Pancreatic Cancer Surgeon

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What is Pancreas or Pancreatic Cancer?
–Types of Pancreatic Cancer Tumors
Causes
Signs and Symptoms
–Risks of Developing Pancreatic Cancer
Diagnosis
–How is Pancreatic Cancer Diagnosed?

What is Pancreas or Pancreatic Cancer?

 
Pancreatic cancer is the fourth most common cause of cancer death in the US.

According to the American Cancer Society’s most recent estimates for pancreatic cancer in the United States, more than:

• 42,000 cases are diagnosed each year
• 35,000 people die because of the disease

The lifetime risk of having pancreatic cancer is about 1 in 72. It is about the same for men and women. The risk increases with age, and most cases are diagnosed in people between 60 and 80 years old.

The pancreas is a spongy, oblong organ about 6 inches long and 2 inches wide. It is located behind the lower part of the stomach, between the stomach and the spine. The pancreas is important because it makes insulin and other hormones that help the body absorb sugar and control blood sugar, and produces juices that aid in digestion.

 It is mainly composed of the exocrine cells that make digestive enzymes and the endocrine (islet) cells that make hormones such as insulin, which controls blood sugar levels. Pancreatic cancer occurs when a cell in the pancreas is damaged and starts to grow out of control.

The vast majority of pancreatic cancers start in exocrine cells found in the pancreas ducts, or small channels that carry digestive enzymes to the intestines. These cancers are called adenocarcinomas that begin in the tissue lining the pancreas, although as many as 20 different types of tumors can be found in the pancreas. As a pancreatic tumor grows, it can invade nearby organs – such as the bile duct, intestine, or stomach – or adjacent blood vessels. Tumor cells can break away and spread to the lymph nodes or liver, or to other places in the abdomen. The outcome for individuals with pancreatic cancer depends on the size and type of the tumor, lymph node involvement, and degree of metastases (spreading) at the time of diagnosis.

Dr. Bilchik and his team diagnose and treat pancreatic cancer with the most advanced therapies available. They provide focused, personalized care with a team that consists of specialist surgeons, oncologists, radiologists, gastroenterologists and specially trained support staff, all to help you make the most informed decision about your care.

As a center that has advanced technology and expertise, they offer the most innovative treatments, including minimally invasive surgery, focused radiation therapy, chemotherapy and new immunotherapy drugs.

Types of Pancreatic Cancer Tumors

The pancreas contains two main types of cells:

• Exocrine cells that produce digestive juices
• Endocrine cells that produce hormones

Adenocarcinoma starts in exocrine cells and accounts for 95% of pancreatic cancers. It occurs in the lining of the pancreatic ducts.

Neuroendocrine tumors involves endocrine cells (islet cells). Most of these tumors are malignant, but insulin-producing islet cell tumors are often benign (non-cancerous). Neuroendocrine tumors can be:

• Functional and produce abnormally high amounts of hormones (insulin, gastrin, glucagon) leading to symptoms such as light headedness, pain, weakness, low and high sugar levels and jaundice.
• Non-functional and produce no hormones

Insulinoma is a rare pancreatic tumor that secretes insulin, the hormone that lowers glucose levels in the blood.

Gastrinoma is a tumor that secretes above-average levels of gastrin, a hormone that stimulates the stomach to secrete acids and enzymes. Gastrinoma can also cause stomach ulcers and can spread to the liver.

Glucagonoma is a tumor that secretes glucagon, a hormone that raises levels of glucose in the blood, often leading to a characteristic rash

Other rare pancreatic tumors:

Pancreaticoblastoma is very rare. This type of pancreatic cancer is found mostly in young children. Isolated sarcomas and lymphomas can also occur in the pancreas. These are also very rare.

Pseudopapillary neoplasms are mostly found in women in their teens and 20s. Patients can present with pain, jaundice, weight loss or a mass. These cancers mainly originate in the head of the pancreas.  Resection of the tumor is often curative.

