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Pancreatic Cancer

Pancreatic Cancer: Introduction

What is cancer?

Cancer is when cells in the body change and grow out of control. Your body is made up of tiny building blocks called cells. Normal cells grow when your body needs them, and die when your body does not need them any longer.

Cancer is made up of abnormal cells that grow even though your body doesn’t need them. In most cancers, the abnormal cells grow to form a lump or mass called a tumor. If cancer cells are in the body long enough, they can grow into (invade) nearby areas. They can even spread to other parts of the body (metastasis).

What is pancreatic cancer?

Pancreatic cancer is cancer that starts in your pancreas. In this cancer, normal cells in the pancreas undergo a series of changes. This can eventually lead to excess cell growth and the formation of tumors.

Understanding the pancreas

The pancreas is a gland, an organ that makes substances the body needs. It has 2 important functions. It makes substances for food digestion and hormones to help control the amount of sugar (glucose) in the blood. It is located in the belly (abdomen). It’s about 6 inches long. One end is wide and is called the head. The middle is called the body. The narrow end is called the tail. The pancreas is made up of 2 main types of cells.

The exocrine pancreas is made up of cells that make digestive juices. These help your body break down foods. Most pancreatic cancers start in this part of the pancreas. Pancreatic juices contain chemicals called enzymes that help you digest food. The pancreas releases these juices (enzymes) during meals. The enzymes enter your intestine through tubes called ducts. The main pancreatic duct is at the head of the pancreas. It joins the common bile duct, which comes from the liver and gallbladder. The enzymes from the pancreas mix with other substances from the liver and gallbladder. The merged ducts open into the first part of the small intestine (duodenum). In the duodenum, the enzymes help break down fats, sugars, and proteins from the food you eat.

The endocrine pancreas makes hormones that are released into the blood. They help control how your body works. The pancreatic endocrine cells are arranged in small clumps called islets of Langerhans. They make many hormones, including insulin and glucagon. These hormones help your body use and store the energy created from the food you eat. A small number of all pancreatic cancers start in endocrine cells.

What are the types of cancer in the pancreas?

Here’s an overview of the types of cancer that can start in the pancreas:

  • Adenocarcinomas. These exocrine cancers start in cells of the pancreatic ducts, or cells that secrete digestive juices (enzymes). More than 95 out of 100 pancreatic cancers are adenocarcinomas. This is usually what’s meant by the term pancreatic cancer .

  • Pancreatic neuroendocrine tumors (NETs). These tumors are also known as islet cell tumors. They start in endocrine cells in the pancreas. There are many types of pancreatic NETs. They can be noncancerous (benign) or cancerous (malignant).

Other types of cancer that can start in the pancreas are much less common. They include acinar cell carcinomas, adenosquamous carcinomas, and squamous cell carcinomas. They also include signet ring cell carcinomas and giant cell tumors.

How pancreatic cancer grows and spreads

Pancreatic cancer often grows within the pancreas for a long time before it causes any symptoms. If the cancer grows outside the pancreas, it often goes into the nearby bile ducts and lymph nodes in your belly (abdomen). In some cases, it spreads to other nearby areas. Pancreatic cancer may also spread to distant parts of the body. These can include your liver or lungs.

When pancreatic cancer spreads to another part of the body, it’s not considered a new cancer. For instance, if it spreads to your liver, it’s not considered liver cancer. It’s called metastatic pancreatic cancer. It’s still treated like pancreatic cancer.

Talk with your healthcare provider

If you have questions about pancreatic cancer, talk with your healthcare provider. Your healthcare provider can help you understand more about this cancer.

Pancreatic Cancer: Risk Factors

What is a risk factor?

A risk factor is anything that may increase your chance of having a disease. Risk factors for a certain type of cancer might include smoking, diet, family history, or many other things. The exact cause of someone’s cancer may not be known. But risk factors can make it more likely for a person to have cancer.

Things you should know about risk factors for cancer:

  • Risk factors can increase a person’s risk, but they don’t always cause the disease.

