1. The Pancreas
   
2. What Is Cancer?
   
3. Symptoms
   
4. Diagnosis and Staging
   
5. Orthodox Treatment
   
6. Side Effects of Orthodox Treatment
   
7. Pain Control
   

The Pancreas

The pancreas is located in the abdomen. It is surrounded by the stomach, intestines, and other organs. The pancreas is about 6 inches long and is shaped like a long, flattened pear--wide at one end and narrow at the other. The wide part of the pancreas is called the head, the narrow end is the tail, and the middle section is called the body of the pancreas.

The pancreas is a gland that has two main functions. It makes pancreatic juices, and it produces several hormones, including insulin.

Pancreatic juices contain proteins called enzymes that help digest food. The pancreas releases these juices, as they are needed, into a system of ducts. The main pancreatic duct joins the common bile duct from the liver and gallbladder. (The common bile duct carries bile, a fluid that helps digest fat.) Together these ducts form a short tube that empties into the duodenum, the first section of the small intestine.

Pancreatic hormones help the body use or store the energy that comes from food. For example, insulin helps control the amount of sugar (a source of energy) in the blood. The pancreas releases insulin and other hormones when they are needed. The hormones enter the bloodstream and travel throughout the body.

What Is Cancer?

Cancer is a group of many different diseases. Cancer occurs when cells divide without order and invade and destroy the tissue around them. To understand cancer, it is helpful to know about normal cells and about what happens when cells become cancerous.

The body is made up of many types of cells. Normally, cells grow and divide to produce more cells only when the body needs them. This orderly process helps keep the body healthy.

Sometimes cells keep dividing when new cells are not needed, forming a mass of extra tissue called a growth or tumor. Tumors can be benign or malignant.

Benign tumors are not cancer. They often can be removed, and they usually do not come back. Cells in benign tumors do not spread to other parts of the body. Most important, benign tumors are rarely a threat to life.

Malignant tumors are cancer. Cells in malignant tumors are abnormal and divide without control or order. These cancer cells can invade and destroy the tissue around them. Also, cancer cells can break away from malignant tumor and enter the bloodstream or the lymphatic system. This process is the way cancer spreads from the original (primary) tumor to form new tumors in other parts of the body. The spread of cancer is called metastasis.

More than 100 different types of cancer are known--and several types of cancer can develop in the pancreas. Cancer of the pancreas is also called pancreatic cancer or carcinoma of the pancreas. Most pancreatic cancers begin in the ducts that carry pancreatic juices. A rare type of pancreatic cancer begins in the cells that produce insulin and other hormones. These cells are called islet cells, or the islets of Langerhans. Cancers that begin in these cells are called islet cell cancers.

As pancreatic cancer grows, the tumor may invade organs that surround the pancreas, such as the stomach or small intestine. Pancreatic cancer cells also may break away from the tumor and spread to other parts of the body. When pancreatic cancer cells spread, they often form new tumors in lymph nodes and the liver, and sometimes in the lungs or bones. The new tumors have the same kind of abnormal cells and the same name as the primary (original) tumor in the pancreas. For example, if pancreatic cancer spreads to the liver, the cancer cells in the liver are pancreatic cancer cells. The disease is metastatic pancreatic cancer; it is not liver cancer.

Symptoms

Pancreatic cancer has been called a "silent" disease because it usually does not cause symptoms early on. The cancer may grow for some time before it causes pressure in the abdomen, pain, or other problems. When symptoms do appear, they may be so vague that they are ignored at first. For these reasons, pancreatic cancer is hard to find early. In many cases, the cancer has spread outside the pancreas by the time it is found.

When symptoms appear, they depend on the location and size of the tumor. If the tumor blocks the common bile duct so that bile cannot pass into the intestines, the skin and whites of the eyes may become yellow, and the urine may become dark. This condition is called jaundice.

As the cancer grows and spreads, pain often develops in the upper abdomen and sometimes spreads to the back. The pain may become worse after the person eats or lies down. Cancer of the pancreas can also cause nausea, loss of appetite, weight loss, and weakness.

Islet cell cancer can cause the pancreas to make too much insulin or other hormones. When this happens, the person may feel weak or dizzy and may have chills, muscle spasms, or diarrhea.

These symptoms may be caused by cancer or by other, less serious problems. Only a doctor can tell for sure.

Diagnosis and Staging

ITo find the cause of a person's symptoms, the doctor performs a physical exam and asks about the person's medical history. In addition to checking general signs of health, the doctor may perform blood, urine, and stool tests.

