Pancreatic Neoplasm
Pancreatic neoplasm is a serious health condition that forms in the tissues of the pancreas, an organ vital for digestion and blood sugar control. Most people don’t show signs in early stages, making this disease particularly challenging to detect and treat.
Table of contents
- What Is Pancreatic Neoplasm?
- Anatomy and Location
- Types of Pancreatic Neoplasms
- Risk Factors
- Signs and Symptoms
- Diagnosis and Detection Challenges
- How Common Is It?
- Outlook and Survival
- Treatment Options
- Living with Pancreatic Neoplasm
What Is Pancreatic Neoplasm?
Pancreatic neoplasm refers to abnormal growths that develop in the pancreas. These neoplasms (abnormal tissue growths) occur when cells in the pancreas mutate and multiply out of control, forming a tumor[1][2]. The pancreas is a gland in your abdomen that sits between your spine and stomach, playing crucial roles in both digestion and blood sugar regulation.
The pancreas produces enzymes (special proteins) that help break down food and hormones (chemical messengers) like insulin and glucagon that control blood sugar levels[6]. When cancer develops in this organ, it can significantly impact these essential functions.
Anatomy and Location
- Pancreas
- Pancreatic duct
- Stomach
- Small intestine
- Common bile duct
The pancreas is shaped like a thin pear lying on its side and is about 6 inches long. It has three main parts: the wider end called the head, the middle section called the body, and the narrow end called the tail[6]. The location of a tumor within these different areas affects how doctors approach treatment, particularly surgery.
Most pancreatic cancers start in the ducts of the pancreas. The main pancreatic duct connects the pancreas to the common bile duct[2]. This anatomical connection helps explain why some symptoms, particularly those related to digestion and bile flow, occur in people with pancreatic neoplasms.
Types of Pancreatic Neoplasms
Pancreatic neoplasms can occur in two main types of cells: exocrine cells (which produce digestive juices) or endocrine cells (which produce hormones). About 95% of pancreatic cancers begin in exocrine cells, while about 5% develop in endocrine cells[6].
Exocrine Tumors
Over 90% of all pancreatic tumors are exocrine tumors[2][5]. The most common type is adenocarcinoma, which accounts for about 90% of all pancreatic cancers. This type begins in the cells lining the pancreatic duct[5].
Other less common exocrine tumors include acinar cell carcinoma, which is very rare and may cause excessive production of pancreatic lipase (an enzyme that digests fats)[5]. Intraductal papillary-mucinous neoplasm (IPMN) is a cystic tumor that grows from the main pancreatic duct or its side branches and may be benign at diagnosis but has a risk of progressing to cancer[5].
Mucinous cystadenocarcinoma is a rare, malignant cystic tumor filled with a thick fluid called mucin. It usually occurs in one area of the pancreas, more commonly in the tail, and is mostly seen in women[5].
Neuroendocrine Tumors
Less than 10% of pancreatic tumors are neuroendocrine tumors, also called islet cell carcinomas[2]. These develop from the hormone-producing cells of the pancreas and may behave differently from exocrine tumors.
Risk Factors
A risk factor is something that increases your chances of developing a disease. Having one or more risk factors does not mean you will definitely get pancreatic neoplasm, and some people with no known risk factors still develop the disease[6].
Smoking is recognized as a strong risk factor for pancreatic cancer. About 20% of pancreatic cancers are caused by smoking[4][6]. Cigarette smoke contains harmful chemicals that can damage the DNA in pancreatic cells, leading to cancer development.
Age is another important factor. Most pancreatic cancer is diagnosed after age 65[1][4]. The disease affects males more than females and African Americans more than whites[4].
Several medical conditions increase risk. Having excess body weight, diabetes, or chronic pancreatitis (long-term inflammation of the pancreas) all raise the likelihood of developing pancreatic cancer[1][4][6]. New research has found that the specific combination of smoking, diabetes, and poor diet increases the risk of pancreatic cancer the most beyond any one factor alone[1].
A family history of pancreatic cancer or pancreatitis increases risk[6]. About 10% of cases have a genetic cause, associated with genetic mutations or syndromes such as Lynch syndrome, Peutz-Jeghers syndrome, Von Hippel-Lindau syndrome, and multiple endocrine neoplasia type 1 (MEN1)[4][6].
Other risk factors include cirrhosis (scarring of the liver), infection with Helicobacter pylori bacteria, and work exposure to certain chemicals in the dry cleaning and metalworking industries[4]. Possible risk factors include heavy alcohol consumption, physical inactivity, high red meat consumption, and drinking two or more soft drinks per day[4].
