Patients and Caregivers

Pancreatic Cancer

Overview

The pancreas is an organ that controls the release of enzymes needed in the digestion of food in the intestines (exocrine cells); it also controls the release of hormones, insulin and glucagon, which control the sugar levels in the blood (endocrine cells). Cancer of the pancreas can occur in both types of cells in the pancreas however it forms most often as exocrine tumors. Tumors can occur from exocrine cells that are benign; however, most often pancreatic exocrine tumors are malignant. Endocrine tumors do occur but are very uncommon, they are most often known as islet cell tumors. Due to the differences in the type of pancreatic cancer the treatment and risk factors are very different, we will only refer to the exocrine type of cancer as it is more prevalent.1

Approximately 37,000 new cases of pancreatic cancer will be diagnosed in 2007 in the United States and about 7,000 new cases will be diagnosed in the UK; worldwide it is expected that about 200,000 cases will be diagnosed. Pancreatic cancer occurs equally in men and women, however there is an increased risk in those over 45 years of age, in African Americans, as well as, a 2-3 times increased risk in smokers.1

CA 19-9® is a test that measures proteins shed by pancreatic cancer cells. The test is used as an aid in monitoring disease status in those patients having confirmed pancreatic cancer who have levels of serum or plasma CA 19-9 above the cutoff, at the time of diagnosis. The biomarker CA 19-9 can be elevated in other cancers and benign conditions such as colorectal cancer, pancreatitis, liver disease, as well as others.

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Diagnosis of Pancreatic Cancer

Pancreatic cancer is most often diagnosed in the later stages of disease, this is due to the location of the pancreas deep in the body and symptoms do not usually occur until the cancer has spread. If signs and symptoms appear in a patient, physicians will use those signs in combination with other clinical tests and exams to determine if the cause is pancreatic cancer.

Symptoms that can occur as a result of pancreatic cancer include: jaundice, yellowing of the eyes and skin; back or abdominal pain; weight and appetite loss; diabetes; and digestive problems.

When examining a patient suspected of having pancreatic cancer, physicians will use one or a combination of different tests. Physical exams will look for masses or fluid build up as well as to check for jaundice. CT Scans, PET Scans, MRI and Ultrasound are all types of imaging that can be used to help physicians diagnose and stage a cancer if present.

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Management of Pancreatic Cancer

Patients diagnosed with pancreatic cancer have few options dependent upon the stage and progression of the cancer. Surgery is always the most effective treatment; however, due to the often late stage diagnosis only 15-20% of patients are eligible for surgery at the time of diagnosis. Other options for the treatment of pancreatic cancer include chemotherapy and chemoradiation treatments. The most effective chemotherapies for this cancer have been gemcitabine, fluorouracil and erlotinib. Radiation therapy alone does not seem to have an effect on pancreatic cancer however it may be effective in combination with other chemotherapeutic agents. During therapy physicians will utilize biomarkers monitor the effectiveness of therapy.

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Frequently Asked Questions

What is the CA 19-9 tumor marker and how does it relate to pancreatic cancer?

CA 19-9 is a tumor-associated antigen, or tumor marker, that is frequently elevated in the serum or plasma of patients that have been diagnosed with cancer of the pancreato-biliary system (i.e. pancreas, gallbladder, biliary tract). In addition, elevated CA 19-9 values have been observed in other malignancies such as lung cancer, other gastrointestinal cancers, and in some nonmalignant disorders.

How is the CA 19-9 test performed?

A blood sample is taken from the patient and then sent to a laboratory for testing to determine the level of CA 19-9 present in the blood. The laboratory determines the amount of antigen present in the blood sample by using a monoclonal antibody known to specifically bind to CA 19-9 antigen. By measuring the amount of bound antigen the laboratory can quantitate the amount of CA 19-9 antigen present in the patient's blood sample.

Why is the CA 19-9 test performed?

The CA 19-9 test is performed periodically to monitor the disease status in those patients having confirmed pancreatic cancer. Physicians and healthcare professionals may use serial CA 19-9 results to help determine the response of a tumor to therapy, to decide whether the treatment should be changed, or to determine if additional tests are necessary.

What do the CA 19-9 test results mean?

Physicians use the CA 19-9 test results in conjunction with other diagnostic test results and full medical history to make decisions about the management of their patients. A physician typically requests a CA 19-9 test prior to the patient receiving treatments. This result serves as a baseline to compare with future measurements. During therapy, serial CA 19-9 results may be used to monitor response to therapy. Increasing results may be indicative of progressive disease, decreasing results may be indicative of response to therapy and constant results may be associated with stable disease.

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Resources

  • Lorenzen Cancer Foundation - The Lorenzen Cancer Foundation is a nonprofit organization whose aim is to present impartial knowledge about pancreatic cancer to give a sense of the range of existing treatment options to help optimize treatment strategies.
  • Pancreatic Cancer Action Network - The Pancreatic Cancer Action Network, Inc. (PanCAN) is the first national patient advocacy organization for the pancreatic cancer community.
  • The Lustgarten Foundation for Pancreatic Cancer Research - The mission of the Lustgarten Foundation is to advance the scientific and medical research related to the diagnosis, treatment, cure and prevention of pancreatic cancer.

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References
  1. Ferlay, J, Bray, F, Psiani, P, Parkin, DM. Cancer Incidence, Mortality and Prevalence Worldwide IARC CancerBase No.5, version 2.0 Lyon, France: IARCH Press; 2004.