The doctor usually orders procedures that produce pictures of the pancreas and the area around it. Pictures can help the doctor diagnose cancer of the pancreas. They also can help the doctor determine the stage, or extent, of the disease by showing whether the cancer affects nearby organs. Pictures that show the location and extent of the cancer help the doctor decide how to treat it. Procedures to produce pictures of the pancreas and nearby organs may include:

• An upper GI series, sometimes called a barium swallow. A series of x-rays of the upper digestive system is taken after the patient drinks a barium solution. The barium shows an outline of the digestive organs on the x-rays.
• CT scanning, the use of an x-ray machine linked with a computer. The x-ray machine is shaped like a doughnut with a large hole. The patient lies on a bed that passes through the hole, and the machine moves along the patient's body, taking many x-rays. The computer puts the x-rays together to produce detailed pictures.
• MRI, the use of a powerful magnet linked to a computer. The MRI machine is very large, with space for the patient to lie in a tunnel inside the magnet. The machine measures the body's response to the magnetic field, and the computer uses this information to make detailed pictures of areas inside the body.
• Ultrasonography, the use of high-frequency sound waves that cannot be heard by humans. An instrument sends sound waves into the patient's abdomen. The echoes that the sound waves produce as they bounce off internal organs create a picture called a sonogram. Healthy tissues and tumors produce different echoes.
• ERCP, a method for taking x-rays of the common bile duct and pancreatic ducts. The doctor passes a long, flexible tube (endoscope) down the throat, through the stomach, and into the small intestine. The doctor then injects dye into the ducts and takes x-rays.
• PTC, in which a thin needle is put into the liver through the skin on the right side of the abdomen. Dye is injected into the bile ducts in the liver so that blockages in the ducts can be seen on x-rays.
• Angiography, x-rays of blood vessels taken after the injection of dye that makes the blood vessels show up on the x-rays.

Pictures of the pancreas and nearby organs provide important clues as to whether a person has cancer. However, doing a biopsy is the only sure way for the doctor to learn whether pancreatic cancer is present. In a biopsy, the doctor removes a tissue sample. A pathologist looks at the tissue under a microscope to check for cancer cells.

Sometimes, the biopsy to diagnose pancreatic cancer is done during surgery. In one type of surgery, called laparoscopy, the doctor inserts a lighted instrument shaped like a thin tube into the abdomen through a small incision. In addition to removing tissue samples to be examined under the microscope, the doctor can see inside the abdomen to determine the location and extent of the disease. During the laparoscopy, the doctor can decide whether a larger operation called a laparotomy is needed to remove the tumor or to relieve symptoms caused by the cancer.

In some cases, a laparotomy is necessary to make a diagnosis. In this operation, the doctor makes a larger incision and directly examines the organs in the abdomen. If cancer is found, the doctor can go ahead with further surgery.

Orthodox Treatment

Cancer of the pancreas is very hard to control. This disease can be cured only when it is found at an early stage, before it has spread. However, treatment can improve the quality of a person's life by controlling the symptoms and complications of this disease.

People with pancreatic cancer are often treated by a team of specialists, which may include surgeons, medical oncologists, radiation oncologists, and endocrinologists. The choice of treatment depends on the type of cancer, the location and size of the tumor, the extent (stage) of the disease, the person's age and general health, and other factors. Cancer that begins in the pancreatic ducts may be treated with surgery, radiation therapy, or chemotherapy. Doctors sometimes use combinations of these treatments. Researchers are also studying biological therapy to see whether it can help when pancreatic cancer has spread to other parts of the body or has recurred. Islet cell cancer is usually treated with surgery or chemotherapy. Doctors may decide to use one method or a combination of treatment methods.

Some people take part in a clinical trial (research study) using new treatment methods. Such studies are designed to improve cancer treatment.

Methods of Treatment

Surgery may be done to remove all or part of the pancreas and other nearby tissue. The type of surgery depends on the type of pancreatic cancer, the location of the tumor in the pancreas, the person's symptoms, whether the cancer involves other organs, and whether the cancer can be completely removed. In the Whipple procedure, the surgeon removes the head of the pancreas, the duodenum, part of the stomach, and other nearby tissue. A total pancreatectomy is surgery to remove the entire pancreas as well as the duodenum, common bile duct, gallbladder, spleen, and nearby lymph nodes.

Sometimes, the cancer cannot be completely removed. However, surgery can help to relieve symptoms that occur if the duodenum or bile duct is blocked. To relieve such symptoms, the surgeon creates a bypass around the blockage.

Radiation therapy (also called radiotherapy) is the use of high-energy rays to damage cancer cells and stop them from growing and dividing. Like surgery, radiation therapy is local therapy; the radiation can affect cancer cells only in the treated area. The radiation to treat pancreatic cancer comes from a machine that aims the rays from radioactive material at a specific area of the body.

