About the Pancreas
The pancreas is an organ that is about six inches long. It is located deep in the belly between the stomach and backbone. The liver, intestine, and other organs surround the pancreas.
The widest part of the pancreas is called the head. The head of the pancreas is on the right and is closest to the small intestine. The middle section is called the body and the thinnest part is on the left and is called the tail.
The pancreas makes pancreatic juices. These juices contain enzymes that help break down food. The juices flow through a system of ducts leading to the main pancreatic duct. The pancreatic juices flow through the main duct to the duodenum, the first part of the small intestine.
The pancreas is also a gland that makes insulin and other hormones. These hormones enter the bloodstream and travel throughout the body. They help the body use or store the energy that comes from food. For example, insulin helps control the amount of sugar in the blood.
Approximately 43,000 new cases of pancreatic cancer are diagnosed in the U.S. every year. It is sometimes called a silent disease: Early pancreatic tumors often do not cause any symptoms, and most patients are not diagnosed until the cancer has spread. Common sites of metastatic spread include the liver, the lining of the abdomen and the lungs.
Solid Tumors of the Pancreas
Pancreatic cancers are distinguished by the type of cell in which they arise. There are two main types of solid pancreatic tumors:
Adenocarcinoma: Between 85 and 90 percent of all pancreatic cancers are adenocarcinomas that arise in the exocrine glands of the pancreas. The exocrine glands produce enzymes that are released into the intestines, where they help digest fats, proteins and carbohydrates.
Neuroendocrine tumors: Less common are neuroendocrine tumors that arise in the islet cells of the pancreas. Islet cells produce insulin and glucagon (which regulate blood sugar) and other hormones.
Symptoms of pancreatic cancer can be related to the type of cell in which the tumor arises and the tumor’s location within the organ. The pancreas is composed of the head, the neck, the body and the tail.
Lesions in the head of the pancreas can sometimes block the common bile duct, leading to jaundice. Symptoms include the darkening of the skin and urine and the yellowing of the whites of the eyes.
Tumors that arise in the exocrine glands sometimes obstruct the pancreatic duct, blocking the flow of digestive enzymes and producing frequent loose bowel movements.
Islet cell tumors can produce excessive hormones, leading to a broad range of symptoms. For example, tumors that produce insulin can cause low blood sugar, leading to symptoms such as lightheadedness.
Other possible indications of pancreatic cancers include unexplained weight loss, inflammation of the pancreas (pancreatitis) and pain that radiates from the epigastric region to the back.
While there are some genetic conditions that increase a person’s risk for pancreatic cancer, most cases cannot be linked to inheritance. Risk factors for pancreatic cancer include chronic pancreatitis, diabetes, obesity and smoking.
Diagnosing Pancreatic Cancer
Signs and symptoms of pancreatic cancer vary and may include:
New Onset Diabetes
Several tests may need to be performed to accurately make a diagnosis of pancreatic cancer and to determine how advanced the cancer is. All the tests below work together to provide your clinical team with the most complete information about your disease.
Blood tests: There is no single blood test that can diagnose pancreatic cancer. However, tumor markers like cancer carbohydrate antigen 19-9 (CA19-9) and carcinoembryonic antigen (CEA) can be used to detect proteins produced by cancer.
Computerized Tomography (CT) scan: This is the most common study used to diagnose and stage pancreatic tumors. It uses a special type of x-ray machine connected to a computer to obtain detailed pictures of the body. This study is used to visualize the pancreas and nearby blood vessels, lymph nodes and organs.
Endoscopic Ultrasound and Fine Needle Aspiration (EUS/FNA): Ultrasound uses sound waves to produce pictures inside the body. This is the most common procedure used to obtain a tissue sample (biopsy) of the pancreatic tumor to test whether it is malignant or benign. During the procedure, a flexible camera with an ultrasound probe on the end is passed down the throat into the stomach and small intestine to look at the pancreas. If a tumor is seen on ultrasound, a small needle on the end of the camera will take a biopsy of tissue which will be sent to pathology for testing.
Endoscopic Retrograde Cholangiopancreatography (ERCP): If you are jaundiced, it is likely the result of a blocked bile duct. This test allows doctors to open up the blocked bile duct. During this test, a flexible tube with a camera is placed down the throat, into the stomach, and small intestine; then a small amount of dye is injected into the bile duct and pancreatic duct to determine if there is a blockage. If a blockage exists, a stent will be placed to relieve the obstruction.
Magnetic Resonance Imaging (MRI): MRI uses powerful magnets and radio waves to generate pictures without the use of x-rays. Similar to a CT scan, this study can provide detailed pictures of the inside of the body.
Positron Emission Tomography (PET) scan: This can is used to identify malignant cells by using a radionuclide tagged sugar molecule, which is injected into a vein. Because cancer cells divide more rapidly than normal cells and need more energy, they will be brighter on the scan.
Cystic Tumors of the Pancreas
Many types of cysts can be found in the pancreas. These abnormalities can be benign, but some are pre-malignant or malignant. Cysts are often found incidentally through a CT or MRI scan done for other purposes.
Serous cystic neoplasms are spongy, localized cysts that are usually benign. These cysts may be located anywhere in the pancreas. They may be removed surgically if they cause symptoms or if a diagnosis cannot be firmly defined by standard imaging and biopsy/fine needle aspiration.
Mucinous cystic neoplasms account for 30 percent of pancreatic cysts. They range from benign to malignant, and approximately one-third are associated with invasive cancer of the pancreas. These cysts are made up of cells that produce mucin, a component of mucus. Most are found in the body or tail of the pancreas.
Intraductal papillary mucinous neoplasms are cysts consisting of mucin-producing tumors. They have a high potential for progressing from benign growths to invasive cancer. These cysts involve the main pancreatic duct or major side branches, and they are usually found in the head and neck of the pancreas.
Pancreatic Cancer Diagnosis and Staging
Patients who present with jaundice usually undergo ultrasound imaging to evaluate suspected bile duct blockage. Pancreatic cancers are diagnosed using CT and MRI scans that provide precise cross-sectional imaging of the tumor and surrounding organs and blood vessels.
Once the diagnostic studies are complete, the clinical stage of the pancreatic cancer will be known. The pathologic stage is determined after surgery and is commonly referred to as the American Joint Committee on Cancer (AJCC) stage. There are four stages of pancreatic cancer:
To learn how physicians determine the stage of a pancreatic tumor and make basic treatment decisions, read The Importance of Accurate Diagnosis and Multimodality Therapy for Pancreatic Cancer by Douglas Evans, MD, Medical College of Wisconsin surgical oncologist.
The pancreatic cancer team at Froedtert & The Medical College of Wisconsin has developed a standard evaluation process that provides patients with a full diagnosis within days. To schedule an appointment, please call 414-805-0505 or 866-680-0505 today.
Nutrition and Pancreatic Cancer
Patients who have undergone pancreas surgery need special nutritional support. For guidance on post-surgery diet and other information on pancreatic cancer, view Nutrition and Pancreatic Cancer, an audio slideshow narrated by registered dietitian Dena McDowell, MS, RD, CD.