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What is pancreatic cancer?

    
Pancreatic cancer happens when abnormal cells grow and start to form tumors in the pancreas. The pancreas produces substances that help your body digest food, as well as insulin and other hormones that help control your blood sugar.

There are two main types of pancreatic tumors: exocrine and endocrine. The type of tumor depends on which type of cells are involved. Exocrine cells make digestive juices and endocrine cells make insulin. Most people with pancreatic cancer have exocrine tumors, which grow faster than endocrine tumors.

Treatments are more successful when the cancer is found early. But in most cases, pancreatic cancer has already spread by the time it is found. Still, treatment may help you feel better, and it helps some people live longer.

Our approach

Northwell Health Cancer Institute takes a comprehensive approach to treating pancreatic cancer. Our multidisciplinary team of specialists has unparalleled experience diagnosing and treating pancreatic cancer at one of the largest cancer centers in the New York metro area. We offer specialized therapies available at only a few cancer centers in the nation, including:

  • Minimally invasive and robotic surgical techniques, which result in quicker recovery, less pain and less scarring
  • Cutting-edge approaches to delivering chemotherapy
  • Precision external beam radiation therapy techniques that protect healthy tissue while targeting diseased areas, including stereotactic body radiation therapy (SBRT)
  • Targeted therapies that identify and attack cancer cells
  • Biologic therapy that boosts the immune system to fight the cancer 
  • Leading-edge therapies that help reduce fatigue, alleviate pain and help the patient stay strong and independent 
  • A broad range of supportive care services

If you have been diagnosed with pancreatic cancer, your oncologist will explain all your treatment options and create a treatment plan tailored to your specific needs and goals. Throughout your treatment, you will work closely with a dedicated team of specialists in medical oncology, surgical oncology and radiation oncology who collaborate to ensure seamless coordination of your care. Because every pancreatic cancer diagnosis is unique, the physicians providing your treatment will meet once a week to share ideas and review every step of your care. 

Research at Northwell

As part of your pancreatic cancer treatment plan, you may have opportunities to participate in clinical trials. These trials study new chemotherapy drugs, radiation technologies and surgical approaches. While not every patient is a candidate for clinical trials, your care team will work with you to determine eligibility. Learn more about clinical trials at Northwell Health.

Symptoms

Pancreatic cancer usually doesn't cause symptoms at first. It's silent and painless. Symptoms usually don't begin until the cancer has spread. They may include:

  • Pain in the upper belly or back
  • Jaundice, a yellowing of the skin and the whites of the eyes, which happens when the growing tumor presses the bile duct closed
  • Unexpected weight loss
  • Loss of appetite
  • Extreme tiredness

Of course, there are other conditions that cause these symptoms, so they don't necessarily mean you have cancer. But it's important to talk to your doctor if you have any of these problems.

Causes

Experts don't know what causes pancreatic cancer. But they do know that changes in the body's DNA play a role in many cancers.

Risk factors

Your risk of getting pancreatic cancer is higher if you:

  • Smoke
  • Have diabetes
  • Have chronic pancreatitis
  • Have a family history of pancreatic cancer
  • Have certain rare inherited conditions, such as hereditary pancreatitis or Lynch syndrome

Diagnosis

    
The first step to making a pancreatic cancer diagnosis is usually a physical, during which a doctor will look for symptoms of pancreatic cancer and other signs. The doctor will also consider personal and family medical history. If pancreatic cancer is suspected, you will be sent for further tests. 

Various procedures and tests are typically used to deliver an accurate pancreatic cancer diagnosis as well as to determine the stage, or extent, of the cancer. These include:

  • Blood tests—Special blood tests check for elevated levels of substances that can indicate tumors, blockages and the presence of cancer.
  • Endoscopic ultrasound (EUS)—A thin, lighted tube called an endoscope is inserted into the body. It emits ultrasound waves and creates images of internal organs and structures.
  • Endoscopic retrograde cholangiopancreatography (ERCP)—With the aid of a video endoscope, this x-ray examination detects blockages and other abnormalities in the pancreas.  
  • Biopsy—A sample of pancreatic tissue is removed by a needle or during a laparoscopic surgical procedure. It is then examined under a microscope by a pathologist to look for signs of cancer.
  • Imaging tests, including:

Treatment

When detected at an early stage, pancreatic cancer has a significantly higher chance of being successfully treated. Surgery, chemotherapy and radiation are the main treatments for pancreatic cancer. New treatment protocols, as well as advanced treatments, are enabling patients to live longer with a better quality of life.

  • Surgery—Surgical treatment for pancreatic cancer includes removing all or part of the pancreas. This can often be performed using minimally invasive surgery. Surgery is not always an option for pancreatic cancer because it is frequently not diagnosed until after the disease has spread. In many cases, other therapies will be combined with surgery to provide the best possible outcome.
  • Chemotherapy—Chemotherapy is used to treat both locally advanced or metastatic pancreatic cancer. Often, a combination of two or more drugs are used together. Chemotherapy is also used as a palliative treatment to minimize symptoms of the cancer.
  • Radiation therapy—Radiation treatment is frequently used for treatment of pancreatic tumors. External-beam radiation therapy is most often used for pancreatic cancer. Higher doses of stereotactic body radiation therapy (SBRT) can provide more localized treatment. Chemotherapy is sometimes given at the same time as radiation therapy to enhance the effect of the radiation. Radiation can also be used to help control pain by shrinking the tumor so that it doesn't press on nerves or other organs.

Living with

  • Take your medicines exactly as prescribed. Call your doctor if you think you are having a problem with your medicine. You may get medicine for nausea and vomiting if you have these side effects.
  • Eat healthy food. If you do not feel like eating, try to eat food that has protein and extra calories to keep up your strength and prevent weight loss. Drink liquid meal replacements for extra calories and protein. Try to eat your main meal early.
  • Get some physical activity every day, but do not get too tired. Keep doing the hobbies you enjoy as your energy allows.
  • Take steps to control your stress and workload. Learn relaxation techniques.
    • Share your feelings. Stress and tension affect our emotions. By expressing your feelings to others, you may be able to understand and cope with them.
    • Consider joining a support group. Talking about a problem with your spouse, a good friend, or other people with similar problems is a good way to reduce tension and stress.
    • Express yourself through art. Try writing, crafts, dance, or art to relieve stress. Some dance, writing, or art groups may be available just for people who have cancer.
    • Be kind to your body and mind. Getting enough sleep, eating a healthy diet, and taking time to do things you enjoy can contribute to an overall feeling of balance in your life and help reduce stress.
    • Get help if you need it. Discuss your concerns with your doctor or counselor.
  • If you are vomiting or have diarrhea:
    • Drink plenty of fluids (enough so that your urine is light yellow or clear like water) to prevent dehydration. Choose water and other caffeine-free clear liquids. If you have kidney, heart, or liver disease and have to limit fluids, talk with your doctor before you increase the amount of fluids you drink.
    • When you are able to eat, try clear soups, mild foods, and liquids until all symptoms are gone for 12 to 48 hours. Other good choices include dry toast, crackers, cooked cereal, and gelatin dessert, such as Jell-O.
  • If you have not already done so, prepare a list of advance directives. Advance directives are instructions to your doctor and family members about what kind of care you want if you become unable to speak or express yourself.
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