Dr. F.W. Nugent is a medical oncologist specializing in gastrointestinal cancers with a special interest in pancreatic cancer. Dr. Nugent graduated from Middlebury College with a bachelors degree in religion before graduating from Albany Medical College. He presently serves as vice-chairman of medical oncology at the Lahey Clinic in Burlington, Massachusetts.
Dr. Keith E. Stuart is a medical oncologist specializing in the study and treatment of cancers involving the gastrointestinal tract, with a special interest in tumors involving the liver. He was educated at Harvard University (graduating magna cum laude) and Albert Einstein College of Medicine and did his medical training at the New England Deaconess Hospital.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
What are the symptoms and signs of pancreatic cancer?
Because the pancreas lies deep in the belly in front of the spine, pancreatic
cancer often grows silently for months before it is discovered. Early symptoms
can be absent or quite subtle. More easily identifiable symptoms develop once
the tumor grows large enough to press on other nearby structures such as nerves
(which causes pain), the intestines (which affects appetite and causes nausea
along with weight loss), or the bile ducts (which causes jaundice or a yellowing
of the skin and can cause loss of appetite and itching). Symptoms in women
rarely differ from those in men. Once the tumor sheds cancer cells into the
blood and lymph systems and metastasizes, more symptoms usually arise depending
on the location of the metastasis. Frequent sites of metastasis for pancreatic
cancer include the liver, the lymph nodes, and the lining of the abdomen (called
the peritoneum). Unfortunately, most pancreatic cancers are found after the
cancer has grown beyond the pancreas or has metastasized to other places.
How is the diagnosis of pancreatic cancer made?
Most people with pancreatic cancer first present to their primary-care doctor
complaining of nonspecific symptoms. These complaints trigger an evaluation
often including a physical examination (usually normal), blood tests, X-rays,
and an ultrasound. If pancreatic cancer is present, the likelihood of an
ultrasound revealing an abnormality in the pancreas is about 75%. If a problem
is identified, frequently a computed tomography (CT) scan is performed as the
next step in the evaluation. A pancreatic mass and the suspicion of pancreatic
cancer is then raised, and a biopsy is performed to yield a diagnosis.
Different strategies can be used to perform a biopsy of the suspected cancer.
Often, a needle biopsy of the liver through the belly wall (percutaneous liver
biopsy) will be used if it appears that there has been spread of the cancer to
the liver. If the tumor remains localized to the pancreas, biopsy of the
pancreas directly usually is performed with the aid of a CT. A direct biopsy also
can be made via an endoscope put down the throat and into the intestines. A
camera on the tip of the endoscope allows the endoscopist to advance the
endoscope within the intestine. An ultrasound device at the tip of the endoscope
locates the area of the pancreas to be biopsied, and a biopsy needle is passed
through a working channel in the endoscope to obtain tissue from the suspected
cancer. Ultimately, a tissue diagnosis is the only way to make the diagnosis
with certainty, and the team of doctors work to obtain a tissue diagnosis in the
easiest way possible.
In addition to radiologic tests, suspicion of a pancreatic cancer can arise
from the elevation of a "tumor marker," a blood test which can be abnormally
high in people with pancreatic cancer. The tumor marker most commonly associated
with pancreatic cancer is called the "CA 19-9." It is often released into the
bloodstream by pancreatic cancer cells and may be elevated in patients newly
found to have the disease. Unfortunately, the CA 19-9 test is not specific for
pancreatic cancer. Other cancers as well as some benign conditions can cause the
CA 19-9 to be elevated. Sometimes (about 10% of the time) the CA 19-9 will be at
normal levels in the blood despite a confirmed diagnosis of pancreatic cancer,
so the tumor marker is not perfect. It can be helpful, however, to follow during the course of illness since its rise and fall may help guide appropriate
therapy.
Abdominal pain is pain in the belly and can be acute or chronic. Causes include inflammation, distention of an organ, and loss of the blood supply to an organ. Abdominal pain can reflect a major problem with one of the organs in the abdomen such as the appendix, gallbladder, large and small intestine, pancreas, liver, colon, duodenum, and spleen.
There are many causes of back pain. Pain in the low back can relate to the bony lumbar spine, discs between the vertebrae, ligaments around the spine and discs, spinal cord and nerves, muscles of the low back, internal organs of the pelvis and abdomen, and the skin covering the lumbar area.