Ampullary cancer is a rare type of exocrine tumor that begins where the bile duct from the liver and the pancreatic duct join with the small intestine. Since it causes jaundice, it may be found earlier than other types of pancreatic cancer and therefore has a better outcome.

Causes of Pancreas or Pancreatic Cancer

The cause of pancreatic cancer is largely unknown.

The following conditions are associated with a greater chance of getting pancreatic cancer

• Diabetes
• Smoking
• Obesity
• Alcohol abuse
• Family History

Signs and Symptoms of Pancreas or Pancreatic Cancer

There are no early warning signs for pancreatic cancer. In fact, symptoms may be so non-specific they are often ignored.

The following are the other most common symptoms associated with pancreatic cancer:

• Pain in the upper abdomen (belly) or upper back
• Loss of appetite
• Weight loss
• Jaundice (yellow skin and eyes, and dark urine)
• Indigestion
• Nausea
• Vomiting
• Extreme fatigue
• An enlarged abdomen from a swollen gallbladder 
• Pale, greasy stools that float in the toilet 

Many of these symptoms can also be caused by other, more common health problems. For example, hepatitis, gallstones, and other liver problems can block the bile duct and are much more common causes of jaundice. 

Other signs of pancreatic cancer, such as an enlarged gallbladder or the sudden onset of type II diabetes, may be found by a physician during an exam, even if there are no other noticeable symptoms.

What are the risks of developing pancreatic cancer?

Risk factors for pancreatic cancer include:

• Age
  • Most pancreatic cancer occurs in people over the age of 55.
• Smoking
  • Heavy cigarette smokers are two or three times more likely than nonsmokers to develop pancreatic cancer.
• Obesity and physical inactivity
  • Pancreatic cancer is more common in people who are very overweight and in people who are not physically active.
• Diabetes
  • Pancreatic cancer occurs more often in people who have type 2 diabetes than in those who do not.
• Gender
  • More men than women are diagnosed with pancreatic cancer.
• Genetic factors
  • Approximately 10 percent of people with pancreatic cancer have one or more inherited genetic mutations that can also cause other diseases, including familial atypical multiple mole melanoma syndrome, familial breast cancer, Peutz-Jeghers syndrome, and hereditary pancreatitis.
  • Mutations in the genes BRCA1 and BRCA2, which increase the risk of breast, prostate, and certain gynecologic cancers, have been found in some families with a history of pancreatic cancer. Other inherited genetic factors have been identified, but do not greatly increase an individual’s risk of developing pancreatic cancer.
• Race
  • African-Americans are more likely than Asians, Hispanics, or whites to be diagnosed with pancreatic cancer.
• Family history
  • The risk for developing pancreatic cancer is higher if a person’s mother, father, or a sibling had the disease. An estimated 5 to 10% of people with pancreatic cancer have one or more family members who have had the disease. According to the National Cancer Institute, people with a strong family history of pancreatic cancer are nine times more likely to develop pancreatic cancer than others.
• Cirrhosis of the liver
  • People with cirrhosis have a higher risk of pancreatic cancer.
• Workplace exposures
  • Exposure to certain occupational pesticides, dyes, and chemicals used in the metal industry may increase the risk of pancreatic cancer.
• Chronic pancreatitis
  • Long-term inflammation of the pancreas, often caused by excessive alcohol abuse, has been linked to an increased risk for pancreatic cancer.
• Environmental Factors
  • Exposure to carcinogens such as asbestos, pesticides, dyes, and petrochemicals may be linked to pancreatic cancer.
• Benign and Pre-cancerous Pancreatic Lesions
  • Advances in imaging technology have dramatically increased the number of small abnormalities that are found in the pancreas. Most of these abnormalities are identified during imaging for another condition. Many of them are benign, fluid-filled cysts and are unlikely to cause symptoms or shorten a person’s life. Others are pre-cancerous and have the ability to turn into pancreatic cancer.

Diagnosis