubles the risk of pancreatic cancer. Smoking is also associated with early age at diagnosis, and, very importantly, the risk of pancreatic cancer drops close to normal in people who quit smoking. Simply put, cigarette smoking is the leading preventable cause of pancreatic cancer. In fact, some scientists have estimated that one in four, or one in five cases of pancreatic cancer are caused by smoking cigarettes.
Age
The risk of developing pancreatic cancer increases with age. Over 80% of the cases develop between the ages of 60 and 80.
Race Studies in the United States have shown that pancreatic cancer is more common in the African American population than it is in the white population. Some of this increased risk may be due to socioeconomic factors and to cigarette smoking.
Gender
Cancer of the pancreas is more common in men than in women. Men are more likely to smoke than women.
Religious background
Pancreatic cancer is proportionally more common in Ashkenazi Jews than the rest of the population. This may be because of a particular inherited mutation in the breast cancer gene (BRCA2) which runs in some Ashkenazi Jewish families.
Chronic pancreatitis
Long-term inflammation of the pancreas (pancreatitis) has been linked to cancer of the pancreas.
Diabetes
Diabetes is both a symptom of pancreatic cancer, and long-standing adult-onset diabetes also increases the risk of pancreatic cancer.
Obesity
Obesity significantly increases the risk of pancreatic cancer.
Diet
Diets high in meats, cholesterol fried foods and nitrosamines may increase risk, while diets high in fruits and vegetables reduce risk. Folate may be protective.
Genetics
As mentioned earlier, a number of inherited cancer syndromes increase the risk of pancreatic cancer. These include inherited mutations in the BRCA2, FAMMM, PalB2 or Peutz-Jeghers genes.
Treatment for pancreatic cancer
Treatment for pancreatic cancer depends on the stage and location of the cancer as well as on your age, overall health and personal preferences. The first goal of pancreatic cancer treatment is to eliminate the cancer, when possible. When that isn't an option, the focus may be on preventing the pancreatic cancer from growing or causing more harm. When pancreatic cancer is advanced and treatments aren't likely to offer a benefit, your doctor will help to relieve symptoms and make you as comfortable as possible.
Surgery
Surgery may be an option if your pancreatic cancer is confined to the pancreas. Operations used in people with pancreatic cancer include:
Surgery for tumors in the pancreatic head. If your pancreatic cancer is located in the head of the pancreas, you may consider an operation called a Whipple procedure (pancreatoduodenectomy). The Whipple procedure involves removing the head of your pancreas, as well as a portion of your small intestine (duodenum), your gallbladder and part of your bile duct. Part of your stomach may be removed as well. Your surgeon reconnects the remaining parts of your pancreas, stomach and intestines to allow you to digest food.
Whipple surgery carries a risk of infection and bleeding. After the surgery, some people experience nausea and vomiting that can occur if the stomach has difficulty emptying (delayed gastric emptying). Expect a long recovery after a Whipple procedure. You'll spend several days in the hospital and then recover for several weeks at home.
Surgery for tumors in the pancreatic tail and body. Surgery to remove the tail of the pancreas or the tail and a small portion of the body is called distal pancreatectomy. Your surgeon may also remove your spleen. Surgery carries a risk of bleeding and infection.
Research shows pancreatic cancer surgery tends to cause fewer complications when done by experienced surgeons. Don't hesitate to ask about your surgeon's experience with pancreatic cancer surgery. If you have any doubts, get a second opinion.
Radiation therapy
Radiation therapy uses high-energy beams, such as X-rays and protons, to destroy cancer cells. You may receive radiation treatments before or after cancer surgery, often in combination with chemotherapy. Or, your doctor may recommend a combination of radiation and chemotherapy treatments when your cancer can't be treated surgically.
Radiation therapy usually comes from a machine that moves around you, directing radiation to specific points on your body (external beam radiation). In specialized medical centers, radiation therapy may be delivered during surgery (intraoperative radiation).
Chemotherapy
During chemotherapy, the patient various drugs (be cytostatics ) administered to a variety of ways, the cell growth inhibiting . Particularly rapidly growing tissues, which can include the tumor tissue, so at inhibited growth and also partially destroyed. Have proven to be advantageous to combine cytotoxic drugs with different side effect profiles to be such as to lower the individual substances. Chemotherapy may be performed prior to surgery in order to shrink the tumor and it to make it as operable ( chemotherapy ). Conversely, if the chemotherapy is carried out after the surgical removal of the tumor, so it is called chemotherapy . Carried out any form of chemotherapy will have to be decided individually.
In people with advanced pancreatic cancer, chemotherapy may be used alone or it may be combined with targeted drug therapy.
Targeted therapy
Targeted therapy uses drugs that attack specific abnormalities within cancer cells. The targeted drug erlotinib (Tarceva) blocks chemicals that signal cancer cells to grow and divide. Erlotinib is usually combined with chemotherapy for use in people with advanced pancreatic cancer.
Lifestyle changes after Pancreatic Cancer
You can't change the fact that you have had cancer. What you can change is how you live the rest of your life -- making choices to help you stay healthy and feel as well as you can. This can be a time to look at your life in new ways. Maybe you are thinking about how to improve your health over the long term. Some people even start during cancer treatment.
Making healthier choices
For many people, a diagnosis of cancer helps them focus on their health in ways they may not have thought much about in the past. Are there things you could do that might make you healthier? Maybe you could try to eat better or get more exercise. Maybe you could cut down on the alcohol, or give up tobacco. Even things like keeping your stress level under control may help. Now is a good time to think about making changes that can have positive effects for the rest of your life. You will feel better and you will also be healthier.
Eating better
If treatment caused weight changes or eating or taste problems, do the best you can and keep in mind that these problems usually get better over time. You may find it helps to eat small portions every 2 to 3 hours until you feel better. You may also want to ask your cancer team about seeing a dietitian, an expert in nutrition who can give you ideas on how to deal with these treatment side effects.
One of the best things you can do after cancer treatment is put healthy eating habits into place. You may be surprised at the long-term benefits of some simple changes, like increasing the variety of healthy foods you eat. Getting to and staying at a healthy weight, eating a healthy diet, and limiting your alcohol intake may lower your risk for a number of types of cancer, as well as having many other health benefits.
Rest, fatigue, and exercise
If you were sick and not very active during treatment, it is normal for your fitness, endurance, and muscle strength to decline. Any plan for physical activity should fit your own situation. An older person who has never exercised will not be able to take on the same amount of exercise as a 20-year-old who plays tennis twice a week. If you haven't exercised in a few years, you will have to start slowly – maybe just by taking short walks.
If you are very tired, you will need to balance activity with rest. It is OK to rest when you need to. Sometimes it's really hard for people to allow themselves to rest when they are used to working all day or taking care of a household, but this is not the time to push yourself too hard. Listen to your body and rest when you need to. (For more information on dealing with fatigue, please see Fatigue in People With Cancer and Anemia in People With Cancer.)
Keep in mind exercise can improve your physical and emotional health.
- It improves your cardiovascular (heart and circulation) fitness.
- Along with a good diet, it will help you get to and stay at a healthy weight.
- It makes your muscles stronger.
- It reduces fatigue and helps you have more energy.
- It can help lower anxiety and depression.
- It can make you feel happier.
- It helps you feel better about yourself.