Muscle spasms are involuntary muscle contractions that come on suddenly and are usually quite painful. Dehydration, doing strenuous exercise in a hot environment, prolonged muscle use, and certain diseases of the nervous system may cause muscle spasms. Symptoms and signs of a muscle spasm include an acute onset of pain and a possible bulge seen or felt beneath the skin where the muscle is located. Gently stretching the muscle usually resolves a muscle spasm.
Nausea is an uneasiness of the stomach that often precedes vomiting. Nausea and vomiting are not diseases, but they are symptoms of many conditions. The causes of vomiting differ according to age, and treatment depends upon the cause of nausea and vomiting.
Itching can be a common problem. Itches can be localized or generalized. There are many causes of itching to include: infection (jock itch, vaginal itch), disease (hyperthyroidism, liver or kidney), reactions to drugs, and skin infestations (pubic or body lice). Treatment for itching varies depending on the cause of the itch.
Jaundice is a yellowish staining of the skin and whites of the eyes (sclerae) with bilirubin, the pigment found in bile. Jaundice can be an indicator of liver or gallbladder disease, or it may result from the rupture of red blood cells (hemolysis).
Stool color is generally brown. When stool color changes, often, an individual becomes concerned. The presence of the bilirubin in bile is generally responsible for stool color. Bilirubin concentration can vary bile color from light yellow to almost black in color. Changes in bilirubin can cause stool to turn green, gray, or clay-like in color. Intestinal bleeding may turn stool black, tarry, red, maroon, or smelly stool. Medication and food may also affect stool color.
Helicobacter pylori (H. pylori) is a bacterium that causes chronic inflammation (gastritis) of the inner lining of the stomach in humans. This bacteria also is the most common cause of ulcers worldwide.
The hepatitis B virus is a unique, coated DNA virus belonging to the Hepadnaviridae family of viruses. The course of the virus is determined primarily by the age at which the infection is acquired and the interaction between the virus and the body's immune system. Successful treatment is associated with a reduction in liver injury and fibrosis (scarring), a decreased likelihood of developing cirrhosis and its complications, including liver cancer, and a prolonged survival.
Ascites, the accumulation of fluid in the abdominal cavity is most commonly caused by cirrhosis of the liver. Some of the other causes of ascites include portal hypertension, congestive heart failure, blood clots, and pancreatitis. The most common symptoms include increased abdominal girth and size, abdominal bloating, and abdominal pain. Treatment depends on the cause of ascites.
Cancer is a disease caused by an abnormal growth of cells, also called malignancy. It is a group of 100 different diseases, and is not contagious. Cancer can be treated through chemotherapy, a treatment of drugs that destroy cancer cells.
Obesity is the state of being well above one's normal weight. A person has traditionally been
considered to be obese if they are more than 20 percent over their ideal weight.
That ideal weight must take into account the person's height, age, sex, and
build.
Smoking is an addiction. More than 430,000 deaths occur each year in the U.S. from smoking related illnesses. Secondhand smoke or "passive smoke" also harm family members, coworkers, and others around smokers. There are a number of techniques available to assist people who want to quit smoking.
Pancreatic cysts are collections of fluid within the pancreas. Some are benign, malignant, or pseudocysts. There are two major types of pancreatic cysts, inflammatory cysts and non-inflammatory cysts. Non-inflammatory cysts include: serous cyst adenomas, mucinous cyst adenomas, intraductal papillary mucinous neoplasm (IPMN), and solid pseudopapillary tumor of the pancreas. Symptoms of pancreatic cysts include abdominal pain, jaundice, fever, chills, and sepsis. Treatment depends on the type of cyst, and patient health.
Though it's difficult to say why some people develop cancer while others don't, research shows that certain risk factors increase a person's odds of developing cancer. These risk factors include growing older, family history of cancer, diet, alcohol and tobacco use, and exposure to sunlight, ionizing radiation, certain chemicals, and some viruses and bacteria.
Digestion is the complex process of turning food you eat into the energy you need to survive. The digestive process also involves creating waste to be eliminated, and is made of a series of muscles that coordinate the movement of food.
Smokeless tobacco can have negative health effects such as cancers, poor oral health (gum disease and tooth decay), infertility, pregnancy complications, and nicotine addiction.
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