Pancreatic Cancer Treatment (PDQ�)
General Information About Pancreatic Cancer
Pancreatic cancer is a disease in which malignant (cancer) cells form in the tissues of the pancreas.
The pancreas has two main jobs in the body:
juicesthat help digest (break down) food.
hormones, such as insulinand glucagon, that help control blood sugar levels. Both of these hormones help the body use and store the energy it gets from food.
This summary provides information on exocrine pancreatic cancer. See the
Smoking and health history can affect the risk of developing pancreatic cancer.
Anything that increases your risk of getting a disease is called a
hereditaryconditions, such as hereditary pancreatitis, multiple endocrine neoplasia type 1 syndrome, hereditary nonpolyposis colon cancer(HNPCC; Lynch syndrome), von Hippel-Lindau syndrome, ataxia-telangiectasia, and the familial atypical multiple mole melanoma syndrome(FAMMM).
Possible signs of pancreatic cancer include jaundice, pain, and weight loss.
These and other
Jaundice(yellowing of the skin and whites of the eyes).
Pain in the upper or middle
Weight loss for no known reason.
Loss of appetite.
Pancreatic cancer is difficult to detect (find) and diagnose early.
Pancreatic cancer is difficult to detect and
There aren?t any noticeable signs or symptoms in the early
stagesof pancreatic cancer.
The signs of pancreatic cancer, when present, are like the signs of many other illnesses.
The pancreas is hidden behind other
organssuch as the stomach, small intestine, liver, gallbladder, spleen, and bile ducts.
Tests that examine the pancreas are used to detect (find), diagnose, and stage pancreatic cancer.
Pancreatic cancer is usually diagnosed with tests and procedures that produce pictures of the pancreas and the area around it. The process used to find out if
Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient?s health habits and past illnesses and treatments will also be taken. Chest x-ray: An x-rayof the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body. CT scan(CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injectedinto a vein or swallowed to help the organs or tissuesshow up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. A spiralor helical CTscan makes a series of very detailed pictures of areas inside the body using an x-ray machine that scans the body in a spiral path. MRI(magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI). PET scan(positron emission tomography scan): A procedure to find malignant tumorcells in the body. A small amount of radionuclide glucose(sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do. Endoscopic ultrasound(EUS): A procedure in which an endoscopeis inserted into the body, usually through the mouth or rectum. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. A probe at the end of the endoscope is used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. This procedure is also called endosonography. Laparoscopy: A surgicalprocedure to look at the organs inside the abdomen to check for signs of disease. Small incisions(cuts) are made in the wall of the abdomen and a laparoscope(a thin, lighted tube) is inserted into one of the incisions. Other instruments may be inserted through the same or other incisions to perform procedures such as removing organs or taking tissue samples for biopsy. Endoscopic retrograde cholangiopancreatography(ERCP): A procedure used to x-ray the ducts(tubes) that carry bilefrom the liver to the gallbladder and from the gallbladder to the small intestine. Sometimes pancreatic cancer causes these ducts to narrow and block or slow the flow of bile, causing jaundice. An endoscope (a thin, lighted tube) is passed through the mouth, esophagus, and stomach into the first part of the small intestine. A catheter(a smaller tube) is then inserted through the endoscope into the pancreatic ducts. A dyeis injected through the catheter into the ducts and an x-ray is taken. If the ducts are blocked by a tumor, a fine tube may be inserted into the duct to unblock it. This tube (or stent) may be left in place to keep the duct open. Tissue samples may also be taken. Percutaneous transhepatic cholangiography(PTC): A procedure used to x-ray the liver and bile ducts. A thin needle is inserted through the skin below the ribs and into the liver. Dye is injected into the liver or bile ducts and an x-ray is taken. If a blockage is found, a thin, flexible tube called a stent is sometimes left in the liver to drain bile into the small intestine or a collection bag outside the body. This test is done only if ERCPcannot be done.
Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a
pathologistto check for signs of cancer. There are several ways to do a biopsy for pancreatic cancer. A fine needlemay be inserted into the pancreas during an x-ray or ultrasoundto remove cells. Tissue may also be removed during a laparoscopy (a surgical incision made in the wall of the abdomen).
Certain factors affect prognosis (chance of recovery) and treatment options.
Whether or not the tumor can be removed by surgery.
The stage of the cancer (the size of the tumor and whether the cancer has spread outside the pancreas to nearby tissues or
lymph nodesor to other places in the body).
The patient?s general health.
Whether the cancer has just been diagnosed or has
Pancreatic cancer can be controlled only if it is found before it has spread, when it can be removed by surgery. If the cancer has spread,
Stages of Pancreatic Cancer
Tests and procedures to stage pancreatic cancer are usually done at the same time as diagnosis.
There are three ways that cancer spreads in the body.
