Pancreatic cancer begins in the tissues of your pancreas — an organ in your abdomen that lies horizontally behind the lower part of your stomach. Your pancreas secretes enzymes that aid digestion and hormones that help regulate the metabolism of sugars.

Pancreatic cancer often has a poor prognosis, even when diagnosed early. Pancreatic cancer typically spreads rapidly and is seldom detected in its early stages, which is a major reason why it's a leading cause of cancer death. Signs and symptoms may not appear until pancreatic cancer is quite advanced and complete surgical removal isn't possible.
Risk factors include: smoking, obesity, diabetes, and certain rare genetic conditions including: multiple endocrine neoplasia type 1 and hereditary nonpolyposis colon cancer among others. Smoking is the cause of about 20% of cases while 10% of cases are linked to inherited genes. Infiltrating ductal adenocarcinoma is the most common type of pancreatic cancer, making up 90% of cases, and references to pancreatic cancer often refer only to that type. It arises within the part of the pancreas that makes digestive enzymes, known as the exocrine pancreas. One to two percent arise from islet cells, and are classified as neuroendocrine tumors. There are also a number of other types of pancreatic cancer. Diagnosis is usually based on a combination of imaging tests such as ultrasound and computer tomography, blood tests such as CEA and CA 19-9 and biopsy. This allows the disease to be divided into five stages.

The most important form of prevention is to cease smoking, after which the risk of the disease returns to normal within 20 years. Other recommendations include limiting alcohol intake and eating a healthy diet. Screening the general population has not been found to be effective. For people affected by the disease treatments may include: surgery, radiation therapy, chemotherapy, or a combination of treatments. Recommendations are partly based on the cancer stage. Surgery may be done in an effort to cure the disease or to try to improve quality of life without trying to cure. Pain management and medications to improve digestion are sometimes needed. Early palliative care is recommended even in those who are receiving active treatment.

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Pancreatic cancer

Pancreatic cancer occurs when cancer cells develop from the pancreas, a glandular organ located behind the stomach. Signs and symptoms of pancreatic cancer may include abdominal or back pain, yellow skin, unexplained weight loss, light colored stools, dark urine and loss of hunger. Early on there are usually no symptoms. Symptoms that are specific enough to suspect pancreatic cancer often do not appear until the disease is already in an advanced stage. By the time of diagnosis the cancer has usually spread to other parts of the body.

Risk factors include: smoking, obesity, diabetes, and certain rare genetic conditions including: multiple endocrine neoplasia type 1 and hereditary nonpolyposis colon cancer among others. Smoking is the cause of about 20% of cases while 10% of cases are linked to inherited genes. Infiltrating ductal adenocarcinoma is the most common type of pancreatic cancer, making up 90% of cases, and references to pancreatic cancer often refer only to that type. It arises within the part of the pancreas that makes digestive enzymes, known as the exocrine pancreas. One to two percent arise from islet cells, and are classified as neuroendocrine tumors. There are also a number of other types of pancreatic cancer. Diagnosis is usually based on a combination of imaging tests such as ultrasound and computer tomography, blood tests such as CEA and CA 19-9 and biopsy. This allows the disease to be divided into five stages.

The most important form of prevention is to cease smoking, after which the risk of the disease returns to normal within 20 years. Other recommendations include limiting alcohol intake and eating a healthy diet. Screening the general population has not been found to be effective. For people affected by the disease treatments may include: surgery, radiation therapy, chemotherapy, or a combination of treatments. Recommendations are partly based on the cancer stage. Surgery may be done in an effort to cure the disease or to try to improve quality of life without trying to cure. Pain management and medications to improve digestion are sometimes needed. Early palliative care is recommended even in those who are receiving active treatment.

In 2012 pancreatic cancer caused 330,000 deaths globally, the seventh most common cause of deaths due to cancer. In the United States it is the fourth most common cause of deaths due to cancer. The disease occurs more often in the developed world, where 68% of new cases occur in 2012. It often has poor outcomes with the average percentage alive for at least one and five years being 25% and 5% respectively. In localized disease where the cancer is small (< 2 cm) the number alive at five years is approximately 20%. For those with neuroendocrine cancer the number alive at five years is better at 65%. In the United States, as of 2006, the economic costs of pancreatic cancer are estimated at $8.6 billion.

