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Pancreatic Cancer


Disease: Pancreatic Cancer Pancreatic Cancer
Category: Tumors

Disease Definition:

The tissues of the pancreas are the first to be affected by pancreas cancer. The pancreas is a large organ located horizontally behind the stomach. Its function is to produce enzymes that aid digestion and hormones that play a major role in the metabolism of sugar in the body.


Even if diagnosed early, pancreatic cancer has a poor prognosis. Most pancreatic cancer cases result in death, because it has a rapid spread rate and it is rarely diagnosed in its early stages, and when diagnosed upon the appearance of signs and symptoms, the cancer will be at its advanced stages and surgical removal will not be an option.

Work Group:

Symptoms, Causes


Appearance of the signs and symptoms of pancreatic cancer is often delayed to the advanced stages of the disease. But when this happens, they might include the followings:


  • A radiating pain from the upper abdomen to the back
  • Jaundice, which is the yellowing of the skin and the whites of the eyes
  • Loss of appetite
  • Weight loss
  • Depression



Pancreatic cancer is developed when the cells of the pancreas undergo a genetic mutation. When this mutation occurs, the cells start a rapid, uncontrollable growth. These cancerous cells do not die as normal cells do. When these cells are accumulated, a tumor is formed.



The pancreas is a 15 cm long organ that has the shape of a pear in horizontal position. The digestive system depends greatly on the function of the pancreas. It produces insulin, which has a major role in the processing of sugar in the body. In addition, it produced digestive juices that take part in the digestive processes.



The course of treatment of pancreatic cancer is determined by its type, which might be:



This is the type of cancer that forms in the ducts of the pancreas. The production of the digestive juices is achieved with the help of cells that line the ducts of the pancreas. Adenocarcinoma cancers are the major percentage of pancreas cancers, which are also called exocrine tumors.


Cancer that forms in the hormone-producing cells:

Endocrine cancer is the name given to the cancer that forms in the hormone-producing cells of the pancreas. This is a rare form of pancreas cancer.


Some factors have their role in increasing the risk of developing pancreatic cancer, such as:


  • Smoking
  • Being overweight or obese
  • Family or personal history of chronic pancreatitis
  • Family or personal history of pancreatic cancer
  • Family history of genetic syndromes, as is the case with BRCA2 gene mutation, Peutz-Jeghers syndrome, Lynch syndrome and familial atypical mole-malignant melanoma (FAMMM).
  • Older age: Older adults are more susceptible to pancreas cancer, and statistically most people diagnosed with the disease are in their 70s or 80s.
  • Being black: Statistically, black people develop pancreas cancer more than white people do.



Complications that rise from the progressing pancreatic cancer can include:



This is because pancreas cancer blocks the liver's bile duct. This condition is characterized by yellow skin and eyes, dark-colored urine and very pale stools. For this reason, it might be recommended to insert a stent in the bile duct to prevent it from closing. In other cases, bypassing may be an option to allow the flow of bile to the intestines.



Severe pain may be caused by a growing tumor that is pressing on the nerves of the abdomen. A patient might feel more comfortable if painkillers are taken, as is the case with radiation therapy that hinders the tumor's growth temporarily. Alcohol is injected in the nerves that are causing pain in some severe cases. This procedure helps control pain of the abdomen (celiac plexus block) by disrupting the pain signals that are sent to the brain.


Bowel obstruction:

When a tumor is growing in size, it might press against the small intestine (duodenum), preventing the flow of digested food to it from the stomach. The insertion of a stent in the small intestine is recommended to prevent it from closing again. A bypass operation is another option to reconnect the stomach to the part of the intestine that is not blocked by the enlarged tumor.


Weight loss:

There are several factors that contribute in the weight loss of a patient with pancreas cancer. Eating may become difficult when the patient is experiencing nausea and vomiting because of the cancer treatments or a tumor pressing on his/her stomach. Or it might be because of irregularities in the digestive system, because of the malfunctioning pancreas, which doesn’t make enough digestive juices. The factors that are causing weight loss should be treated by a physician. To assist the digestive system in its function, pancreatic enzyme supplements are recommended. In order to maintain weight, the patient should add more calories to his/her diet and try to make the mealtime relaxed and pleasant.



Most patients diagnosed with the disease eventually die from it. Even if the disease is diagnosed early and treated, the patient is at a high risk of relapse and death.


The stage and location of the cancer, the patient’s age, overall health and personal preferences are the factors that dictate the course of treatment. The major goal of treatment is to eliminate cancer if possible. If that is not possible, treatment is meant to prevent cancer from growing and causing further complications. If that is not possible either, and treatment won't do any good to a patient, a physician should prescribe medications that ease the disease, making the patient more comfortable.



Most of pancreatic cancers are not considered resectable. For surgery is not an option when the cancer has already infected other tissues like lymph nodes or blood vessels. If surgery is still an option, a surgeon might recommend:


Surgery for tumors in the pancreatic head:

Pancreatoduodenectomy, otherwise called Whipple procedure is considered when the cancer is restricted to the head of the pancreas only. This operation calls for the surgical removal of the head of one's pancreas along with a portion of the small intestine (duodenum), the gallbladder and part of the bile duct, and maybe some portion of the stomach. After removing what needs to be removed, the remaining parts are connected back on to enable the patient digest food.


This procedure is accompanied with the risk of infection and bleeding, and results in temporary diabetes until the pancreas recovers from the operation. If the stomach has difficulty emptying after surgery, the patient may experience nausea and vomiting. Recovery from the surgery takes a long time, for a patient remains hospitalized for about 10 days, and he/she may need up to several weeks to return to normal life.


Surgery for tumors in the pancreatic tail and body:

Distal pancreatectomy is the name of the operation where the tail of the pancreas or the tail and small portion of the body is removed; the spleen might also be removed. This procedure is accompanied with the risk of infection and bleeding.


Statistically, when surgery is performed by an experienced surgeon, the patient may experience fewer complications after the operation. The patient should also feel free to ask another physician to get a second opinion.



In radiation therapy, a high energy beam is directed towards the cancer cells to destroy them. The patient could be subjected to radiation treatment before or after cancer surgery. Or it can also be one of the treatment options along with chemotherapy in case surgery is not an option. A patient may be subjected to radiation either from outside by the help of a machine, or it can be implanted in the body, near the treatment location. Radiation is also used during some types of surgery.



Cancer cells are killed by chemotherapy. It can be administered orally or by injection, and it can be only one type or a combination of many. Chemotherapy can be combined with radiation therapy and the method is called chemoradiation. Chemoradiation is considered a treatment option when cancer has already spread to the nearby organs and not any further from that. The combination of radiation and chemotherapy has also been proven beneficial for preventing cancer recurrence after surgery. Chemotherapy may be combined with targeted drug therapy for patients with advanced pancreatic cancer.



This type of cancer treatment is still under development. These drugs are meant to attack certain abnormalities in the cancer cells. For example, erlotinib is a drug that stops the growth of cancer cells by blocking chemicals that signal their growth and division. This drug is administered along with chemotherapy for patients in advanced stages of pancreatic cancer.


Clinical trials are still being carried out for many other types of targeted drugs. An example of those drugs is cetuximab, which has the same effect as erlotinib but a different course of action.


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Consultants Corner

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Dr. Samer Al-Jneidy Pediatrician

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