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Pancreatic Cancer:

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The medical team at the University of Michigan Pancreatic Cancer Clinic at the Comprehensive Cancer Center created this booklet to help explain pancreatic cancer and the treatment options available to you. Your medical team is available to help answer questions about this material and to help answer any questions you may have. Do not hesitate to contact us as you make your treatment decisions. Resource phone numbers are listed in the back of this booklet.Throughout this booklet you will find several items that give you more information about a topic. First, you will find key concepts and definitions within boxes in the margins of the text. These definitions provide the foundation for a better understanding of pancreatic cancer. You will also find circles within the text that direct you to more information about a certain topic. The information in this booklet will be reviewed and discussed throughout your treatment. Please bring this booklet with you to all appointments. You will find blank pages at the back of the book to use for questions, appointments or other notes.
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Pancreatic Cancer:

A Patient Guide



Staff of the Comprehensive Cancer Center’s Multidisciplinary Pancreatic
Cancer Program provided information for this handbook:
GI Oncology Program, Patient Education Program, Gastrointestinal Surgery
Department, Medical Oncology, Radiation Oncology and Surgical Oncology




Note: We will refer to this booklet during many of your visits.
Please bring it with you to all appointments.



Digestive System Anatomy
Esophagus
Liver
Stomach
Gallbladder
Duodenum
Colon
Pancreas
(behind the
stomach)



Anatomy of the Pancreas





Celiac

plexus
Pancreatic Duct

Common bile duct







Head
Body
Tail


Pancreas

Sphincter of Oddi
ii


Pancreatic Cancer: A Patient’s Guide

Topic:






C

an be fo

und on page:
I.
PREPARING: Information to help you make treatment decisions

A. Where is the pancreas located?




1
B. What does the pancreas do?




2
C. What is cancer and how does it affect the pancreas?

2
D. How common is pancreatic cancer and who is at risk?
3
E. Is
pancreatic
cancer
hereditary?
3
F. What are the symptoms of pancreatic cancer?


4
G. How is pancreatic cancer diagnosed?



7
H. What are the types of cancer found in the pancreas?

9





II.
TREATMENT: Information about the treatment of pancreatic cancer





A. What are the treatment options?




11
B. How does a patient decide on treatment?


11
C. What factors affect prognosis and recovery?


12

D. Surgery







13
E. Radiation therapy






20
F. Chemotherapy






22
G. Clinical trials







24






III.
MEETING OBSTACLES: Information to help manage physical and
emotional challenges



27

A. What can I do to maintain weight and increase appetite?
28
B. What can be done for itching and yellowing of the skin?
30
C. What can be done to treat pain?




31
D. Why does high blood sugar and diabetes happen?

35
E. What can be done to prevent constipation?


36
F. What
do
pancreatic
enzymes
do?
38
G. What should I do for swollen legs?




39
H. How do I cope with my feelings?




40


IV.
RESOURCES: Information about resources available at UM and

in the community for patients with pancreatic cancer 43
A. Support and Coping Resources





B.


Information
Resources



VIII. Note Pages







44

Calendar & Appointments





46

Maps of the University of Michigan Hospitals



49
Important Phone Numbers





51
iii

Introduction

The medical team at the University of Michigan Pancreatic Cancer Clinic at the
Comprehensive Cancer Center created this booklet to help explain pancreatic
cancer and the treatment options available to you. Your medical team is available to
help answer questions about this material and to help answer any questions you may
have. Do not hesitate to contact us as you make your treatment decisions.
Resource phone numbers are listed in the back of this booklet.


Booklet Key

Throughout this booklet you will find several items that give you more information
about a topic.

First, you will find key concepts and definitions within boxes in the margins of the text.
These definitions provide the foundation for a better understanding of pancreatic
cancer.


You will also find circles within the text that direct you to more
information about a certain topic.


All of this information is available at the Patient Education Resource Center located on
level B1 of the Cancer Center Building.









The information in this booklet wil be reviewed and discussed
throughout your treatment.


Please bring this booklet with you to all appointments.

You will find blank pages at the back of the book to use for
questions, appointments or other notes.
iv


About Pancreatic Cancer

Where is the pancreas located?
The pancreas is pear-shaped and approximately 6-8 inches long. It has a wider end
called the head, the middle part called the body and a tapered end called the tail.
Refer to Figure 1. The head of the pancreas is on the right side of your body. It lies
close to the liver and the section of the small bowel called the ‘duodenum’. The tail is
close to the stomach on the left side of the abdomen. The pancreatic duct is a
channel that runs through the pancreas and empties digestive juices into the small
bowel. The common bile duct is another channel that drains bile from the gallbladder
and runs through the head of the pancreas connecting with the pancreatic duct to
form the Ampulla of Vater.





Celiac

plexus
Pancreatic Duct



Common bile duct






Head
Body
Tail


Sphincter of Oddi
Pancreas

Figure 1. Anatomy of the Pancreas

1

What does the pancreas do?
The pancreas has 2 main functions in the body:
• to make digestive juices (called enzymes) that flow through the
pancreatic ducts and help break down fats and sugars in the digestive
system, and
• to secrete hormones, like insulin, that affect how the body uses and
stores nutrients.

The part of the pancreas that produces the digestive juices is called the exocrine
pancreas and the other part that produce hormones is called the endocrine
pancreas.


