FAQ for Pancreatic Cancerfor the newbies on the group

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FAQ for Pancreatic Cancer

What are the symptoms of Pancreatic Cancer?

Pancreatic cancer usually does not cause symptoms early on. The cancer may grow

for some time before it causes pressure in the abdomen, pain or other problems.

In many cases, the cancer has spread outside the pancreas by the time it is

found. When symptoms appear, they depend on the location and size of the tumor.

If the tumor blocks the common bile duct so that bile cannot pass into the

intestines, the skin and whites of the eyes may become yellow, and urine may

become dark. This condition is called jaundice. Pain often develops in the upper

abdomen and sometimes spreads to the back. Cancer of the pancreas can also cause

nausea, loss of appetite, depression, weight loss, and weakness. These symptoms

may be caused by cancer or by other, less serious problems. Only a doctor can

correctly diagnose the cause of the symptoms.

What diagnostic tests are used to determine the presence of pancreatic cancer?

There are several different tests that can be used to diagnose pancreatic

cancer:

Ultrasonography

This method uses high-frequency sound waves that are above the human audible

range. An instrument sends sound waves into the patient's abdomen, and the

echoes that the sound waves produce as they bounce off internal organs creates a

picture called a sonogram. Healthy tissues and tumors produce different echoes.

CT scanning (Computed Tomography)

This method of testing involves the use of an x-ray machine which is linked to a

computer. The patient lies on a bed that passes through a hole, and the machine

moves along the patient's body, simultaneously taking multiple x-rays. The

computer then pieces the x-rays together to produce detailed pictures.

ERCP (Endoscopic retrograde cholangiopancretography)

A method for taking x-rays of the common bile duct and the pancreatic ducts. The

doctor passes a long, flexible tube called an endoscope down the throat, through

the stomach, and into the small intestine. The doctor then injects dye into the

ducts and takes x-rays.

EUS (Endoscopic Ultrasound)

This is a test that combines ultrasound(sound waves) with an endoscope. The

doctor places the tube (endoscope) into the stomach and the ultrasound machine

(which is on the endoscope) is used to direct sound waves to the pancreas. This

test is especially useful for detecting small tumors of the pancreas.

MRI (Magnetic Resonance Imaging)

This method of testing involves the use of an x-ray machine which is linked to a

computer. The patient lies on a bed that passes through a hole, and the machine

moves along the patient's body, simultaneously taking multiple x-rays. The

computer then pieces the x-rays together to produce detailed pictures.

PTC (Cholangiogram, Percutaneous Transhepatic)

A thin needle is put into the liver through the skin on the right side of the

abdomen. Dye is injected in to the bile ducts in the liver so that blockages in

the ducts can be seen on x-rays.

What else can be done to diagnose Pancreatic Cancer?

Pictures of the pancreas and nearby organs provide important clues as to whether

a person has cancer. However, doing a biopsy is the only sure way for a doctor

to determine whether pancreatic cancer is present. In a biopsy, the doctor

removes a small tissue sample. A pathologist examines the tissue under a

microscope to check for cancer cells. Biopsies can be done by several different

methods: CT scan guided, ultrasound guided, ERCP guided, or EUS guided.

What can be done for the pain that is associated with Pancreatic Cancer?

There are several ways to control pain. In most cases, the doctor prescribes

medication to control the pain. However, in some cases pain medication is not

enough. The doctor may use other treatments that effect the nerves in the

abdomen. The doctor may inject alcohol in to the area around certain nerves to

block the feeling of pain. This procedure rarely causes problems and usually

provides pain relief. Sometimes, the doctor cuts nerves in the abdomen during

surgery to block the feeling of pain. In addition, radiation therapy can help

relieve pain by shrinking the tumor.

How is Pancreatic Cancer treated?

Carcinoma of the pancreas can be treated in several different ways. If possible,

the doctor will recommend surgery to remove the tumor. In most cases, the type

of operation performed is known as a Whipple Operation. This surgery removes a

large part of the pancreas, the duodenum and a portion of the bile duct. The

patient may develop diabetes mellitus and need to take insulin. Often patients

will need to take pancreatic enzyme supplements to prevent fat and protein

malabsorbtion which leads to diarrhea, steillarrhea and weight loss.

What can be done if surgery is not possible?

In patients who have cancer that is unresectible (unable to operate on), other

options are pursued to relieve the symptoms of the cancer. If the bile duct is

obstructed by the cancer, jaundice will develop. The jaundice and obstruction

may lead to intense itching, poor appetite, diarrhea, weight loss and fever. It

is important to alleviate this jaundice. ERCP with stent placement is the most

common method. This involves the use of a flexible tube (endoscope) inserted

into the intestine. The doctor then places a stent into the bile duct to allow

the flow of bile into the intestine. This stent may be made of plastic or

stainless steel. Jaundice may also be relieved by puncturing the liver via an

incision within the skin on the right side of the abdomen. A tube (stent) can

then be inserted. Surgery may be used to bypass the obstruction of the bile duct

in some instances.

What about chemotherapy?

In the past, chemotherapy has not been effective in the treatment of pancreatic

cancer. Recently, a new agent called gemcitabine has been approved by the FDA to

help shrink the tumor in pancreatic cancer. As with all chemotherapy there are

side effects which include nausea, vomiting, and decreased white blood cell

counts.

What new promising research is being done for the treatment of pancreatic

cancer?

For many years, the use of a single chemotherapeutic agent --5-fluorouracil

(5-FU)-- represented the only available treatment that could be offered to

patients with pancreatic cancer. For individuals whose tumors were resectable,

the 5-FU was often given post-operatively in combination with radiation therapy

in an attempt to reduce the likelihood of recurrence. For patients whom the

tumor had not spread but could not be surgically removed, the combination of

5-FU and radiation therapy appeared to retard tumor growth and prolong survival.

Recently, an additional chemotherapeutic agent --gemcitabine-- has been

identified. This compound acts in a totally different manner than 5-FU, has a

similar likelihood of causing tumor regression as does 5-FU, but perhaps has an

increased probability of reducing symptoms, and can also be effectively combined

with radiation therapy. Gemcitabine was initially administered in weekly 30

minute infusions, but recently presented data suggest that the compound may act

in a more effective manner if administered in a three-hour infusion every three

weeks. Ongoing studies are comparing gemcitabine to a combination of gemcitabine

and 5-FU and also are exploring the addition of such other forms of chemotherapy

as cisplatin, docetaxol (Taxotere), or irinotecan (Camptosar) to gemcitabine.

Another and totally different novel form of therapy that is undergoing

evaluation focuses on the finding that more than 90 percent of pancreatic

cancers contain the mutation in a specific gene know as ras. The " electrical

circuitry " in cells having this mutation are dependent on a unique enzyme -

farnesyl transferase. It has been shown in the laboratory that chemical

compounds that can inhibit faresyl transferase will selectively eradicate only

those cells containing mutations in the ras gene. At least four pharmaceutical

companies have now developed farnesyl transferase inhibitors and clinical

studies have been initiated to determine how effective these compounds may be in

the treatment of patients with advanced pancreatic cancer.

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