Pancreatic Cancer

When facing a pancreatic cancer diagnosis, you want an experienced team on your side. Saint Luke’s is the only cancer program in Kansas City to be nationally recognized as an NPF Pancreatic Cancer Center by the National Pancreas Foundation. Our care team includes leading experts in medical and radiation oncology, surgery, immunotherapy, and genomics. They work together to customize a treatment plan tailored to your unique needs.

Saint Luke’s Cancer Specialists provide early detection, expert diagnosis, personalized treatment options, and survivorship support to every patient. If surgery is needed, the Saint Luke’s Liver Biliary & Pancreatic Center provides expert surgical care for pancreatic cancer patients.

What Is Pancreatic Cancer?

What Is Pancreatic Cancer?

Front view of liver, gallbladder, stomach, and pancreas.Cancer happens when cells in the body begin changing and multiplying out of control. These cells can form lumps of tissue called tumors. Cancer that starts in the pancreas is called pancreatic cancer.

Understanding the pancreas

The pancreas is a gland (an organ that makes substances the body needs) located in the abdomen (stomach area). One of its jobs is to make pancreatic enzymes. They travel to the small intestine to help digest food. The pancreas also makes hormones, like insulin and glucagon, to help control the amount of glucose (sugar) in the blood.

When pancreatic cancer forms

Pancreatic cancer forms when cells in the pancreas change and multiply abnormally. This cancer can interfere with the working of the pancreas and may invade nearby organs. Pancreatic cancer may also spread to other parts of the body. This spread is called metastasis. The more cancer spreads, the harder it is to treat.

Treatment choices for pancreatic cancer

You and your healthcare provider will discuss a treatment plan that's best for your needs. Treatment choices may include:

  • Surgery to remove the cancer in the pancreas and sometimes surrounding tissue.

  • Radiation therapy, which uses directed rays of energy to kill cancer cells.

  • Chemotherapy, which uses strong medicines to kill cancer cells.

Diagnosis

Pancreatic Cancer: Diagnosis

If your healthcare provider thinks you might have pancreatic cancer, you’ll need certain exams and tests to be sure. Diagnosing pancreatic cancer starts with your healthcare provider asking you questions. He or she will ask you about your health history, your symptoms, risk factors, and family history of disease. Your healthcare provider will also give you a physical exam.

What tests might I need?

You may have one or more of the following tests:

  • Blood tests

  • Imaging and endoscopy tests

  • Pancreatic biopsy

Blood tests

You may have blood tests to look for signs of pancreatic cancer.

Liver function tests (LFTs)

These tests look for certain chemicals in your blood. They can sometimes help tell if a bile duct is blocked. This might be from a pancreatic tumor. These tests can't tell for sure if you have pancreatic cancer. This is because there are other causes of blocked bile ducts. But if the results of these tests are abnormal, your healthcare provider may do other tests to check for cancer.

CA19-9

This is a tumor marker. It’s a substance that can sometimes be found in your blood if you have cancer. This test by itself cannot diagnose pancreatic cancer, because not everyone who has pancreatic cancer has a high CA19-9 level. Plus, sometimes people have an elevated CA19-9 level without having pancreatic cancer. But if this test is abnormal, your healthcare provider might do other tests to look for pancreatic cancer. 

Imaging and endoscopy tests

Your healthcare provider may do imaging and endoscopy tests to look for pancreatic cancer. Imaging tests use X-rays, sound waves, or other ways of taking pictures of the inside of your body. For endoscopy tests, a thin tube (endoscope) is put into your body. This lets your healthcare provider see organs and other tissues.

Ultrasound

An ultrasound uses sound waves to look for abnormalities in your pancreas and bile ducts. The sound waves bounce off body parts and send back a series of signals. Then a computer turns these into images of your body. This might be the first imagine test you have because it’s easy and doesn’t use radiation. During an ultrasound, the sound waves come from a wand-like instrument that’s placed on the skin over your abdomen and aimed at your pancreas.

For an endoscopic ultrasound (EUS), the image of the pancreas is taken from inside your body. This makes a better picture. Your healthcare provider puts a thin, lighted tube called an endoscope down your throat, through your stomach, and into the first part of the small intestine. At the tip of the scope is an ultrasound device. It bounces waves into the nearby area, including the pancreas, to make an image of it. During the test, if your healthcare provider sees anything suspicious, he or she may pass a small, hollow needle down the endoscope to take a sample of tissue. This is called a biopsy.

CT scan

A CT scan uses X-rays taken from many angles. It creates very detailed cross-section pictures of your pancreas and nearby organs. This test can often show pancreatic tumors and blocked bile ducts.

