Pancreatic cancer

Signs and symptoms of pancreatic cancer

The pancreas is about six inches long and sits behind the stomach in the back of the abdomen. The organ has two jobs: 1) making digestive enzymes that help break down food and 2) producing hormones, including insulin. These hormones regulate the body's use of sugars and starches.

Based on the type of cell they start in, pancreatic tumors are classified as exocrine or neuroendocrine tumors. Each acts differently and responds to different treatments. Exocrine tumors are the most common, accounting for about 94% of pancreatic cancers. The most common type of pancreatic cancer is adenocarcinoma.

Neuroendocrine tumors, also called islet cell tumors, account for about 6% of pancreatic tumors.

In most cases, symptoms develop after the cancer has grown and/or spread. Symptoms can include:

• Jaundice: Bile builds up in the blood when the cancer blocks the duct that releases bile into the intestine. Your skin and eyes turn yellow due to jaundice. That blockage also causes light-colored stools, itching and dark urine.
• Back pain
• Abdominal pain: You may feel a dull ache in your upper abdomen. The pain can radiate to the back and may come and go. It may get worse after you eat or lie down.
• Bloating: You may feel full early in a meal or notice swelling in the abdomen
• Nausea
• Vomiting
• Diarrhea

As the cancer grows and spreads, it affects the entire body. Over time, the cancer produces such symptoms as:

• Weight loss
• Weakness and discomfort
• Loss of appetite
• Elevated blood sugars; some people develop diabetes when the cancer affects the ability of the pancreas to produce insulin

Generally, symptoms appear earlier from cancers in the head of the pancreas than in the body and tail of the organ. With advanced pancreatic cancer, you also may have fluid in the abdomen and blood clots.

Even if you have some or all of these symptoms, you don't necessarily have pancreatic cancer – other diseases also can cause these symptoms.

Rare pancreatic cancer symptoms

Islet cell tumors, also called neuroendocrine tumors, start from pancreatic cells that produce hormones. These types of tumors make up less than 5% of all pancreas tumors.

Islet cell tumors can cause such symptoms as:

• Insulinomas – too much insulin: Sweating, lightheadedness, anxiety and fainting from low blood sugar.
• Gastrinomas – too much gastrin, a hormone that prompts gastric juice secretion: Abdominal pain, reflux, stomach ulcers that can bleed and weight loss.
• Glucagonomas – too much glucagon, a hormone that helps break down glycogen to glucose in the liver: Diarrhea, excessive thirst or urination, weight loss.
• Somatostatinomas – too much somatostatin, a hormone that inhibits gastric secretion and release of somatotropin: Diarrhea, weight loss, abdominal pain and foul-smelling, fatty stools.
• VIPomas – too much vasoactive intestinal peptide, a polypeptide secreted by cells in the intestinal tract: Watery diarrhea, abdominal cramping and facial flushing.

Pancreatic cancer causes and risk factors

Your risk of getting pancreatic cancer over your lifetime is about 1 in 65. About 5-10% of pancreatic cancers are hereditary, but most happen due to age, obesity or smoking.

Changes in your DNA cause cancer. These changes can occur over time, randomly, or possibly because you were exposed to something harmful.

You may have a higher risk of developing pancreatic cancer if you have:

• A first-degree relative who had pancreatic cancer before age 50
• Two or more first-degree relatives who had pancreatic cancer
• A genetic syndrome associated with pancreatic cancer

If you have any of these risks, your care needs to start with genetic counseling and an assessment of your individual risk of developing pancreatic cancer.

Pancreatic cancer that's caused by an inherited gene mutation tends to surface at a younger age.

Risk factors for pancreatic cancer include:

• Having diabetes for many years
• Having chronic and hereditary pancreatitis
• Smoking
• Being of African-American or Ashkenazi Jewish descent
• Being over age 60
• Being male – they're slightly more likely to get the disease than females
• Eating a lot of red and processed meats
• Being obese

Other risk factors include chronic pancreatitis and cirrhosis of the liver. A high-fat diet and lack of exercise may also play a role.

Please note that even if you have one or more of these risk factors, it does not mean you'll get the disease.

Types of pancreatic cancer

Based on the type of cell they start in, pancreatic tumors are exocrine or neuroendocrine tumors. Each type behaves differently and responds to different treatments.

Exocrine tumors are the most common, accounting for about 94% of pancreatic cancers. The most common type of pancreatic cancer is adenocarcinoma. It generally starts in the ducts of the pancreas but can also form from the cells that create digestive enzymes. Other subtypes include:

• Adenosquamous carcinomas
• Squamous cell carcinomas
• Signet ring cell carcinomas
• Undifferentiated carcinomas

Symptoms can include jaundice, blood clots, dark urine, light-colored, greasy and/or floating stools, upper abdominal or back pain, nausea and vomiting, weight loss or loss of appetite, enlarged liver or gallbladder, fatty tissue abnormalities under the skin, diabetes and itchy skin.

Neuroendocrine tumors, also called islet cell tumors, account for about 6% of pancreatic tumors.

Stages of pancreatic cancer

When you're diagnosed with pancreatic cancer, your HonorHealth team of specialists will try to determine if and how far it has spread. This is known as staging. It determines how serious the cancer is and how it can best be treated.

Clinical staging describes the amount or spread of cancer in the body using tests that are done before surgery.

• Resectable cancer has not spread outside the pancreas and appears to be easily treated with surgery.
• Borderline resectable cancer is confined to the pancreas but approaches nearby structures or severe symptoms are present, raising concern that the cancer might not be resectable with clear margins.
• Locally advanced unresectable cancer has spread outside the pancreas to nearby blood vessels or other tissues and cannot be treated with surgery.
• Metastatic cancer has spread outside the pancreas to organs and tissues far away in the body.

Surgical staging describes the size and spread of cancer in the body after a pathologist has reviewed a tissue specimen from the tumor. The lower the number, the less the cancer has spread. The earliest stage for pancreatic cancers are:

• Stage 0: Known as carcinoma in situ, this stage means that the cancer:
  • Is only in the top layers of pancreatic duct cells
  • Has not spread to deeper tissues or outside the pancreas, to nearby lymph nodes or other parts of the body
• Stage 1: The cancer:
  • Is only in the pancreas and ranges in size from 2 to 4 centimeters (0.8 inch to 1.6 inches) in width
  • Has not spread to nearby lymph nodes or to other parts of the body
• Stage II: The cancer:
  • Is only in the pancreas and ranges in size from 2 to 4 centimeters (0.8 inch to 1.6 inches) in width
  • Is still confined to the pancreas
  • Has spread to up to three nearby lymph nodes
  • Has not spread to other parts of the body
• Stage III: The cancer:
  • May be confined to the pancreas
  • Ranges in size from 2 to 4 centimeters (0.8 inch to 1.6 inches) in width
  • Is growing outside the pancreas and into major blood vessels nearby
  • Has spread to four or more nearby lymph nodes
  • Has not spread to other parts of the body
• Stage IV: The cancer:
  • Has spread (metastasized) to such sites as the liver, peritoneum (the lining of the abdominal cavity), lungs or bones
  • Can be any size and may have spread to nearby lymph nodes

Tumor markers

Tumor markers are substances that can sometimes be detected in your blood when you have cancer. CA 19-9 is a tumor marker that may be helpful with pancreatic cancer. When the CA 19-9 level drops after surgery and your HonorHealth doctors find low levels of it at that time, you tend to have a better prognosis.

Based on your staging and tumor markers, your team will determine appropriate treatment options for your pancreatic cancer.