The pancreas is an oblong flattened gland located deep in the abdomen. It is an integral part of the digestive system. It is about 6 inches long and is shaped like a flat pear. The widest part of the pancreas is the head, the middle section is the body, and the thinnest part is the tail.

The pancreas produces insulin and other hormones. These hormones help the body use or store the energy that comes from food. The pancreas also makes pancreatic juices which contain enzymes that help digest food. The pancreas releases the juices into a system of ducts leading to the common bile duct. The common bile duct empties into the duodenum, the first section of the small intestine.

Cancer is the illness or condition that is caused when cells multiply uncontrollably forming a growth or tumor and destroying healthy tissue.

Benign tumors are not cancer and are usually not life threatening. In most cases, benign tumors can be removed and do not come back. Cells from benign tumors do not spread to tissues around them or to other parts of the body.

Malignant tumors are cancer. The term malignant is used to describe a tumor that invades the tissue around it and may spread to other parts of the body.  Malignant tumors are more serious and may be life threatening.

Benign tumors are not cancer and are usually not life threatening. In most cases, benign tumors can be removed and do not come back. Cells from benign tumors do not spread to tissues around them or to other parts of the body.

Malignant tumors are cancer. The term malignant is used to describe a tumor that invades the tissue around it and may spread to other parts of the body.  Malignant tumors are more serious and may be life threatening.

Cancer cells can break away from a malignant tumor and enter the bloodstream or lymphatic system. That is how cancer cells metastasize, or spread from the original cancer (primary tumor) to form new tumors in other organs.

Most pancreatic cancers begin in the ducts that carry pancreatic juices. Cancer of the pancreas may be called pancreatic cancer or carcinoma of the pancreas.

A rare type of pancreatic cancer that begins in the cells that make insulin and other hormones.

When cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary tumor. For example, if cancer of the pancreas spreads to the liver, the cancer cells in the liver are pancreatic cancer cells. The disease is metastatic pancreatic cancer, not liver cancer. It is treated as pancreatic cancer, not liver cancer.

No.  Cancer does not spread from person to person.

No one knows the exact causes of pancreatic cancer though research has shown that people with certain risk factors are more likely to develop pancreatic cancer. Risk factors include:

• Cigarette smoking - Cigarette smoke contains a large number of carcinogens (cancer causing chemicals.) Therefore, it is not surprising that cigarette smoking is one of the biggest risk factors for developing pancreatic cancer. According to some reports smokers have a 2-3 fold increased risk of developing pancreatic cancer.
• Age - The risk of developing pancreatic cancer increases with age. Over 80% of the cases develop between the ages of 60 and 80.
• Race - Studies in the United States have shown that pancreatic cancer is more common in the African-American population than it is in the white population. Some of this increased risk may be due to socioeconomic factors and to cigarette smoking.
• Gender - Cancer of the pancreas is more common in men than in women. This may be, in part, because men are more likely to smoke than women.
• Religious Background - Pancreatic cancer is proportionally more common in Jews than the rest of the population. This may be because of a particular inherited mutation in the breast cancer gene (BRCA2) which runs in some Jewish families.
• Chronic pancreatitis - Long-term inflammation of the pancreas (pancreatitis) has been linked to cancer of the pancreas.
• Diabetes - There have been a number of reports which suggest that diabetics have an increased risk of developing pancreatic cancer.
• Peptic ulcer surgery - Patients who have had a portion of their stomach removed (partial gastrectomy) appear to have an increased risk for developing pancreatic cancer.
• Diet - Diets high in meats, cholesterol fried foods and nitrosamines may increase the risk, while diets high in fruits and vegetables may reduce the risk of pancreatic cancer.

People who think they may be at risk for pancreatic cancer should discuss this concern with their doctor. The doctor may suggest ways to reduce the risk and can plan an appropriate schedule for checkups.

In the early stages, pancreatic cancer is extremely difficult to detect because often there are no symptoms. But, as the cancer grows, symptoms may include:

• Pain in the upper abdomen or upper back
• Yellow skin and eyes, and dark urine from jaundice
• Weakness
• Loss of appetite
• Nausea and vomiting
• Weight loss

These symptoms are not sure signs of pancreatic cancer. An infection or other problem could also cause these symptoms. Only a doctor can diagnose the cause of a person's symptoms. Anyone with these symptoms should see a doctor so that the doctor can treat any problem as early as possible.

Pancreatic cancer can be difficult to detect and diagnose. A variety of techniques can be used to establish a diagnosis. These techniques include lab tests, CT scan, endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP).

Although all of these techniques may reveal a suspicious mass in the pancreas, by far the best diagnostic method remains histopathology.

Lab tests - The doctor may take blood, urine, and stool samples to check for bilirubin and other substances. Bilirubin is a substance that passes from the liver to the gallbladder to the intestine. If the common bile duct is blocked by a tumor, the bilirubin cannot pass through normally. Blockage may cause the level of bilirubin in the blood, stool, or urine to become very high. High bilirubin levels can result from cancer or from noncancerous conditions.