Chemotherapy is the use of drugs to kill cancer cells. It may be given alone or along with radiation therapy to relieve symptoms of the disease if the cancer cannot be removed. When the cancer can be removed, doctors sometimes give chemotherapy after surgery to help control the growth of cancer cells that may remain in the body. The doctor may use one drug or a combination of drugs.

Chemotherapy is usually given in cycles: a treatment period followed by a recovery period, then another treatment period, and so on. Most anticancer drugs are given by injection into a vein (IV); some are given by mouth. Chemotherapy is a systemic therapy, meaning that the drugs flow through the body in the bloodstream.

Biological therapy (also called immunotherapy) is a form of treatment that uses the body's natural ability (immune system) to fight disease or to protect the body from treatment side effects. Researchers are testing several types of biological therapy, alone or in combination with chemotherapy. These treatments may be used when pancreatic cancer has spread to other organs or when it has recurred.

Side Effects of Orthodox Treatment

It is hard to limit the effects of treatment so that only cancer cells are removed or destroyed. Because treatment also damages healthy cells and tissues, it often causes unpleasant side effects.

The side effects of cancer treatment vary. They depend mainly on the type and extent of the treatment. Also, each person reacts differently.

Surgery--The side effects of surgery depend on the location of the tumor, the type of operation, the patient's general health, and other factors. Although patients are often uncomfortable during the first few days after surgery, this pain can be controlled with medicine. Patients should feel free to discuss pain relief with the doctor or nurse. It is also common for patients to feel tired or weak for a while. The length of time it takes to recover from an operation varies for each patient.

Radiation Therapy--With radiation therapy, the side effects depend on the treatment dose and the part of the body that is treated. The most common side effects are tiredness, skin reactions (such as a rash or redness) in the treated areas, and loss of appetite. Radiation therapy also may cause a decrease in the number of white blood cells, cells that help protect the body against infection.

Chemotherapy--The side effects of chemotherapy depend mainly on the drugs and the doses the patient receives. Generally, anticancer drugs affect cells that divide rapidly. These include blood cells, which fight infection, help the blood to clot, or carry oxygen to all parts of the body. When blood cells are affected by anticancer drugs, patients are more likely to get infections, may bruise or bleed easily, and may have less energy. Cells that line the digestive tract also divide rapidly. As a result of chemotherapy, patients may have side effects, such as loss of appetite, nausea and vomiting, hair loss, or mouth sores. For some patients, the doctor may prescribe medicine to help with side effects, especially with nausea and vomiting. Usually, these side effects gradually go away during the recovery period or after treatment stops.

Hair loss, another side effect of chemotherapy, is a major concern for many patients. Some chemotherapy drugs only cause the hair to thin out, while others may result in the loss of all body hair. Patients may feel better if they decide how to handle hair loss before starting treatment.

In some men and women, chemotherapy drugs cause changes that may result in a loss of fertility (the ability to have children). Loss of fertility may be temporary or permanent depending on the drugs used and the patient's age. For men, sperm banking before treatment may be a choice. Women's menstrual periods may stop, and they may have hot flashes and vaginal dryness. Periods are more likely to return in young women.

In some cases, bone marrow transplantation and peripheral stem cell support are used to replace tissue that forms blood cells when that tissue has been destroyed by the effects of chemotherapy or radiation therapy.

Biological Therapy--The side effects of biological therapy depend on the type of treatment. Often, these treatments cause flu-like symptoms such as chills, fever, muscle aches, weakness, loss of appetite, nausea, vomiting, and diarrhea. Some patients get a rash, and some bleed or bruise easily. In addition, interleukin therapy can cause swelling.

Pain Control

Pain is a common problem for people with pancreatic cancer, especially when the cancer grows outside the pancreas and presses against nerves and other organs. However, the doctor can usually relieve or reduce pain. It is important for patients to report their pain so the doctor can take steps to help relieve it.

There are several ways to control pain caused by pancreatic cancer. In most cases, the doctor prescribes medicine to control the pain. Sometimes a combination of pain medicines is needed. Medicines that relieve pain may make people drowsy and constipated, but resting and taking laxatives can help. In some cases, pain medicine is not enough. The doctor may use other treatments that affect nerves in the abdomen. For example, the doctor may inject alcohol into the area around certain nerves to block the feeling of pain. The injection can be done during surgery or by using a long needle inserted through the skin into the abdomen. This procedure rarely causes problems and usually provides pain relief. Sometimes, the doctor cuts nerves in the abdomen during surgery to block the feeling of pain. In addition, radiation therapy can help relieve pain by shrinking the tumor.