Positron emission tomography (PET) scan

For this test, your healthcare provider injects a radioactive substance, usually bound to a type of sugar, through your vein. Then your body is scanned. The radioactive sugar substance collects in cancer cells, which will show up on images. The picture from this test is not as detailed as a CT scan. It isn’t used alone to diagnose pancreatic cancer, but it can still sometimes be helpful. A PET scan may be done in combination with a CT scan (PET/CT scan). 

MRI

This test creates detailed images of your pancreas and nearby organs. It does this by using magnets and radio waves. While MRIs can show more detail than other imaging tests, they aren’t used as often as CT scans when looking for pancreatic cancer.

Endoscopic retrograde cholangiopancreatography (ERCP)

This test is a type of X-ray test to look at the bile ducts and the pancreatic duct. Your healthcare provider inserts an endoscope down your throat, through your stomach, and into your small intestine. Then, he or she slips a smaller tube through the larger tube into the common bile duct. Next, he or she injects dye through the tube. This goes into your bile and pancreatic ducts. Your healthcare provider then takes X-rays of the area to look for any places that might be blocked by a tumor. If your healthcare provider sees anything suspicious, he or she may take a tissue sample (biopsy) and check it for cancer.

Magnetic resonance cholangiopancreatography (MRCP)

This test is similar to an ERCP except it uses an MRI instead of an endoscope. MRCP can show both the bile ducts and the pancreatic duct without the need for an endoscope. However, if your healthcare provider sees something suspicious, he or she cannot take a biopsy during this test.

Percutaneous transhepatic cholangiography (PTC)

This is another type of X-ray test of the bile duct. Your healthcare provider puts a thin needle through the skin on the right side of your abdomen and into your liver. He or she injects dye through the needle. The dye highlights blockages in bile ducts. These can then be seen on an X-ray. If a blocked bile duct is seen, your healthcare provider may take a biopsy and check it for cancer. Because this test is more invasive, it’s only done if an ERCP cannot be done.

Pancreatic biopsy

If an imaging test shows something in your pancreas that looks like it might be cancer, your healthcare provider may take small samples of pancreas tissue. This is called a biopsy. This is usually the only way to be sure of a pancreatic cancer diagnosis. A doctor who specializes in looking at cells, called a pathologist, looks at the samples under a microscope. He or she can tell whether they contain cancer. There are different types of biopsies.

Percutaneous (though the skin) needle biopsy

For this test, your healthcare provider puts a thin, hollow needle through your skin and into the pancreatic tumor to get a sample of it. This is usually done during a CT scan or ultrasound of the pancreas. This lets your healthcare provider see the needle going into the tumor. 

Endoscopic biopsy

During procedures such as endoscopic ultrasound or ERCP, your healthcare provider may pass long, thin instruments down the scope to take samples of suspicious areas. This might be done with a thin, hollow needle or with a small brush.

Laparoscopic biopsy

For this test, your surgeon makes a small cut on your abdomen. He or she then puts a thin tube with a light and a tiny video camera on the end. This lets your him or her see your pancreas and nearby areas. Your surgeon may make other small cuts to insert other tools to remove cells for testing.

Getting your test results

When your healthcare provider has the results of your tests, he or she will contact you. Your provider will talk with you about other tests you may need if pancreatic cancer is found. Make sure you understand the results and what follow-up you need.

Treatment Choices

Pancreatic Cancer: Treatment Choices

Various types of treatment can be used for pancreatic cancer. Which may work best for you? It depends on a number of factors. These include the size, location, and stage of your cancer. Factors also include your age, overall health, and what side effects you’ll find acceptable.

Learning about your treatment options

You may have questions and concerns about your treatment options. You may also want to know how you’ll feel and function after treatment, and if you’ll have to change your normal activities.

Your healthcare provider is the best person to answer your questions. He or she can tell you what your treatment choices are, how successful they’re expected to be, and what the risks and side effects are. Your healthcare provider may suggest a specific treatment. Or he or she may offer more than one, and ask you to decide which one you’d like to use. It can be hard to make this decision. It is important to take the time you need to make the best decision.

Deciding on the best plan may take some time. Talk with your healthcare provider about how much time you can take to explore your options. You may want to get another opinion before deciding on your treatment plan. In fact, some insurance companies may require a second opinion. In addition, you may want to involve your family and friends in this process.

Understanding the goals of treatment for pancreatic cancer

For some pancreatic cancers, the goal of treatment is to cure the cancer. If cure isn’t possible, treatment may be used to shrink the cancer or keep it under control for as long as possible. Treatment can also improve your quality of life by helping to control the symptoms of the disease. The goals of treatment can include one or more of these things:

  • Remove or destroy the cancer in your pancreas

  • Remove or destroy tumors in other parts of your body

  • Stop or slow the growth or spread of pancreatic cancer cells

  • Prevent or delay the cancer from coming back

  • Ease symptoms from the cancer. These can include pain or pressure on your organs.

