Symptoms, Risk and Diagnosis of Pancreatic Cancer

The pancreas has two main functions: to make juices that help digest food, and to make hormones, such as insulin and glucagon, that help control blood sugar levels. The digestive juices are made by exocrine pancreas cells and the hormones are made by endocrine pancreas cells. There are two man types of pancreatic cancer seen at Siteman:

Pancreatic adenocarcinomas: About 95 percent of pancreatic cancers begin in exocrine cells and are very hard to detect because symptoms start later and are non-specific to pancreatic cancer.

Neuroendocrine (islet cell) tumors: Pancreatic neuroendocrine tumors (NETs) may be benign or cancerous. Functional tumors make different kinds of hormones such as gastrin, insulin and glucagon, with different effects on the body.

The main goal at the Siteman Cancer Center is to get a correct diagnosis of your condition and decide on the proper treatment. Specialists here excel in using the technology and experience to make an accurate diagnosis, often down to the genetic level so the best treatment options may be identified.

Estimate your risk for pancreatic cancer.

Symptoms of Pancreatic Adenocarcinoma

There may be no signs or symptoms in the early stages. As the tumor grows, you may experience some of the following:

• Jaundice (yellowing of the skin and whites of the eyes)
• Light-colored stools
• Dark urine
• Pain in the upper or middle abdomen and back
• Weight loss for no known reason
• Loss of appetite
• Feeling very tired

Risk Factors for Pancreatic Adenocarcinoma

• Smoking
• Being obese
• Having a personal history of chronic pancreatitis
• Having a family history of pancreatic cancer or pancreatitis
• Having certain hereditary conditions, such as:
  • Hereditary breast and ovarian cancer syndrome
  • Hereditary nonpolyposis colon cancer (HNPCC; Lynch syndrome)
  • Familial atypical multiple mole melanoma (FAMMM) syndrome

Symptoms of Neuroendocrine (Islet Cell) Tumors

Pancreatic NETs may be functional or nonfunctional. Functional tumors make extra amounts of hormones, such as gastrin, insulin, and glucagon that cause signs and symptoms. In nonfunctional tumors, signs and symptoms are caused by the tumor as it spreads and grows. While most pancreatic NETs are functional and often benign, nonfunctional tumors are usually cancerous.

Too much gastrin can cause: stomach ulcers that keep coming back, pain in the abdomen relieved after taking an antacid, gastric reflux.

Too much insulin can cause: low blood sugar and fast heartbeat.

Too much glucagon can cause: skin rash on the face, stomach, or legs, high blood sugar, blood clots in the lung, arms or legs, weight loss for no known reason, or a sore mouth. 

Too much somatostatin may cause: high blood sugar, gallstones, or jaundice.

Risk Factors for Pancreatic NETs

• Having certain hereditary conditions, such as: Multiple endocrine neoplasia type 1 (MEN1) syndrome

Diagnosing Pancreatic Adenocarcinoma

Making a diagnosis of pancreatic cancer may involve different approaches. The following tests and procedures may be used:

1. Physical exam and history: This basic exam looks at the patient’s past illnesses and treatments, and any signs of disease, or abnormalities
2. Blood chemistry studies: A blood sample is checked to measure the amounts of certain substances like glucose released into the blood by different organs. An unusually higher or lower than normal amount can be a sign of disease in the organ that makes it.
3. Tumor marker test: A sample of blood is checked to measure the amounts of certain substances, such as CA 19-9, made by organs, tissues, or tumor cells in the body. Certain substances are linked to specific types of cancer when found in increased levels. It is not definitive. In ten percent of patients with cancer, it will not be elevated, and some without cancer will have elevated levels.
4. Endoscopic retrograde cholangiopancreatography (ERCP): This procedure uses x-ray of the ducts (tubes) that carry bile from the liver to the gallbladder and from the gallbladder to the small intestine. Sometimes pancreatic cancer causes these ducts to narrow and block or slow the flow of bile, causing jaundice. If the ducts are blocked by a tumor, a fine tube may be inserted into the duct to unblock it and be left in place to keep the duct open. Tissue samples may also be taken and checked under a microscope for signs of cancer.
5. Liver function test: A blood sample is checked to look for unusual amounts of certain enzymes that might indicate the that cancer has spread to the liver
6. Abdominal CT Scan: Detailed pictures inside the body and organs can identify some problems
7. Endoscopic Ultrasound (EUS) with biopsy: This type of imaging uses sound waves instead of radiation to identify abnormal areas in the pancreas or nearby organs that may then be biopsied.

Diagnosing Pancreatic NETs

1. Physical exam and history: This basic exam looks at the patient’s past illnesses and treatments, and any signs of disease, or abnormalities.
2. Chromogranin A test: A blood sample measures the amount of chromogranin A in the blood. A higher than normal amount of chromogranin A and normal amounts of hormones such as gastrin, insulin and glucagon can be a sign of a non-functional pancreatic NET. Other kinds of blood tests may be done to check for functional NETs.
3. Somatostatin receptor scintigraphy: This is a type of radionuclide scan that may be used to find small pancreatic NETs.
4. Abdominal CT Scan: Detailed pictures inside the body and organs can identify some problems.
5. Endoscopic Ultrasound (EUS) with biopsy: This type of imaging uses sound waves instead of radiation to identify abnormal areas in the pancreas or nearby organs.

Staging of Pancreatic Cancer

Staging for exocrine pancreatic cancer is ranked I through IV and recurrent, meaning the cancer comes back after treatment. Most staging is done during diagnosis. For endocrine cancers, staging is not commonly used to determine treatment.

Prognosis

The prognosis (chance of recovery) depends on the following:

• The stage and grade of the cancer
• Whether the cancer has spread outside the pancreas
• The patient’s age and general health
• Whether the cancer has recurred.
• How well their tumor responds to treatment
• How well they tolerate the treatment

Pancreatic cancer is best controlled before it has spread and can be removed by surgery. However the recurrence rate is high. Clinical trials are a good option for getting the latest treatment.

Patient and Caregiver Support

The Pancreatic Cancer Action Network provides information and support for patients, families, caregivers and advocates.