There are two general types of pancreatic cancer: adenocarcinoma and islet cell tumors.

Adenocarcinoma is the most common type of pancreatic cancer. These cancers arise in the ducts of the pancreas (tubes that carry digestive juices to the small intestine).

Islet cell tumors are a rare group of tumors that arise from the hormone producing islet cells.

Cancer of the pancreas accounts for about two percent of all new cancers. It is more common among men than women, and most cases occur between ages 65 and 79. Its causes are unknown, but may be related to smoking, pancreatitis, and diabetes.

On this page:

• Symptoms
• Screening and Diagnosis
• Treatment
• Islet Cell Tumors
• Care Team

Symptoms

The symptoms for pancreatic cancer are nonspecific, meaning it could be caused by a variety of more common, less serious problems. Some symptoms that do arise include:

• jaundice (yellow skin often associated with dark urine, light colored stool and/or itching),
• nausea,
• loss of appetite,
• weight loss without trying to lose weight, and
• pain in the upper or middle of the abdomen or back.

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Screening and Diagnosis

Currently, there are no good screening tests for pancreatic cancer.

pancreatic cancer is difficult to diagnose early. Often the diagnosis is not made until jaundice occurs. Jaundice is caused by the inability of bile to drain from the liver, due to a tumor blocking the bile duct that is at the head of the pancreas. A physician will conduct a variety of tests to confirm the cause of jaundice, including blood tests that indicate a blockage. An ultrasound and CT scan often follow these tests. An endoscopic retrograde cholangiopancreatogram (ERCP) may be conducted to relieve the blockage with a stent.

A critical test for staging pancreatic cancer is the endoscopic ultrasound. This test is very sensitive at staging the tumor and defining the potential for surgical removal. Endoscopic ultrasound is a valuable procedure to determine the extent of the tumor and provides a minimally invasive way to biopsy suspicious pancreatic masses.

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Treatment

The type of treatment for pancreatic cancer depends on the tumor's stage, or how advanced it is. For tumors located only in the pancreas (localized), surgical removal is the only therapy that could potentially cure the disease. To treat locally advanced tumors, chemotherapy and radiation are given before surgery in an attempt to convert unremovable tumors to those that can be removed for potential cure. Chemotherapy and radiation also are commonly given to patients after surgery.

Since most tumors occur in the head of the pancreas, a surgeon uses a procedure called pancreatoduodenectomy (or Whipple procedure). Before the Whipple procedure, a surgeon conducts a diagnostic laparoscopy to determine the if spread of the tumor has occurred. This minimally invasive survey of the abdomen, in which a tiny camera is inserted through small puncture holes in the abdomen, helps reduce the need for large incisions when unexpected advanced disease is found.

If the surgeon finds that the disease is more advanced than originally thought during the pre-surgery tests or at the time of operation, expandable metal stents are inserted and used to open the blocked common bile duct in order to treat the jaundice. Sometimes surgeons will not perform surgery for the bile duct or the stomach unless the stents fail. Surgical drainage of the stomach and/or bile duct is performed only in selected patients.

Once the jaundice has been treated in patients with metastatic pancreatic cancer, chemotherapy (such as gemcitabine) is given. Locally advanced inoperable tumors sometimes can be temporarily treated with radiotherapy and/or chemotherapy. However, a number of new drugs and therapy combinations currently are being evaluated to treat inoperable pancreatic cancers.

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Islet Cell Tumors

Islet cell cancers are rare tumors arising from the hormone producing cells in the pancreas. Frequently, these tumors secrete hormones like insulin, glucagon, gastrin, pancreatic polypeptide, and a variety of others. These tumors behave differently over time when compared to adenocarcinoma of the pancreas. Some islet cell tumors, like insulinomas, tend to be small and can be surgically removed. Other tumors are not found early and have a tendency to spread out of the pancreas. Treatment is highly individualized and depends on the type of tumor and the degree of spread.

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Care Team

The interdisciplinary Hepatobiliary and Pancreatic Diseases Team, consisting of surgeons, oncologists, gastroenterologists, radiologists, and nutritionists, regularly meets to discuss how to best treat each new patient. This insures a comprehensive approach to each patient's care.

The surgeons and radiologists involved in the Hepatobiliary and Pancreatic Diseases Team have been on the forefront in the application of new and advanced techniques in the management of liver tumors, including:

• Liver resection
• Bile duct resection
• Radiofrequency ablation (heating the tumor using CT guidance or surgery)
• Percutaneous alcohol ablation (direct injection of alcohol into the tumor)
• Cryoablation (freezing the tumor)
• Chemoembolization (injecting a mixture of chemotherapy and a substance to block blood flow into the artery supplying the tumor)

The links below go to physician profiles on the University of Minnesota Physicians Web site. To return to this site, either bookmark this page or use your browser's back button.

Digestive Tract Interdisciplinary Clinical Team

Surgery: Hepatobiliary

Todd Tuttle, M.D.

Eric Jensen, M.D.

Surgery: Pancreatic

Todd Tuttle, M.D.

Eric Jensen, M.D.

Selwyn Vickers, M.D.

Medical Oncology

Edward Greeno, M.D.

Arkadiusz Dudek, M.D.

Gastroenterology: Hepatology and Nutrition

Martin Freeman, M.D.

Jack Lake, M.D.

Shawn Mallery, M.D.

Rebecca Lai, M.D.

Interventional Radiology

David Hunter, M.D.

Therapeutic Radiology: Radiation Oncology

Chung K. Lee, M.D.

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