The pancreas is a 6-inch-long organ located behind the stomach in the upper abdomen. It produces enzymes that help break down food and hormones that help the body regulate itself. When malignant cells grow and multiply within the tissues of the pancreas, pancreatic cancer develops. Every year sees about 57,000 diagnoses of pancreatic cancer, which affects men and women equally.
"In some cases, a malignant tumor cannot be surgically removed because it’s too close to major blood vessels, making surgery risky," says Kimberly Johung, MD, PhD, director of the Gastrointestinal Radiotherapy Program at Yale Medicine. That's when a type of higher-dose radiation therapy called stereotactic body radiotherapy (SBRT) may be beneficial.
What are the common types of pancreatic cancer?
There are two major types of pancreatic cancer: exocrine pancreatic cancer and endocrine pancreatic cancer.
Exocrine pancreatic cancers (which develop in the ducts that carry enzyme-rich pancreatic juices essential to the digestive process to the intestine) account for about 96 percent of all cases of the disease in the United States.
Endocrine pancreatic cancer forms in hormone-producing pancreatic cells that manufacture insulin and glucagon, which help control blood sugar.
What are risk factors for pancreatic cancer?
Risk factors for pancreatic cancer include:
- Age: Most cases of pancreatic cancer are diagnosed in people 65 and older.
- Smoking: Smokers are at a much higher risk of developing pancreatic cancer than nonsmokers.
- Exposure to industrial chemicals: Frequent contact with pesticides, industrial dyes, and other chemicals increases risk.
- Family history and genetic syndromes: Pancreatic cancer seems to run in families, although not always. Similarly, a genetic disorder passed from parents to children may contribute to a person’s likelihood of getting the disease. Genetic disorders linked to pancreatic cancer include a mutation of one of the so-called “breast cancer genes,” BRCA2, a gene mutation responsible for familial melanoma, and a mutation that leads to familial pancreatitis.
- Chronic inflammation of the pancreas (pancreatitis): People suffering from long-term inflammation of the pancreas (a result of smoking, alcohol abuse, gallstones, and other health problems) appear to have higher rates of pancreatic cancer.
How is pancreatic cancer diagnosed?
If you have symptoms of pancreatic cancer, your primary care doctor will perform a physical exam, focusing on the abdomen to check for swelling possibly caused by fluid buildup.
If you have jaundice, your doctor is likely to order blood tests to assess liver function, and to look for evidence of a bile obstruction.
You'll then be referred to a gastroenterologist, a doctor who specializes in diseases of the digestive system.
Next, your doctors will order imaging scans, typically a (computerized tomography) CT scan or an MRI, to look for a tumor mass.
If a mass is detected, the gastroenterologist will biopsy the tumor via endoscopic ultrasound. You'll be sedated and a thin tube with an ultrasound probe at the end is inserted in your mouth and run down into the stomach or into the top of the small intestine. A small needle is inserted into the tube, pushed through the stomach or intestinal wall and fed into the pancreas to obtain a small sample of the tumor. A pathologist will analyze the tissue sample to determine whether the cells are cancerous.
How is pancreatic cancer treated?
Treatment for pancreatic cancer depends on the stage of the cancer, or how advanced it is. Doctors use a numerical scale from 0 to IV, with Stage 0 meaning that cancerous cells exist only in a section of pancreatic tissue and Stage IV meaning that cancerous cells have spread to other organs and/or lymph nodes.
Pancreatic cancer is difficult to catch at an early stage because symptoms don’t typically appear until the cancer is advanced and has already spread.
For most of those cases, treatment consists of chemotherapy, in which drugs that kill fast-growing cancer cells (and also rapidly multiplying noncancerous cells) are given once a week, usually intravenously.
In up to 25 percent of cases where the cancer has not spread, and the tumor is in a place where it can be safely removed, surgery can be performed.
In those cases, chemotherapy is a key component of treatment, with each patient’s regimen tailored to his or her specific case.
Often, a five-week course of daily external beam radiation, in which high energy X-ray beams are aimed at the tumor area, is used in combination with chemotherapy, which may be delivered in pill or intravenous form.
Yale Medicine offers a newer form of radiation treatment for pancreatic cancer called stereotactic body radiotherapy (SBRT). Instead of giving a small dose of radiation every day for five weeks in combination with chemotherapy, radiation oncologists administer a higher dose of radiation to a very specific area. Patients undergoing SBRT usually receive five radiation treatments without receiving chemotherapy at the same time.
"In addition to being more convenient, and possibly better tolerated by patients, there’s initial data showing that SBRT may control tumors better than conventional radiation," says Dr. Johung.
How is Yale Medicine’s approach to treating pancreatic cancer unique?
At Yale Medicine, each case of pancreatic cancer is addressed by a team of doctors devoted to using the most effective treatments based on the latest scientific evidence. Yale Medicine clinicians are also at the forefront of research into pancreatic cancer treatments.