pancreas cancer : The Pancreatic and Biliary Disease

Pancreatic Cancer
The fourth leading cause of cancer death, pancreatic cancer, will probably kill about 29,000 Americans in 2001. It strikes men and women equally. Like so many other cancers, the earlier it's caught, the greater the chances of survival. However, there is no way to screen for it. By the time symptoms appear, it's usually too late for a cure.

The Pancreatic and Biliary Disease Program in conjunction with the Samuel Oschin Comprehensive Cancer Institute diagnoses and treats pancreatic cancer.


Diagnosis
The exocrine part of the pancreas (which produces the digestive fluids that help break down fats, proteins and carbohydrates) is where 95% of all pancreatic cancers, or adenocarcinomas, begin. The other 5% grow in the endocrine section, where hormones like insulin are made. It's important to identify which type of tumor it is, since they behave, develop and respond to treatment differently.

Pancreatic cancer's symptoms are like those of many other pancreatic conditions. Early on, there may be no symptoms at all. As the tumor develops, the patient may have abdominal pain, nausea, loss of appetite, weight loss and jaundice. Other symptoms include itching, brown urine and light clay-colored stools. But these symptoms can point to other conditions as well. That's why it's important to be seen by an expert, who may use any of the following tests:

Lab tests: basic blood work; a test called CA19-9.
Ultrasound: though not a definitive test for tumors, it is a good way to find gallstones or cysts in the pancreas.
Computed tomography (CT): these three-dimensional X-rays are the most accurate test for cancer. A CT scan is also used to guide a biopsy needle exactly to the tumor to take a tissue sample for lab analysis.
Magnetic resonance imaging (MRI): this uses magnetic fields and radio waves to create detailed images of soft tissue. A special type, magnetic resonance cholangiopancreatography (MRCP), can find blockages in the pancreatic and bile ducts.
Endoscopic retrograde cholangiopancreatography (ERCP): The doctor uses an endoscope (a flexible tube with an optical device) to reach the duodenum and injects a dye to outline the bile and pancreatic ducts. He or she may take a fluid sampling, remove a gallstone or unclog a blockage. This is considered the 'gold standard' for pancreatic and biliary diagnosis, but there is a 2 to 5% risk of causing pancreatitis.

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