Pancreatic Cancer Hero

Pancreatic Cancer

Additional resources to support you every step of the way

Everything you need to learn more about pancreatic cancer

A cancer diagnosis is a life-changing event for patients and their family members as well. It can be an overwhelming experience for everyone involved. On this page, we’ve gathered a number of additional resources and support materials to help you stay informed and hopeful during this difficult time.

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Pancreatic Cancer Basics

About the pancreas
The pancreas is about a six-inch long organ. It’s located deep in the belly between the stomach and backbone and is surrounded by the liver, intestine and other organs.

The pancreas is composed of four sections: the head, the neck, the body and the tail. The head is the widest part of the pancreas. It’s located on the right side of the body, closest to the small intestine. The middle section is called the body and the thinnest part, called the tail, is on the left side of the body.

The pancreas has two main functions. It makes pancreatic juices and it’s also a gland that makes hormones, including insulin. Pancreatic juices contain enzymes that help break down food. They flow through a system of ducts leading to the main pancreatic duct and the duodenum, the first part of the small intestine. The hormones it makes enter the bloodstream and travel throughout the body. They help the body use or store energy that comes from food. For example, insulin helps control the amount of sugar in the blood.

About pancreatic cancer
Approximately 43,000 new cases of pancreatic cancer are diagnosed in the U.S. every year. It’s sometimes called a silent disease since 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.

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.

Types of tumors
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. This type of tumor arises 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
Neuroendocrine tumors arise in the islet cells of the pancreas and are less common than adenocarcinoma. Islet cells produce insulin and glucagon, which regulate blood sugar and other hormones.

Many types of cysts can be found in the pancreas and are often found incidentally through a CT or MRI scan done for other purposes. These abnormalities can be benign, but some are pre-malignant or malignant. There are three different types of cystic tumors:

Serous cystic neoplasms
These spongy, localized cysts can be located anywhere in the pancreas and are usually benign. If they cause symptoms or if a diagnosis cannot be firmly defined by standard imaging and biopsy/fine needle aspiration, they may be removed surgically.

Mucinous cystic neoplasms
These cysts account for 30 percent of all 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
These cysts consist 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.

Symptoms
Generally, the signs and symptoms of pancreatic cancer vary and may include:

  • Abdominal pain
  • Pain that radiates from the upper abdomen region to the back
  • Pancreatitis
  • Jaundice
  • New onset diabetes
  • Diarrhea
  • Weight Loss

More specific 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.

Lesions in the head of the pancreas
These lesions can sometimes block the common bile duct, leading to jaundice. Symptoms include darkening of the skin and urine and yellowing of the whites of the eyes.

Tumors that arise in the exocrine glands
These tumors can sometimes obstruct the pancreatic duct, blocking the flow of digestive enzymes and producing frequent loose bowel movements.

Islet cell tumors
These 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.

Diagnosing pancreatic cancer
Several tests may need to be performed to accurately make a diagnosis of pancreatic cancer and to determine how advanced the cancer is. Patients who present with jaundice usually undergo ultrasound imaging to evaluate suspected bile duct blockage. In general, pancreatic cancers are diagnosed using CT and MRI scans that provide precise cross-sectional imaging of the tumor and surrounding organs and blood vessels.

All of the test 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 the 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 passed down the throat, into the stomach and the small intestine. Once it is in the small intestine, 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 scan is used to identify malignant cells by using a radionuclide tagged sugar molecule injected into a vein. Because cancer cells divide more rapidly than normal cells and need more energy, they will appear brighter on the scan.

