Ask the Doctors by Eve Glazier, M.D. and Elizabeth Ko, M.D

Pancreatic Cancer's Location Makes It Difficult to Diagnose

Dear Doctor: Is there a cure for pancreatic cancer? Does anyone know what causes it? Does eating raw steak cause it? Or smoking?

Dear Reader: At this time, there is no known cure for pancreatic cancer, the third most deadly cancer in the United States. Symptoms of pancreatic cancer are so vague that they can be confused with a range of other diseases and conditions. Because there is no reliable screening test at this time to catch pancreatic cancer in its earlier stages, it is often diagnosed only after it has spread.

The pancreas is a spongy gland, about 6 to 10 inches long, wide at the head and narrow at the tail, with a shape that has been compared to a fish. Its job is to make enzymes to help with digestion and hormones that play a role in the regulation of blood sugar. The pancreas is located in the upper left part of the abdomen, between the stomach and the spine. Also surrounding it are the liver, spleen and small intestine, a location that adds to the challenge of making an accurate diagnosis when anything goes wrong.

The majority of the pancreas -- 95 percent -- is devoted to tissues that produce enzymes. The remaining 5 percent is made up of endocrine cells, which secrete hormones, including insulin. Cancer can start in either of these two types of tissues, but the most common form occurs in the enzyme-producing cells and ducts.

Although the exact cause of pancreatic cancer has not yet been identified, certain risk factors are known. As you mention, cigarette smoking is one of the risk factors. So is a family history of the disease, as well as repeated bouts of pancreatitis, an inflammatory condition in which the pancreatic enzymes build up and begin to digest the organ. Pancreatic cysts are also believed to be possible precursors of cancer. We don't know of a connection between eating raw beef and this type of cancer.

When cancer develops in the pancreas, it interferes with the normal functioning of the organ. This results in symptoms that can include pain in the upper abdomen, fluid build-up, nausea, weight loss, jaundice, poor appetite, loose and foul-smelling stools, or diarrhea. In some cases, the sudden onset of diabetes can be a symptom of pancreatic cancer. But as we mentioned before, the location of the pancreas, deep in the abdomen and amid a cluster of other organs, makes it a challenge to accurately identify the source of the symptoms.

Treatment includes surgery, chemotherapy, ablation (extreme cold or heat), radiation and certain drug regimens. The approach chosen depends on the type of cells that are involved, the age of the patient and the stage of the disease. Also a factor is how the patient feels about the possible side effects of a recommended treatment, and the likelihood that it will be helpful.

Despite being a deadly cancer in which survival rates have not measurably improved in 40 years, pancreatic cancer has a low profile. In our opinion, research money directed to developing a reliable screening test for pancreatic cancer should become a priority.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)