Signs and Symptoms
Unfortunately, pancreatic neoplasm typically does not cause any early signs or symptoms[1][2]. We usually don’t see signs of pancreatic cancer until it’s in more advanced stages[1]. This lack of early warning signals makes the disease particularly difficult to catch when treatment would be most effective.
Symptoms typically emerge once the tumor starts impacting other organs in the digestive system[2]. Some people develop vague symptoms up to one year before they receive a diagnosis[2].
Common symptoms include jaundice (yellowing of the skin and whites of the eyes), which occurs when the tumor blocks the bile duct[2][6]. Along with jaundice, people may notice dark urine and light-colored stool[2][6].
Pain is another frequent symptom. Many people report that their first pancreatic cancer symptoms were back pain or stomach pain[2]. Upper abdominal pain and middle back pain can occur and may get worse after meals or when lying down[2][6]. These symptoms can come and go at first but may worsen over time.
Digestive symptoms are common and include nausea and vomiting, gas or bloating, and lack of appetite[2][6]. Weight loss without trying is a significant warning sign[2][6]. People may also experience fatigue and itchy skin[2].
Some people develop new-onset diabetes or experience blood clots[2]. Healthcare providers might suspect pancreatic cancer if someone has recently developed diabetes or pancreatitis[2].
Diagnosis and Detection Challenges
Pancreatic cancer is difficult to detect and diagnose for several reasons[6]. There are no noticeable signs or symptoms in the early stages. When symptoms do appear, they are similar to signs of many other illnesses, such as pancreatitis or an ulcer. The pancreas is also hidden behind other organs in the abdomen, making it difficult to visualize clearly on imaging tests[6].
Early-stage pancreatic tumors don’t show up on imaging tests. For this reason, many people don’t receive a diagnosis until the cancer has spread (a process called metastasis)[2].
To diagnose pancreatic neoplasm, doctors use tests that examine the pancreas[6]. Imaging tests may include a helical computed tomographic scan (CT scan), magnetic resonance imaging (MRI), and endoscopic ultrasonography[6]. These tests create pictures of the inside of the body to help doctors see any abnormal growths.
Blood tests can measure tumor markers such as cancer antigen (CA) 19-9. Most patients with pancreatic cancer have an elevated CA 19-9 level at diagnosis. However, the presence of a normal CA 19-9 level does not rule out cancer[17].
A biopsy (removal of a small tissue sample for examination under a microscope) may be performed to confirm the diagnosis. Minimally invasive techniques such as laparoscopy and laparoscopic ultrasonography may be used to decrease the need for more extensive surgery[6].
How Common Is It?
Pancreatic cancer is responsible for approximately 3% of all cancers in the United States. It ranks as the 10th most common cancer in men and the 8th most common cancer in women[2]. In 2014, the American Cancer Society estimated 46,420 new cases of pancreatic cancer with 39,590 deaths in the United States[14].
Cases of pancreatic cancer are on the rise. Trends indicate that pancreatic cancer will be the second leading cause of cancer death in the United States by 2030[2]. The incidence of pancreatic cancer has markedly increased over the past several decades, and it currently ranks as the fourth leading cause of cancer death in men and the third leading cause of cancer death in women[17].
Globally, based on GLOBOCAN 2012 estimates, pancreatic cancer kills more than 331,000 people per year and ranks as the seventh principal cause of cancer death in both genders[4]. The estimated global 5-year survival rate for pancreatic cancer is about 5%[4].
Incidence rates are highest in Northern America, Western Europe, Europe, and Australia/New Zealand. The lowest incidence rates are in Middle Africa and South-Central Asia[4].
Outlook and Survival
The outlook for pancreatic neoplasm remains challenging. The 5-year survival rate in the United States ranges from 5% to 15%, with an overall survival rate of only 6%[4]. Pancreatic cancer survival rates are low because the disease is difficult to detect in the early stages[2].
Several factors influence outlook and survival. The primary factors include whether the tumor is localized and can be completely removed with surgery, whether the tumor has spread to lymph nodes or elsewhere, and the patient’s general health[17].
Surgical resection is the only current option for a cure, but only 20% of pancreatic cancer is surgically removable at the time of diagnosis[4]. Unfortunately, 80% of patients diagnosed with pancreatic cancer present with spread to other areas or local advanced disease at initial diagnosis[14].
Even at high-volume specialty centers where the 5-year survival rate for patients is higher than in the general population, disease recurrence is still a major problem. For patients who have undergone surgical removal of the involved pancreas, published series from high-volume referral centers indicate that only 10% to 27% of patients with early-stage disease who underwent removal survived at least 5 years[14].
There is a high frequency of undetected cancer spread at initial presentation as well as a high frequency of undetectable disease outside the pancreas at the time of surgical removal, which contributes to the poor long-term outcomes[14].