Staging treatment
There are two different types of staging: clinical and pathologic. Clinical staging is based off of all the diagnostic tests that are before surgery. Pathological staging is determined after surgery. It combines the results the clinical staging with the surgical results and is commonly referred to as the American Joint Committee on Cancer (AJCC) stage. There are four stages of pancreatic cancer:

Resectable
Cancer limited to pancreas and surgically removable.
AJCC staging I or II

Borderline Resectable
Cancer limited to the pancreas, but anatomy suggests that adjacent blood vessels may be involved.
Imaging studios are inconclusive, but suspicious for cancer outside the pancreas.
AJCC staging I, II or III

Locally Advanced
Cancer encases the major blood vessels near the pancreas and is no longer surgically removable.
AJCC staging III

Metastatic
Cancer has spread outside of pancreas to other tissue and/or organs.
AJCC staging IV

Nutrition

Nutrition and pancreatic cancer
Pancreatic cancer may cause significant nutrition challenges. Upon diagnosis, you should seek the expertise of a Registered Dietitian (RD) to provide a nutritional assessment and meal planning goals. It is important that patients understand the importance of consuming a diet rich in protein, calories, vitamins and minerals. Hydration is also an important component of any nutrition plan. Goal setting based on the patient may include weight management (either to regain weight loss or maintain current weight), symptom management, nutrition education and meal planning. Empowering you with nutrition knowledge is vitally important for meeting your personal nutrition goals.

Common nutrition side effects that patients may experience with pancreatic cancer:

  • Sense of fullness
  • Poor appetite
  • Nausea and/or vomiting
  • Gas, bloating or cramping
  • Diarrhea including foul smelling oily stools
  • Weight loss
  • Diabetes

Working with your medical team, it is important to create effective tools to combat these side effects. Often times, eating smaller meals lower in fat (5-6 meals) throughout the day will be better tolerated. Medications may be prescribed to help with appetite, loose stools and nausea. Pancreatic enzymes are also helpful if malabsorption is noted.

The role of pancreatic enzymes
The pancreas has two main functions: the endocrine function and the exocrine function. The role of secreting digestive enzymes into the small intestine to aid in the absorption of nutrients into the body is known as the exocrine function of the pancreas. Signs and symptoms of pancreatic exocrine insufficiency may include loose stools, excess gas and/or abdominal cramping when eating. Oral pancreatic enzymes replace what the pancreas is no longer able to do and may help with the absorption of nutrients, lessening stooling issues and gas associated with eating. These enzymes are given by prescription and we recommend not purchasing over the counter varieties. Prescription enzymes are stronger, have been tested for safety and are standardized to ensure that each capsule contains the correct amount of pancreatic enzymes. It is important to take enzymes as prescribed by your healthcare team. Taking enzymes at the beginning, or throughout the meal time, will result in the best absorption. Often your physician may also recommend taking an acid reducer medication to reduce the stomach acid, allowing the enzymes to work more effectively.

Diet while in the hospital
Following surgery, your diet will be advanced over four to six days. A feeding tube (J-tube) may be placed in your small bowel during your surgery to ensure good nutrition, which is necessary for your body to heal.

After your bowel function returns, you will be started on a low fat and low fiber diet. You may also need a lactose restriction for your diet. Once eating, most patients require enzyme replacement to help digest the food eaten at meal time.

Diet at home after surgery
You will be discharged from the hospital on a low fat, low fiber diet, eating small meals and snacks throughout the day. If you are unable to tolerate the diet you may also need to rely on a feeding tube in your small intestine to help meet your nutritional needs. As your eating improves, you will use the feeding tube less and eventually the feeding tube will be removed.

It is important to monitor your weight when you are home from the hospital. Most people lose weight after surgery and need to increase calorie and protein intake to promote weight gain. The dietitian along with the rest of your healthcare team will assist in setting nutrition goals and monitoring your progress in regaining the weight which you have lost. The dietitian will also help you troubleshoot food intolerances due to surgery and will recommend foods to help alleviate side effects such as nausea, bloating, cramping and diarrhea.

It is important to remember to drink enough liquids to prevent dehydration. Sipping on liquids at meals and in between meals will help ensure adequate hydration. Speak to your healthcare team for specific hydration requirements.