Types of treatment for pancreatic cancer

Several types of treatment can be used for pancreatic cancer. Different combinations of treatment may be used. These depend on a number of factors, such as: 

  • The size and location of the cancer 

  • The stage (extent) of the cancer

  • Your age and overall health

  • Your personal concerns and preferences

Each treatment has its own goals.

Surgery

This is often the preferred treatment for early stage pancreatic cancer if it can be done. This is because it may cure the cancer if it’s caught early enough. Unfortunately, pancreatic cancer has usually spread too far to be removed completely. If the cancer can’t be removed, your healthcare provider might still suggest a less extensive surgery to ease symptoms.

Radiation therapy

This treatment is often used with chemotherapy, either before or after surgery. Radiation and chemotherapy (chemo) before surgery can help shrink a tumor and make it easier to take out. After surgery, radiation and chemo can be used to try to kill any cancer cells that are left. Radiation may also be used as part of the main treatment in people who can't have surgery. Or it may be used to help relieve symptoms in people with advanced cancer.  

Chemo and targeted therapy

For pancreatic cancer, chemo may be used before or after surgery (often with radiation). Or it may be the main treatment for people who can't have surgery. Targeted therapy medicines work differently from standard chemo medicines. They may be used along with chemo in some situations.

Supportive care

Your healthcare provider may suggest treatments that help ease your symptoms, but don’t treat the cancer. These can sometimes be used along with other treatments. Or your healthcare provider may suggest supportive care if he or she believes that available treatments are more likely to do you more harm than good.

Clinical trials for new treatments

Researchers are always looking for new ways to treat pancreatic cancer. These new methods are tested in clinical trials. Talk with your healthcare provider to find out if there are any clinical trials you should consider.

Talking with your healthcare provider

At first, thinking about treatment options may seem overwhelming. Talk with your healthcare team and loved ones. Make a list of questions. Consider the benefits and possible side effects of each option. Discuss your concerns with your healthcare provider before making a decision.

Pancreatic Cancer Statistics

Pancreatic Cancer: Statistics

What are statistics?

Some people use numbers called statistics to figure out their chances of getting cancer. Or they use them to try to figure out their chances of dying from cancer. Because no 2 people are alike, statistics can’t be used to predict what will happen to 1 person. The statistics below describe large groups of people. They do not take into account a person's own risk factors, such as family history, behaviors, or cancer screenings. If you have questions, talk with your healthcare provider.

What are the statistics for pancreatic cancer?

Here are some statistics about pancreatic cancer:

  • About 55,440 new cases of this cancer will be diagnosed in the United States in 2018.

  • About 44,330 people will die of pancreatic cancer in 2018.

The average person's risk of getting this cancer in their lifetime is about 1 in 65 for women and 1 in 63 for men. Your chance of getting this cancer may be higher or lower. This depends on your risk factors.

Source: American Cancer Society

Clinical Trials

A Phase III Study of BBI-608 plus nab-Paclitaxel with Gemcitabine in Adult Patients with Metastatic Pancreatic Adenocarcinoma

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Randomized Phase II Study of Perioperative mFOLFIRINOX Versus Gemcitabine/Nab-Paclitaxel as Therapy for Resectable Pancreatic Adenocarcinoma

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A Phase IB/II Randomized Study of Modified FOLFIRINOX + Pegylated Recombinant Human Hyaluronidase (PEGPH20) Versus Modified FOLFIRINOX Alone in Patients with Good Performance Status Metastatic Pancreatic Adenocarcinoma

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A Phase II-R and a Phase III Trial Evaluating Both Erlotinib (Ph II-R) and Chemoradiation (Ph III) as Adjuvant Treatment for Patients with Resected Head of Pancreas Adenocarcinoma

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A Phase II Study of MLN0128 (TAK-228) in Rapalog-Resistant Advanced Pancreatic Neuroendocrine Tumors (PNET)

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Preoperative Extended Chemotherapy vs. Chemotherapy Plus Hypofractionated Radiation Therapy for Borderline Resectable Adenocarcinoma of the Head of the Pancreas

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News

MEDIA COVERAGE: Saint Luke's Announces Center for Precision Oncology
Our precision oncology experts treat your tumor’s mutation, not just your cancer’s location. It’s the only program within 450 miles that offers this level of expertise in clinical oncology, tumor genomics, and computational biology.
MEDIA COVERAGE: Saint Luke's signs cancer trial agreement with hospital with National Cancer Institute designation
Saint Luke’s Health System has signed an agreement with Washington University’s Alvin J. Siteman Cancer Center that will give its patients access to National Cancer Institute trials for new treatments.

Saint Luke’s Cancer Institute

Saint Luke's provides comprehensive cancer care, from expert diagnosis and personalized treatment plans to survivorship support.