Signs and symptoms

Early pancreatic cancer usually does not cause symptoms, so that the disease is typically not diagnosed until it has spread beyond the pancreas itself. This is one of the key factors in the poor survival rate.

Common symptoms before diagnosis include:

Pain in the upper abdomen or back, often spreading from around the stomach to the back. The location of the pain can indicate the part of the pancreas where a tumor is located. The pain may be worst at night and may increase over time to become 'severe and unremitting'. It may be slightly relieved by bending forwards. In the UK, about half of new cases of pancreatic cancer are diagnosed following a visit to a hospital emergency department for pain or jaundice, or both. Up to 2/3 of patients have abdominal pain, 46% accompanied by jaundice, with 13% having jaundice without pain.Painless jaundice (yellow tint to whites of eyes (sclera) or yellowish skin, possibly in combination with darkened urine) when a cancer of the head of the pancreas (75% of cases) obstructs the common bile duct as it runs through the pancreas. This may also cause pale-colored stool and steatorrhea. The jaundice may be associated with itching as the salt from excess bile can cause skin irritation.Unexplained weight loss (cachexia)

Other symptoms

Indigestion (dyspepsia) or heartburn.Poor appetite or nausea and vomitingDiarrhea, loose stools.Trousseau's syndrome, in which blood clots form spontaneously in the portal blood vessels, the deep veins of the extremities, or the superficial veins anywhere on the body, may be associated with pancreatic cancer, and is found in about 10% of cases.Pulmonary embolisms due to pancreatic cancers producing blood clotting chemicals.Diabetes mellitus, or elevated blood sugar levels. Many patients with pancreatic cancer develop diabetes months to even years before they are diagnosed with pancreatic cancer, suggesting new onset diabetes in an elderly individual may be an early warning sign of pancreatic cancer.Clinical depression has been reported in association with pancreatic cancer in some 10-20% of cases, and can be a hindrance to optimal management. The depression may be there before the cancer is diagnosed, and is perhaps caused by the cancer. But the mechanism for this association is not known.Symptoms of pancreatic cancer metastasis. Typically, pancreatic cancer first metastasizes to regional lymph nodes, and later to the liver or to the peritoneal cavity, large intestine or lungs; it rarely metastasizes to bone or brain.

Diagnosis
Treatment for pancreatic cancer depends on the stage and location of the cancer as well as on your age, overall health and personal preferences.

The first goal of pancreatic cancer treatment is to eliminate the cancer, when possible. When that isn't an option, the focus may be on preventing the pancreatic cancer from growing or causing more harm.

When pancreatic cancer is advanced and treatments aren't likely to offer a benefit, your doctor will help to relieve symptoms and make you as comfortable as possible.

Surgery

Surgery may be an option if your pancreatic cancer is confined to the pancreas. Operations used in people with pancreatic cancer include:

Surgery for tumors in the pancreatic head. If your pancreatic cancer is located in the head of the pancreas, you may consider an operation called a Whipple procedure (pancreatoduodenectomy).

The Whipple procedure involves removing the head of your pancreas, as well as a portion of your small intestine (duodenum), your gallbladder and part of your bile duct. Part of your stomach may be removed as well. Your surgeon reconnects the remaining parts of your pancreas, stomach and intestines to allow you to digest food.

Whipple surgery carries a risk of infection and bleeding. After the surgery, some people experience nausea and vomiting that can occur if the stomach has difficulty emptying (delayed gastric emptying).

Expect a long recovery after a Whipple procedure. You'll spend several days in the hospital and then recover for several weeks at home.

Surgery for tumors in the pancreatic tail and body. Surgery to remove the tail of the pancreas or the tail and a small portion of the body is called distal pancreatectomy. Your surgeon may also remove your spleen. Surgery carries a risk of bleeding and infection.

Research shows pancreatic cancer surgery tends to cause fewer complications when done by experienced surgeons. Don't hesitate to ask about your surgeon's experience with pancreatic cancer surgery.

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