Pancreatic Cancer

The pancreas is a gland about six inches long that is shaped like a skinny pear lying on its side. The wider end of the pancreas is called the head, the middle is the body and the narrow end is the tail. The pancreas is behind the stomach and in front of the spine. The job of the pancreas is to produce juices that help break down food and to produce hormones such as insulin and glucagon, which help control blood sugar levels. The digestive juices are produced by exocrine pancreas cells, and the hormones are produced by endocrine pancreas cells. About 95% of pancreatic cancer begins in exocrine cells.

Research has shown that smoking, long-standing diabetes, chronic pancreatitis and certain hereditary conditions are possible risk factors for pancreatic cancer.

Symptoms may include jaundice (yellowing of the eyes and skin), pain in the upper or middle abdomen and back, unexplained weight loss or loss of appetite and fatigue.

Pancreatic cancer is difficult to diagnose because there aren’t any noticeable signs or symptoms in the early stages, and when the signs become apparent, they are like the signs of many other illnesses. The pancreas is hidden behind other organs and not easy to see.

Diagnosis is usually made with tests that show pictures of the pancreas and the area around it such as X-ray, CT scan, PET scan, endoscopic ultrasound, endoscopic retrograde cholangiopancreatography (ERCP), or MRI, along with physical exam and history. Sometimes a laparoscopy (a surgical procedure to look at the organs inside the abdomen through small incisions) is necessary to make a diagnosis or to take tissues for biopsy.

A biopsy is necessary to “stage” the pancreatic cancer – to determine whether the cancer cells have spread within and around the pancreas.

The chance of recovery (prognosis) and the treatment options depend on many things – whether the tumor can be removed by surgery, the stage of the cancer, the patient’s general health, and whether the cancer has just been diagnosed or has recurred.

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, palliative treatment (pain control and comfort measures) can improve the patient’s quality of life by controlling the symptoms and complications.

Three types of treatment are typically used: surgery, radiation and chemotherapy.

A Whipple procedure is a surgical procedure in which the head of the pancreas, the gallbladder, part of the stomach, part of the small intestine and the bile duct are removed. Enough of the pancreas is left to produce digestive juices and insulin.

Total pancreatectomy is a removal of the entire pancreas, part of the stomach, part of the small intestine, the common bile duct, the gallbladder, the spleen and nearby lymph nodes – all in an effort to remove the tumor.

Distal pancreatectomy is a procedure in which the body and tail of the pancreas and usually the spleen are removed.

If the cancer has spread, and cannot be removed, the following types of palliative surgery can be done to relieve the symptoms:

  • Biliary bypass is performed when the cancer is blocking the small intestine and bile is building up in the gallbladder. During this operation, the surgeon cuts the gallbladder or bile duct and sews it to the small intestine to create a new pathway around the blocked area.
  • Endoscopic stent placement is performed when the tumor blocks the bile duct. A stent (a small open tube) is placed to drain bile that has built up in the area and drains it to the outside of the body or into the small intestine.
  • Gastric bypass is used if the tumor blocks the flow of food from the stomach. In this case, the doctor sews the stomach directly to the small intestine so the patient can continue to eat normally.

Radiation therapy is a cancer treatment that uses high-energy X-rays or other types of radiation to kill cancer cells. This can be done externally (using a machine outside the body) or internally (using a radioactive substance sealed in needles, seeds, wires or catheters that is placed directly into or near the cancer). The way the radiation is given depends on the type and stage of the cancer being treated.

Chemotherapy is a treatment that involves drugs to stop the growth of cancer cells, either by killing the cells or stopping the cells from dividing. This can be taken by mouth, injected into a vein or muscle or administered through an IV. Regardless of the method, the drugs enter the bloodstream and can reach the cancer cells throughout the body. Sometimes the drugs are placed directly into an organ or into the abdomen – again, which type depends on the stage of the cancer being treated.

The HPB-GI surgeons at Washington University specialize in novel treatments for pancreatic cancer. They are attempting to improve outcomes with new treatment strategies incorporating results from our research program into the clinical realm. They are actively testing new agents in clinical trials to improve outcomes and patient survival.

They have also described a procedure called “RAMPS” (radical antegrade modular pancreatosplenectomy) for tumors of the body and tail of the pancreas that has demonstrated superior outcomes compared to standard techniques.

Surgeons who treat pancreatic cancer:

David C. Linehan, MD, Section Chief

Ryan C. Fields, MD

William G. Hawkins, MD

Steven M. Strasberg, MD

More information on pancreatic cancer:

Siteman Cancer Center locations for HPB-GI surgeons:

Main campus (St. Louis)

South County campus

West County campus