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Introduction to Pancreatic Cancer Patient Care at BMC

Boston Medical Center's Hepatobiliary and Pancreatic Tumor Program was established in 2008 to effectively treat the growing number of patients being diagnosed with cancers of the liver, bile ducts, gallbladder, and pancreas.

In a highly supportive and collaborative environment, physicians who are nationally recognized leaders in the care of patients with all stages of pancreatic cancer provide the most advanced, coordinated, and comprehensive medical care available—treatment that is effective and innovative in curing and controlling cancer and managing its impact on quality of life.

At BMC, diagnosis and treatment of patients with pancreatic cancer combines the resources of a multidisciplinary clinical center dedicated to personal, patient-focused care with the state-of-the-art expertise and technological advances of a major teaching hospital. As the primary teaching affiliate of the Boston University School of Medicine, BMC is at the forefront of clinical practice, surgical expertise, and research in oncology.

What Is Pancreatic Cancer?

Pancreatic cancer is caused by the abnormal growth of cells in the pancreas.

The pancreas is located deep inside the abdomen behind the stomach in an area called the retroperitoneum and is surrounded by the liver, spleen, small intestine, and other organs.

There are two types of glands in the pancreas: exocrine glands and endocrine glands. Exocrine glands produce pancreatic enzymes that help to digest proteins and starches. These enzymes are secreted into the pancreatic duct and empty into the first part of the small intestine, called the duodenum, when eating.

Endocrine glands (found in clusters called islets) produce insulin and other regulatory hormones. These hormones circulate through the body via the bloodstream and keep various systems in check. For example, insulin helps regulate blood sugar levels.

Pancreatic tumors can be benign (noncancerous) or malignant (cancerous). Benign tumors are generally not life threatening and can often be removed. Malignant tumors, on the other hand, can be life threatening, as they sometimes invade surrounding tissues and organs and can spread to distant sites in the body.

Pancreatic cancers are divided by location. Proximal pancreatic cancers are cancers that develop in the uncinate process and head of the pancreas. Distal pancreatic cancers are cancers that develop in the body and tail of the pancreas.

Pancreatic cancers can develop in both exocrine and endocrine cells. Exocrine tumors are more common than endocrine tumors (also referred to as islet cell tumors or neuroendocrine tumors).

Symptoms of Pancreatic Cancer

Many early-stage pancreatic cancers do not cause symptoms, with symptoms only developing with progression. Common symptoms include:

  • Yellow skin and eyes, dark urine, and pale stools (jaundice)
  • Pain in the upper abdomen
  • Chronic pain the middle part of the back
  • Nausea and vomiting
  • Stools that float in the toilet
  • Loss of appetite or feeling full
  • Unintentional weight loss
  • Weakness and fatigue

Many of these symptoms can be caused by health problems other than pancreatic cancer. Individuals experiencing any of these symptoms should see their physician.

Causes of Pancreatic Cancer

Although the exact causes of pancreatic cancer remain unknown, certain risk factors connected to the disease have been identified:

  • Tobacco use: Smoking tobacco is a key risk factor for developing pancreatic cancer. Smokers are at twice the risk of developing the disease as nonsmokers (American Cancer Society 2015a).
  • Age and sex: The risk of developing pancreatic cancer increases with age, and the disease is more prominent in men versus women.
  • Race: Pancreatic cancer occurs more frequently in African Americans than Caucasians, although the reasons for this are not completely understood.
  • Family history and genetic mutations: One in 10 cases of pancreatic cancer are considered familial and are thought to be the result of genetic mutations (American Cancer Society 2015a). Genetic testing can detect these mutations in some cases.
  • Obesity: The risk of developing pancreatic cancer is approximately 20% higher in people who are overweight or obese (American Cancer Society 2015b).
  • Diabetes: Type 2 diabetes is associated with pancreatic cancer, and while the association is not clear, it may increase a person's risk of developing the disease.
  • Pancreatitis and cirrhosis: The risk of developing pancreatic cancer is higher in people who have chronic pancreatitis (inflammation of the pancreas) and cirrhosis (scarring of the liver due to inflammation).

Risk factors currently under study include diet (particularly a diet high in animal fat) and alcohol consumption (American Cancer Society 2015a; National Cancer Institute 2010)

References

American Cancer Society. 2015a. Pancreatic Cancer Overview. PDF.

-----2015b. "What are the risk factors for pancreatic cancer?" Last modified January 9, 2015.
http://www.cancer.org/cancer/pancreaticcancer/detailedguide/pancreatic-cancer-risk-factors

American Joint Committee on Cancer. 2009. Pancreas Cancer Staging. 7th ed. PDF. https://cancerstaging.org/references-tools/quickreferences/Documents/PancreasSmall.pdf

National Cancer Institute. 2010. What You Need To Know About™ Cancer of the Pancreas. Bethesda: National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services. http://www.cancer.gov/publications/patient-education/pancreas.pdf

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