Frequently Asked Questions about Pancreatic Cancer

What is pancreatic cancer?
The pancreas contains 2 different kinds of glands. The exocrine glands make pancreatic "juice." This juice has enzymes which break down fats and proteins in foods so the body can use them. Most of the cells in the pancreas are part of the exocrine system. A smaller number of cells in the pancreas are endocrine cells. These cells are arranged in clusters called islets. They make hormones like insulin that help balance the amount of sugar in the blood.

Types of pancreatic tumors
Both the exocrine and endocrine cells of the pancreas can form tumors. But tumors formed by the exocrine cells are much more common. Not all of these tumors are cancer. A small number are not cancer (benign). It is important to know whether a tumor is from the exocrine or endocrine part of the pancreas. Each type of tumor has its own signs and symptoms, is found using different tests, is treated in different ways, and has a different outlook for survival (prognosis).

Exocrine tumors
Tumors of the exocrine part of the gland are likely to be cancer. Nearly all of these tumors are a kind called adenocarcinomas. Treatment of cancer of the exocrine pancreas is mostly based on the stage of the cancer, not its exact type. The stage of the cancer describes how far it has progressed. A special type of cancer (called ampullary cancer) can start where the bile duct (from the liver) and the pancreatic duct empty into the small intestine. This type of cancer often causes signs such as yellowing of the skin and eyes, so it is usually found at an earlier stage than most pancreatic cancers. Finding it early means that the chances of successful treatment are better. Ampullary cancers are covered here with pancreatic cancer because their treatments are very much alike.

Endocrine Tumors
Tumors of the endocrine pancreas are much less common. They are known as islet cell tumors and are divided into several sub-types. Most of these are benign, but there are a few that are cancer.

How many people get pancreatic cancer?
The American Cancer Society's most recent estimates for pancreatic cancer in the United States are for 2009:

• 42,470 new cases of pancreatic cancer
• 35,240 deaths from pancreatic cancer

The lifetime risk of having pancreatic cancer is about 1 in 76. It is about the same for both men and women

What causes pancreatic cancer?
We still do not know exactly what causes most cases of pancreatic cancer. But some risk factors have been linked to the disease. A risk factor is something that affects a person's chance of getting a disease such as cancer. Some risk factors, such as smoking, can be controlled. Others, like a person's age or race, can't be changed.

Recent research has shown that some of these risk factors affect the DNA of cells in the pancreas, which can lead to abnormal cell growth and may cause tumors to form. DNA is the substance in each cell that carries our genes -- the instructions for how our cells work.
But risk factors don't tell us everything. Having a risk factor, or even several risk factors, does not mean that you will get the disease. And many people who get the disease do not have any known risk factors.

What are the risk factors for pancreatic cancer?

• Age: The risk of this cancer goes up with age. Almost 90% of patients are older than 55. The average age at the time the cancer is found is 72.
• Gender: Men have this cancer slightly more often than women.
• Race: African Americans are more likely to have this cancer than are whites.
• Smoking: The risk of getting cancer of the pancreas is 2 to 3 times higher in smokers. About 2 to 3 out of 10 cases of pancreatic cancer are thought to be caused by smoking. People who use smokeless (spit or chew) tobacco are also more likely to get pancreatic cancer.
• Diet: There may be a link between pancreatic cancer and high-fat diets that include a lot of red meat, pork, and processed meat (such as sausage and bacon). Some studies have found that diets high in fruits and vegetables may help reduce the risk of pancreatic cancer. But not all studies have found such links, and the exact role of diet in pancreatic cancer is still under study.
• Obesity and lack of exercise: Very overweight people are more likely to develop pancreatic cancer, as are those who don't get much exercise.
• Diabetes: Pancreatic cancer is more common in people with this disease. The reason for this is not known.
• Chronic pancreatitis: This is a long-term inflammation of the pancreas. It is linked with a slightly higher risk of pancreatic cancer, but most people with this condition do not get pancreatic cancer.
• Cirrhosis of the liver: Cirrhosis is a scarring of the liver. It happens in people with liver damage from things like hepatitis and alcohol use. People with cirrhosis seem to have an increased risk of pancreatic cancer.
• Work exposure: Heavy exposure at work to certain things (pesticides, dyes, and chemicals) may increase the risk of getting cancer of the pancreas.
• Family history: Cancer of the pancreas seems to run in some families.
• Gene changes: Inherited gene changes (mutations) are abnormal copies of certain genes that can be passed from parent to child. These changed genes may cause pancreatic cancers and can cause other problems, too. The genes that cause these problems have been found by scientists and can be recognized by genetic testing.
• Stomach problems: Having too much stomach acid or having bacteria called H. pylori in the stomach may increase the risk of pancreatic cancer.

Can pancreatic cancer be prevented?
There is no sure way to prevent cancer of the pancreas at this time. For now, the best advice is to avoid smoking, the major risk factor that you can change. Staying at a good weight, eating a good diet, and exercising are also important.

What are the symptoms of pancreatic cancer?

• Jaundice: A yellow color of the eyes and skin is called jaundice. It is caused by a build-up of a substance (bilirubin) that is made in the liver. At least half of all people with pancreatic cancer (and all people with ampullary cancer) have jaundice. While jaundice can be a sign of cancer, more often it is caused by something else.
• Pain: Pain in the belly area (abdomen) or in the middle of the back is a very common sign of advanced pancreatic cancer. Again, such pain is often caused by something other than cancer.
• Weight loss: Losing weight (without trying) over a number of months is very common in patients with this cancer. They may also feel very tired and not feel like eating.
• Digestive problems: If the cancer blocks the release of the pancreatic juice into the intestine, a person may not be able to digest fatty foods. Stools might be pale, bulky, greasy, and float in the toilet. Other problems may include nausea, vomiting, and pain that gets worse after eating.
• Swollen gallbladder: The doctor may find that the gallbladder is enlarged. The doctor can feel this and see it on imaging studies.
• Blood clots: Sometimes blood clots form in the veins or cause problems with fatty tissue under the skin. Clots can sometimes travel to the lungs and cause trouble with breathing. But having a blood clot does not usually mean that you have cancer. Most blood clots are caused by other things
• Diabetes: This cancer can cause problems with blood sugar. Sometimes (but not often) it can cause diabetes.

What’s new in pancreatic research?
Scientists are learning more about some of the changes in DNA that cause cells to become cancerous. In some families an inherited risk greatly increases the chance that members will have pancreatic cancer. The major focus of much research is on finding better treatments for pancreatic cancer.

• Chemotherapy
• Targeted therapies
• Growth factor inhibitors
• Anti-angiogenesis factors
• Immune therapy
• Low molecular weight heparin
• Individualization of therapy