What is cancer and how does it affect the pancreas?
Normal cells grow, divide, and die in a control ed fashion that is regulated in the body.
Cancer is a disease where cells divide and grow in an abnormal, poorly controlled
manner where the balance of cell growth and death is disturbed. Medical research
has led to an increase understanding of these abnormalities and continues to be a
focus in the understanding of how to treat cancer.

Cells that continue to grow and divide unchecked become a malignant mass or
tumor that can affect how an organ works. The original site of the abnormal cell
growth is called the cancer’s “primary site”. In pancreatic cancer, the primary site is
the pancreas. Even when the pancreatic cancer is found in areas outside the
pancreas, such as the liver, the disease is still called pancreatic cancer.

Abnormal or unchecked cel s can also grow to invade nearby organs and structures.
Cancer cel s spread and invade organs by traveling to other structures in the body by
way of the lymphatic system and the blood stream. This spreading is called metastasis.


2


How common is pancreatic cancer and who is at risk?
The American Cancer Society estimates that 32,180 men and women will be diagnosed
with pancreatic cancer in 2005. It is the fourth leading cause of cancer death in the
United States. It most commonly affects patients in the 60-80 year age range, although
older and younger patients can be affected. Pancreatic cancer may be related to
exposure to cancer-causing agents called carcinogens.

Some factors that increase the risk of pancreatic cancer are:
• Cigarette smoking
• A diet high in fat and low in fiber
• Diabetes mellitus
• Chronic pancreatitis
• Family history (see below)

There is no reliable way to prevent pancreatic cancer, however, general cancer
prevention guidelines include eating a high-fiber, low-fat diet, exercising, and
avoiding smoking.


Information
Is pancreatic cancer hereditary?
about genetic counseling at the
University of Michigan can be found
Research is being done to better understand possible
at www.mcancer.org or at the
Patient Education Resource Center
hereditary factors in pancreatic cancer. There does
(PERC) on level B1 of the
Cancer Center.
seem to be a hereditary component in 10-15% of
patients with pancreatic cancer. Genetic syndromes such as
hereditary pancreatitis, hereditary nonpolyposis colorectal cancer, familial atypical
multiple mole melanoma syndrome, and Peutz-Jeghers syndrome are currently being
studied for their specific gene changes.

Families with medical histories of known hereditary cancer syndromes that include
pancreatic cancer should consider genetic counseling and testing in a research setting.
Patients who have a family history of colon cancer, pancreatic cancer, and melanoma
may be at an increased risk for pancreatic cancer.
3

What are the symptoms of pancreatic cancer?
Symptoms do vary and are related to the extent of disease and the location of the
tumor in the pancreas. The head of the pancreas is located close to the common bile
duct and duodenum (small bowel) so tumors located in the head of the pancreas
may grow and block these structures. Refer to Figure 2.


Liver


Gallbladder

Stomach

Portal

Vein
Pancreas

Common
Bile Duct

Duodenum

Superior Mesenteric

Artery and Vein

Figure 2. The pancreas and surrounding organs

Jaundice
Bile duct blockage can lead to jaundice in 70-85% of patients with tumors in the head
of the pancreas. Symptoms of jaundice include:
• yellowing of the skin,
• yellowing of the whites of the eyes,
• light-colored (clay colored) bowel movements,
• dark-colored urine and
• itching

4


Nausea, Vomiting, Weight Loss
Stomach emptying can be delayed when the duodenum is compressed. This causes
a feeling of fullness and contributes to symptoms of nausea and vomiting. These
symptoms are initially present in 35-45% of patients with pancreatic cancer. Patients
sometimes have a loss of appetite and nausea that leads to weight loss. In advanced
disease, up to 5% of patients have tumors that cause complete blockage of the
duodenum (small bowel). In this case, surgery may be done to bypass the blockage
and improve digestion.

Fatigue
In more advanced disease, patients can have a feeling of being tired and fatigued.
There are many causes of fatigue in patients with cancer,

Abdominal Pain
75-90% of patients with pancreatic cancer have abdominal pain. This may be
described as cramping or gas-like pain. Pain may also spread, or radiate, to the back
and shoulders.

Blood Clots
There is an increased risk for blood clots in patients with pancreatic cancer. A blood
clot can be a first symptom of pancreatic cancer. The cancer itself causes changes
in the blood that increases the risk for blood clots. Some clots have no symptoms, but
swelling, pain and redness can be present in the area of a clot.

Diabetes
The onset of diabetes mellitus (called simply, diabetes) or difficulty controlling blood
sugar levels is also associated with pancreatic cancer. Diabetes may be diagnosed
before or after the diagnosis of pancreatic cancer. Diabetes occurs when the body
does not produce enough of the hormone, insulin, or is unable to use insulin properly.
Insulin helps your body regulate the blood sugar level, so without insulin, blood sugar
levels are often high.

5

Pancreatic Insufficiency
The pancreas secretes digestive enzymes, or juices into the small intestines. These
juices help digest food in the intestines. Patients with pancreatic cancer may not have
adequate amounts of these juices in the intestines. If this happens, food isn’t digested
normally. This is called pancreatic insufficiency.

Symptoms of pancreatic insufficiency include diarrhea and cramping often after
eating. This happens because food passes through the digestive tract not fully
digested. As the indigestible food passes through, it pulls water into the intestines that
causes diarrhea and cramping. Refer to page 38 for a discussion on management of
pancreatic insufficiency with enzymes.









6


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