Supplements, vitamins and minerals
If you are currently taking or are interested in taking vitamin, mineral or herbal supplements please discuss this with your healthcare team. Your doctor may want to do blood work to determine if any vitamin or mineral deficiencies are present and will prescribe supplements based on need. In most cases, a standard multivitamin, which meets, but does not exceed 100 percent of the daily value is well-tolerated.

Diabetes mellitus and pancreatic cancer
Patients with pre-existing diabetes mellitus or newly diagnosed diabetes mellitus share the same goals: attain and maintain blood sugar targets. It is not uncommon for previously well-controlled diabetes to become uncontrolled and it is not uncommon for diabetes to be diagnosed at the same time as pancreatic cancer. Recently diagnosed diabetes mellitus may be caused from the tumor itself and for a majority of patients, may resolve (or improve) after surgery.

A blood test often obtained is glycosylated hemoglobin or A1c. The A1c measures average blood glucose over the past two to three months. If elevated, your medical team may refer you to a diabetes specialist. You may be asked to: check blood sugar several times per day with a glucose meter, take oral diabetes medication and/or take insulin injections.

Monitoring blood sugar
The goal of monitoring blood sugar is to determine whether glucose levels are being maintained in a safe range on a day-to-day basis. Self-measurement of blood glucose levels is the standard method for routine monitoring. Your medical team will obtain periodic laboratory blood glucose; however, that reading only reflects one point in time. You may be asked to check your glucose several times per day.

Blood sugar targets
Hyperglycemia is defined as higher than normal blood glucose after fasting at least eight hours or any time of day. Generally targeted blood sugars are 80-130 mg/dL before a meal. Blood sugars greater than 180 mg/dL after a patient has eaten are too high and may require medication or medication adjustment. Blood sugar goals are individualized and may change throughout treatment.

Diabetes medications
The medications required for good blood sugar control may change depending on where you are in your treatment course. Insulin may be the preferred medication as doses can be customized for time of day, dietary intake and treatment changes. Your diabetes specialist is a key team member and should be kept apprised of blood sugar monitoring on a regular basis for any necessary medication changes.

Insulin
Insulin is a hormone released by the pancreas in response to glucose. The higher the glucose, the more insulin is released. Insulin stimulates the cells to take up glucose and cells convert glucose to energy for use and to build energy stores. When the pancreas does not release enough insulin, insulin injections may be necessary for blood sugar control. Good blood sugar control is key to help prevent weight loss and dehydration and to promote metabolic health.

Nutrition and diabetes
During your treatment course you will be seen by many members of the healthcare team. Our registered dietitians and diabetes specialists are available to work closely with you to assist you with your meal planning for symptom management as well as medication adjustment through all phases of treatment. In general, our goal is to promote good nutrition and good glycemic control with as few dietary restrictions as possible. Please speak to your healthcare team for more information.

Pancreatic Cancer Support Group

This support group aims to support, educate and provide a network for people who have been diagnosed with pancreas cancer, as well as their families and significant others. The group meets the third Wednesday of every other month, February through December. Please use the link below for more information.

Read more

Videos

Multidisciplinary Pancreatic Cancer Program, Part One

A discussion with Beth Erickson-Wittmann, MD; Paul Ritch, MD; Parag Tolat, MD; and Susan Tsai, MD, MHS

Multidisciplinary Pancreatic Cancer Program, Part Two

A discussion with Beth Erickson-Wittmann, MD; Paul Ritch, MD; Parag Tolat, MD; and Susan Tsai, MD, MHS

Liver and Pancreas Tumors

A discussion with Kathleen K. Christians, MD

Surgeons and oncologists at Froedtert and MCW have developed a unique personalized medicine clinical trial for pancreatic cancer. In this clinical trial a patient’s tumor is tested extensively to identify which chemotherapy treatment has the greatest chance of successfully treating the cancer. It’s being run by Dr. Doug Evans, Dr. Paul Ritch and a team of surgical oncologists and other cancer specialists.