Pancreatic cancer care at HonorHealth

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With one of the highest mortality rates among all cancer types, pancreatic cancer claims about 40,000 lives annually. It also is one of the most challenging types of cancer to treat because it grows undetected for years and symptoms are slow to appear.

With a proven track record of advances in diagnosing and treating pancreatic cancer, the HonorHealth Virginia G. Piper Cancer Care Network provides the personalized care and attention you need. That care starts with genetic counseling and an assessment of your individual risk of developing pancreatic cancer. And, if you've been diagnosed with the disease, the team of specialists and staff will help you understand advances in treatment and determine the right course of treatment.

Advances in drug discovery are showing promise in treating all stages of pancreatic cancer. HonorHealth offers some of the most promising pancreatic cancer clinical trials and research studies in the country. The HonorHealth Research Institute has been instrumental in developing and fast-tracking FDA approval for many of the current advances in pancreatic cancer treatment. In fact, a drug developed through a partnership with HonorHealth is the first FDA-approved drug shown to extend the lives of stage 4 patients.

Causes and survivability

Pancreatic cancer has a strong hereditary component, with at least 5-10 percent resulting from an inherited gene mutation. As with all hereditary cancers, pancreatic cancer that's caused by an inherited gene mutation is usually more aggressive and difficult to treat. It also tends to surface at a younger age.

pancreatic cancer risk factors

Many patients ask why mortality rates for pancreatic cancer are so high. Pancreatic cancer usually grows and spreads for quite some time before symptoms begin to surface. As a result, pancreatic cancer is often detected and diagnosed in the later stages of the disease cycle, after it has spread beyond the pancreas. That's why it is particularly important to find a cancer expert who understands how the disease grows and responds to treatment.

Types of pancreatic cancer

Pancreatic cancer is classified in two broad categories — exocrine and endocrine disease. The disease type is related to the type of cells that make up the cancer tumor. Most pancreatic cancers are exocrine cancers. Endocrine pancreatic cancers, sometimes called pancreatic neuroendocrine tumors or islet cell tumors, are much less common.

What is exocrine pancreatic cancer?

The most common subtype of exocrine pancreatic cancer is pancreatic adenocarcinoma. It generally starts in the ducts of the pancreas but also can form from the actual cells that create digestive enzymes. Other subtypes include:

  • Adenosquamous carcinomas.
  • Squamous cell carcinomas.
  • Signet ring cell carcinomas.
  • Undifferentiated carcinomas.

Symptoms can include jaundice, blood clots, dark urine, light-colored, greasy and/or floating stools, upper abdominal or back pain, nausea and vomiting, weight loss or loss of appetite, enlarged liver or gallbladder, fatty tissue abnormalities under the skin, diabetes and itchy skin.

What is endocrine pancreatic cancer?

Tumors that develop from endocrine cells can be benign (noncancerous) or malignant (cancerous). Many of these tumors produce hormones excreted into the blood, causing noticeable symptoms.

The names of endocrine pancreatic cancers, which also are referred to as neuroendocrine tumors, correspond to the specific type of hormones they produce, including:

  • Gastrinomas.
  • Insulinomas.
  • Glucagonomas.
  • Somatostatinomas.
  • VIPomas (vasoactive intestinal peptide).
  • PPomas (pancreatic polypeptide).

The two most common subtypes of endocrine pancreatic cancer are gastrinomas and insulinomas.

Symptoms of endocrine pancreatic cancers vary based on the type of hormones the tumors release into the bloodstream. Some cancers don't show symptoms until after they have spread beyond the pancreas. When these cancers spread to the liver, it enlarges and causes abdominal pain and a loss of appetite. Other symptoms can include jaundice, shortness of breath or a lingering cough.

Some endocrine tumors don't create or release hormones so they don't produce cancer symptoms. This explains why they aren't usually discovered until they become quite large, often in the later stages of the disease course.

Diagnosing pancreatic cancer

In addition to an in-office physical exam that may reveal an enlarged mass in the abdomen or swollen lymph nodes, your doctor may order blood tests; medical imaging tests such as an ultrasound, CT scan, PET scan, or MRI; endoscopy; and/or biopsy to collect a tissue sample or cells.

Two other specialized and widely used imaging tests to diagnose pancreatic cancer are:

  • Endoscopic retrograde cholangiopancreatography, or ERCP, uses a camera attached to a flexible tube called an endoscope. It's inserted through the mouth and into the small intestine to take images and collect tissue samples using a small brush-like attachment. The imaging test involves injecting a special dye into the bile ducts in your pancreas so they appear on an X-ray. A biopsy to collect tissue or cell samples may also be done.
  • Endoscopic ultrasound obtains a picture of your pancreas from inside the abdomen using sound waves. In some cases, a biopsy to collect cells may be done during the endoscopic ultrasound.

Stages of pancreatic cancer

Tests performed to make a diagnosis also help your doctor determine to which stage pancreatic cancer has progressed. This includes knowing exactly where the cancer is located, whether it has metastasized, or spread to other organs, and to which organs it has spread.

The four stages of pancreatic cancer are:

  • Stage 1: Cancer is limited to the pancreas.
  • Stage 2: Cancer has spread to tissues, organs and/or lymph nodes.
  • Stage 3: Cancer has spread to major blood vessels surrounding the pancreas.
  • Stage 4: Cancer has spread to distant organs such as the liver and/or lungs.

As usual with cancer, the earlier you detect the disease, the better your chances of surviving it. The stage of your cancer guides your HonorHealth Virginia G. Piper Cancer Care Network doctors as they create your personalized treatment plan. The stage also helps your doctors determine your prognosis or chance of recovery.

Treatment options for pancreatic cancer

There are multiple treatment options for every stage of pancreatic cancer, whether it's been diagnosed early or late. In the early stages, doctors may be able to surgically remove the cancerous mass. In late stages, however, treatment may focus more on controlling the cancer.

Treatment options are:

  • Surgery, which may include the Whipple procedure. The complex surgery involves removing the head of the pancreas along with portions of the small intestine, bile ducts, gallbladder and stomach. The surgeon then reconnects the digestive tract and biliary system so you can eat and digest food normally.
  • Ablation to destroy the tumor, using radiofrequency waves, microwave therapy or cold therapy.
  • Chemotherapy.
  • Radiation therapy.
  • Immunotherapy.
  • Clinical trials.

A multidisciplinary team of medical oncologists, surgeons, nurses, radiation oncologists, radiologists, pathologists, genetic counselors and other cancer will create the treatment plan tailored to you and the unique aspects of your disease.

Support services for pancreatic cancer patients

Support services are tailored to your individual cancer type and your personal preferences. Additionally, a pancreatic cancer support group meets the second Monday of the month from 4 to 5:30 p.m. at 10460 N. 92nd St., Scottsdale, first-floor conference room. There is no cost to attend. To register, call 480-323-1321.

Because pancreatic cancer impacts your body's ability to turn what you eat into fuel, your digestion and ability to regulate blood sugar can be affected. Chemotherapy, radiation, surgery and other pancreatic cancer treatments can also make it difficult to get the nutrition you need.

HonorHealth can help you overcome the various nutrition hurdles that accompany pancreatic cancer and related treatment through nutritional counseling. One-on-one consultations with registered dietitians and nutritionists can help you understand your nutrition needs. To make an appointment with a board-certified cancer dietitian, call 480-882-4703 and/or have your physician fax a referral to 480-882-6188.