  • Some people with risk factors never develop cancer. Other people with cancer have no known risk factors.

  • Some risk factors are very well known. But there’s ongoing research about risk factors for many types of cancer.

Some risk factors, such as family history, may not be in your control. But others may be things you can change. Knowing the risk factors can help you make choices that might lower your risk. For instance, if an unhealthy diet is a risk factor, you may choose to eat healthy foods. If excess weight is a risk factor, you may decide to try to lose weight.

Who is at risk for pancreatic cancer?

Anyone can get pancreatic cancer. But there are some factors that can increase your risk, such as:

  • Older age. Your risk of pancreatic cancer goes up as you get older. Pancreatic cancer is rare before age 45. Most people are 65 or older when they’re diagnosed.

  • Gender. Men are more likely to get pancreatic cancer than women.

  • Race. African Americans and people of Ashkenazi Jewish descent are slightly more likely to get pancreatic cancer than people of other races.

  • Tobacco use. The use of any type of tobacco (including chewing tobacco) increases your risk of this cancer.

  • Obesity. People who are overweight or obese have a higher risk of having and dying from pancreatic cancer.

  • Diabetes. People with long-term diabetes, especially type 2 diabetes, are at increased risk for this cancer.

  • Chronic pancreatitis. Long-term inflammation of the pancreas is linked with a higher risk of pancreatic cancer.

  • Cirrhosis. Scarring of the liver increases your risk. This can result from liver damage due to hepatitis or heavy alcohol use.

  • Family history. People with family members who have had pancreatic cancer are at higher risk. Still, most people with pancreatic cancer do not have a family history of the disease.

  • Certain inherited genetic syndromes.  Certain rare, inherited syndromes are linked to gene changes that are passed on in families. Some of these can increase the risk of this cancer, including Lynch syndrome, hereditary pancreatitis, and Peutz-Jeghers syndrome. They also include hereditary breast and ovarian cancer (HBOC) syndrome and familial atypical multiple mole melanoma (FAMMM) syndrome. 

  • Helicobacter pylori infection. This is a type of bacteria that can infect your stomach and cause ulcers. It also seems to increase the risk of pancreatic cancer.

  • Exposure to certain chemicals, especially in the workplace. People who are exposed to certain chemicals at work, like certain dyes, pesticides, dry-cleaning products, and benzene, might have a higher risk of pancreatic cancer.

Other factors might affect pancreatic cancer risk. These include eating an unhealthy diet, not being physically active, and heavy alcohol use. Research on these and other risk factors is in progress.

What are your risk factors?

Talk with your healthcare provider about your risk factors for pancreatic cancer. Ask what you can do about them. Some risk factors, like your age, are not under your control. But there are some things you can do that might help lower your risk:

  • Do not use any form of tobacco. If you do, try to quit.

  • Limit how much alcohol you drink.

  • Reach and stay at a healthy weight. Eating a healthy diet and staying active can help.

  • Avoid exposure to chemicals that might increase your risk. If you work with chemicals, use protective gear.

Should you be screened for pancreatic cancer?

Screening is the process of looking for disease in people who don’t have symptoms. Screening for pancreatic cancer in the general population is not recommended by any major medical group in the U.S. at this time. Still, if you have a strong family history of pancreatic cancer, you might want to talk with your healthcare provider about screening. Or you can ask about genetic counseling and testing to help see if you are at higher risk. Some people at increased risk might benefit from screening.

If your healthcare provider thinks screening might be helpful, an endoscopic ultrasound might be done. This test uses a thin tube called an endoscope with a tiny ultrasound probe on the end. The scope is passed down your throat, through your stomach, and into the first part of your small intestine. A computer uses the sound waves from the probe to make pictures of your pancreas on a screen. If a tumor is seen, a small, hollow needle can be passed through the scope to take small pieces of it for testing. This is called a biopsy. Your healthcare provider can also use other imaging scans to check for pancreatic cancer.

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