Treatment Options
Treatment depends on the position of the cancer in the pancreas, how big it is, the type of pancreatic cancer, whether it has spread, whether doctors can remove it with surgery, and the patient’s general health[8][15].
Surgery
Surgery is the primary mode of treatment for pancreatic cancer and offers the only option for cure[16]. However, typically, disease spread outside the pancreas prevents curative removal, and surgical treatment may be palliative (focused on comfort) at best[16].
The type of surgery depends on where the cancer is located in the pancreas. Common procedures include pancreaticoduodenectomy (also called the Whipple procedure), which is one of the most common procedures for cancer in the head or uncinate process of the pancreas[10]. Other options include distal pancreatectomy (removal of the tail and sometimes body of the pancreas) and total pancreatectomy (removal of the entire pancreas)[16].
Chemotherapy
Chemotherapy is one of the main treatments for pancreatic cancer. It uses drugs to kill cancer cells or stop them from growing[15]. Chemotherapy may be given before surgery (called neoadjuvant therapy) to shrink the tumor, after surgery (called adjuvant therapy) to kill any remaining cancer cells, or for advanced cancer to help control symptoms and prolong life[12][15].
Radiation Therapy
Radiation therapy uses high-energy x-rays to kill cancer cells[15]. It may be used alone or combined with chemotherapy (called chemoradiotherapy). Radiation is sometimes given before surgery to shrink tumors or after surgery to kill remaining cancer cells.
Targeted Therapy and Immunotherapy
Doctors may use targeted cancer drugs or immunotherapy to help treat pancreatic cancer[15]. These treatments work differently from chemotherapy by targeting specific features of cancer cells or helping the immune system fight cancer.
Palliative Treatment
Pancreatic cancer is often diagnosed at an advanced stage. Treatments to control symptoms of advanced pancreatic cancer are an important part of care[15]. These may include procedures to relieve blockages in the bile duct or digestive system, pain management, nutritional support, and other supportive care measures.
Living with Pancreatic Neoplasm
A diagnosis of pancreatic neoplasm requires adapting to many life changes. The disease brings a wide range of emotions, various physical symptoms, and numerous decisions about care[20]. While the disease and its treatment can be stressful, there are things patients can do to cope better.
Developing a Support System
A strong support system, including family, friends, clergy, and a good medical team, helps patients deal with different aspects of pancreatic cancer[20]. Family and friends are important members of a support network. Patients may find comfort in talking to their support network about emotions and physical feelings on a day-to-day basis.
There may be times when patients find comfort in writing in a journal, joining a formal support group, or seeking individual counseling[20]. Support groups provide opportunities to talk with other individuals who are also dealing with cancer. Many find the process of helping other people with their care rewarding and empowering.
Maintaining a Positive Outlook
Staying positive and hoping for the best can push a patient to continue battling the disease and follow medical advice. A positive outlook can help a patient take better care of themselves and can also inspire appreciation of things that are meaningful in the present[20].
Nutrition and Diet
Maintaining a balanced diet is essential for pancreatic cancer patients, as it supports overall health and helps manage treatment side effects[22]. Proper nutrition provides the necessary nutrients to maintain energy levels, support the immune system, and promote healing.
Dietary needs will change after diagnosis. Certain foods can be difficult to digest and worsen symptoms. It’s important to avoid fatty foods such as fried foods and high-fat meats, which can be hard to digest. Sugary foods can lead to blood sugar spikes, potentially worsening fatigue and nausea. Spicy and acidic foods can irritate the digestive tract[22].
Staying hydrated is crucial, especially if experiencing diarrhea or vomiting[22]. Water, herbal teas, and clear broths are excellent choices.
Physical Activity
Regular physical activity offers numerous benefits, including improved mood, increased energy levels, and better overall health[22]. Exercise can help reduce fatigue, enhance physical function, and improve mental health.
Suitable exercises include walking, swimming, yoga, and stretching[22]. It’s important to start with small, achievable goals and gradually increase activity over time. Listening to your body’s signals is crucial—pay attention to signs of fatigue or pain and rest when needed[22].
Finding a New Normal
Life changes after a pancreatic cancer diagnosis. Experts agree that living each day as normally as possible, whether you’re a patient or a loved one, is key. Also critical is being open to new meaning in life, altering routines and hobbies if needed, and embracing a “new normal”[18].
Change in life events can spur interest in new hobbies and pursuits. Consider journaling, meditation, yoga and other relaxation exercises, as well as social activities in the community[18]. Remember that you are not your cancer. Even though you have the disease, you get to decide how you want to live the rest of your life. You can choose to live with hope.