CT scan  (computed tomography) - An x-ray machine linked to a computer takes a series of detailed pictures. The x-ray machine is shaped like a donut with a large hole. The patient lies on a bed that passes through the hole. As the bed moves slowly through the hole, the machine takes many x-rays. The computer puts the x-rays together to create pictures of the pancreas and other organs and blood vessels in the abdomen.

Ultrasonography - The ultrasound device uses sound waves to produce a pattern of echoes as they bounce off internal organs. The echoes create a picture of the pancreas and other organs inside the abdomen. The echoes from tumors are different from echoes made by healthy tissues. The ultrasound procedure may use an external or internal device, or both types:

Transabdominal ultrasound - To make images of the pancreas, the doctor places the ultrasound device on the abdomen and slowly moves it around.

EUS (Endoscopic ultrasound) - The doctor passes a thin, lighted tube (endoscope) through the patient's mouth and stomach, down into the first part of the small intestine. At the tip of the endoscope is an ultrasound device. The doctor slowly withdraws the endoscope from the intestine toward the stomach to make images of the pancreas and surrounding organs and tissues.

ERCP (endoscopic retrograde cholangiopancreatography) - The doctor passes an endoscope through the patient's mouth and stomach, down into the first part of the small intestine. The doctor slips a smaller tube (catheter) through the endoscope into the bile ducts and pancreatic ducts. After injecting dye through the catheter into the ducts, the doctor takes x-ray pictures. The x-rays can show whether the ducts are narrowed or blocked by a tumor or other condition.

PTC (percutaneous transhepatic cholangiography) - A dye is injected through a thin needle inserted through the skin into the liver. Unless there is a blockage, the dye should move freely through the bile ducts. The dye makes the bile ducts show up on x-ray pictures. From the pictures, the doctor can tell whether there is a blockage from a tumor or other condition.

Biopsy - In some cases, the doctor may remove tissue. A pathologist then uses a microscope to look for cancer cells in the tissue. The doctor may obtain tissue in several ways. One way is by inserting a needle into the pancreas to remove cells. This is called fine-needle aspiration. The doctor uses x-ray or ultrasound to guide the needle. Sometimes the doctor obtains a sample of tissue during EUS or ERCP. Another way is to open the abdomen during an operation.

• What kind of biopsy will I have?
• How long will it take? Will I be awake? Will it hurt?
• Are there any risks?
• How soon will I know the results?
• If I do have cancer, who will talk to me about treatment? When?

When pancreatic cancer is diagnosed, the doctor needs to know the stage, or extent, of the disease to plan the best treatment. Staging is a careful attempt to find out the size of the tumor in the pancreas, whether the cancer has spread, and if so, to what parts of the body. The results of various diagnostic tests will indicate how far the cancer has progressed and determine the stage. Subsequent decisions about treatment will be based upon the stage assigned.

The shock and stress that people may feel after a diagnosis of cancer can make it hard for them to think of everything they want to ask the doctor. Often it helps to make a list of questions before an appointment. To help remember what the doctor says, patients may take notes or ask whether they may use a tape recorder. Some patients also want to have a family member or friend with them when they talk to the doctor-to take part in the discussion, to take notes, or just to listen.  Always remember that the doctor is there to answer your questions dont be afraid to voice your opinion or question any action or procedure.

If you are meeting with a surgeon or oncologist for the first time, you may want to ask:

• Have you ever treated a PC patient before?
• If this is a surgeon, how many surgeries have you performed on PC patients?
• What has the general outcome of those patients been?
• Where were you trained? (medical school, residency)
• Which surgeons did you study under?

At any point in the relationship with your physician, you have the right to ask:

• What is the diagnosis?
• What treatments are recommended?
• Are there other treatment options available that you do not provide? (i.e. protocol treatments, herbal therapy, touch therapy, other alternative therapies)
• What are the benefits of each treatment?
• What are the side effects of each treatment?
• What are the medications being prescribed?
• What are they for?
• What are their side effects?
• Are there any clinical drug trials I can participate in?
• How should I expect to feel during the treatment(s)?
• What are the risks of the treatment(s)?
• Will my diet need to be changed or modified?
• Will I need to take enzymes, vitamins, etc?
• Do not forget to ask about the things that are most important to you:
• How will this affect my ability to work?
• Can this treatment be done as an outpatient so that I can spend more time at home with family?
• Will I have any physical limitations?
• How will my current lifestyle be changed?
• Finally - and most importantly - ask these questions of YOURSELF:
• Does my doctor appear interested in answering my questions?
• Or, does my doctor look annoyed when I ask questions, like I'm doubting their expertise or I am holding them up?
• Do I feel that my doctor cares about my medical outcome?

If you are uncomfortable with the results of some of these questions, you may want to re-evaluate your choice of physician or get a second opinion.

Cancer of the pancreas is very hard to control with current treatments. For that reason, many doctors encourage patients with this disease to consider taking part in a clinical trial. Clinical trials are an important option for people with all stages of pancreatic cancer.  For more information on Clinical Trials click here (link to HopeLink/Clinical trials section of website)

Palliative therapy aims to improve quality of life by controlling pain and other problems caused by pancreatic cancer.

An oncologist is a doctor who specializes in treating cancer. Specialists who treat pancreatic cancer include surgeons, medical oncologists, and radiation oncologists.