The three ways that cancer spreads in the body are:
tissue. Cancer invadesthe surrounding normal tissue.
lymph system. Cancer invades the lymph system and travels through the lymph vesselsto other places in the body.
blood. Cancer invades the veinsand capillariesand travels through the blood to other places in the body.
The following stages are used for pancreatic cancer:
Stage 0 (Carcinoma in Situ)
Stage IA: The tumoris 2 centimetersor smaller. Stage IB: The tumoris larger than 2 centimeters.
Stage IIA: Cancerhas spread to nearby tissueand organsbut has not spread to nearby lymph nodes. Stage IIB: Cancerhas spread to nearby lymph nodesand may have spread to nearby tissueand organs.
Recurrent Pancreatic Cancer
Treatment Option Overview
There are different types of treatment for patients with pancreatic cancer.
Different types of treatment are available for patients with
Three types of standard treatment are used:
One of the following types of
Whipple procedure: A surgical procedure in which the head of the pancreas, the gallbladder, part of the stomach, part of the small intestine, and the bile ductare removed. Enough of the pancreas is left to produce digestive juicesand insulin. Total pancreatectomy: This operation removes the whole pancreas, part of the stomach, part of the small intestine, the common bile duct, the gallbladder, the spleen, and nearby lymph nodes. Distal pancreatectomy: The body and the tail of the pancreas and usually the spleen are removed.
If the cancer has spread and cannot be removed, the following types of
biliary bypass: If cancer is blocking the small intestine and bileis building up in the gallbladder, a biliary bypass may be done. During this operation, the doctor will cut the gallbladder or bile duct and sew it to the small intestine to create a new pathway around the blocked area. Endoscopic stentplacement: If the tumor is blocking the bile duct, surgery may be done to put in a stent (a thin tube) to drain bile that has built up in the area. The doctor may place the stent through a catheterthat drains to the outside of the body or the stent may go around the blocked area and drain the bile into the small intestine. Gastricbypass: If the tumor is blocking the flow of food from the stomach, the stomach may be sewn directly to the small intestine so the patient can continue to eat normally.
See Drugs Approved for Pancreatic Cancer for more information.
There are treatments for pain caused by pancreatic cancer.
Pain can occur when the tumor presses on
Patients with pancreatic cancer have special nutritional needs.
Surgery to remove the pancreas may interfere with the production of
New types of treatment are being tested in clinical trials.
This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI Web site.
Patients may want to think about taking part in a clinical trial.
For some patients, taking part in a
Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
Patients can enter clinical trials before, during, or after starting their cancer treatment.
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from
Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from
Follow-up tests may be needed
Some of the tests that were done to
Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has
Treatment Options by Stage
A link to a list of current
Stages I and II Pancreatic Cancer
chemotherapyand radiation therapy.
clinical trialof surgery followed by radiation therapy with chemotherapy. Chemotherapy is given before, during, and after the radiation therapy.
A clinical trial of surgery followed by chemotherapy.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage I pancreatic cancer and stage II pancreatic cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Stage III Pancreatic Cancer
Palliative surgeryor stentplacement to bypassblocked areas in ductsor the small intestine. Chemotherapywith gemcitabine.
clinical trialof new anticancer therapies together with chemotherapy or chemoradiation.
A clinical trial of
radiation therapygiven during surgery or internal radiationtherapy.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage III pancreatic cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Stage IV Pancreatic Cancer
Chemotherapywith gemcitabinewith or without erlotinib. Palliative treatmentsfor pain, such as nerve blocks, and other supportive care.
surgeryor stentplacement to bypassblocked areas in ductsor the small intestine. Clinical trialsof new anticancer agents with or without chemotherapy.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage IV pancreatic cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Treatment Options for Recurrent Pancreatic Cancer
Chemotherapy. Palliative surgeryor stentplacement to bypassblocked areas in ductsor the small intestine.
Other palliative medical care to reduce
symptoms, such as nerve blocksto relieve pain. Clinical trialsof chemotherapy, new anticancer therapies, or biologic therapy.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with recurrent pancreatic cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
To Learn More About Pancreatic Cancer
For more information from the
Pancreatic Cancer Home Page
What You Need to Know About? Cancer of the Pancreas
Drugs Approved for Pancreatic Cancer
What You Need to Know About? Cancer
Understanding Cancer Series: Cancer
Chemotherapy and You: Support for People With Cancer
Radiation Therapy and You: Support for People With Cancer
Coping with Cancer: Supportive and Palliative Care
Information For Survivors/Caregivers/Advocates
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Changes to This Summary (11/10/2011)
Editorial changes were made to this summary.
PDQ is a comprehensive cancer database available on NCI's Web site.
PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at NCI's Web site. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.
PDQ contains cancer information summaries.
The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.
The PDQ cancer information summaries are developed by cancer experts and reviewed regularly.
Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.
PDQ also contains information on clinical trials.
A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Listings of clinical trials are included in PDQ and are available online at NCI's Web site. Descriptions of the trials are available in health professional and patient versions. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237).