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Information About Cancer
Neuroendocrine Cancers

Pancreatic Cancer

The Pancreas

The pancreas is an elongated, tapered organ located across the back of the abdomen, behind the stomach. The right side of the organ (called the head) is the widest part of the organ and lies in the curve of the duodenum (the first section of the small intestine). The tapered left side extends slightly upward (called the body of the pancreas) and ends near the spleen (called the tail).

Pancreatic Cancer

Pancreatic cancer is now the fourth leading cause of cancer death, according to the American Cancer Society. There were an estimated 30,700 new pancreatic cancer cases in 2003, with the majority occurring in people 60 years of age or older.

Although the majority (approximately 95 percent) of pancreatic tumors are composed of adenocarcinomas, other types of tumors such as pancreatic lymphomas have a much more favorable prognosis.  Other types of rare pancreatic tumors include cystadenocarcinomas and acinar cell carcinoma.

Neuroendocrine Pancreatic Tumors

There are also tumors in the pancreas that are called endocrine tumors because they secrete hormones. These are typically benign and include the following:

  • Insulinoma - secretes insulin, the hormone that lowers glucose levels in the blood. The most common form of endocrine pancreatic tumor. Some cases are caused by a genetic syndrome and may warrant a visit with one of the Cancer Center’s genetic counselors.

  • Gastrinoma - secretes above average levels of gastrin, a hormone that stimulates the stomach to secrete acids and enzymes. Gastrinoma can cause peptic ulcers. About one-quarter of gastrinomas are caused by a genetic syndrome and may warrant a visit with one of the Cancer Center’s  genetic counselors.

  • Glucagonoma - secretes glucagon, a hormone that raises levels of glucose in the blood, leading to a rash. Tumors tend to be large and to metastasize.

  • VIPoma - secretes vasoactive intestinal polypeptide (VIP), leading to severe intermittent diarrhea that causes further problems including dramatic potassium loss. Despite the name, in rare instances VIPomas secrete hormones other than VIP.

Stanford Expertise

The Pancreas Center at Stanford (PCS) is a multidisciplinary team of experts dedicated to the  treatment of patients with benign and malignant diseases of the pancreas.

It has clearly  been shown that hospitals and physicians who treat large numbers of patients with diseases of the pancreas have much better outcomes, lower complication rates, and few, if any deaths directly  attributable to surgical and related interventions. Because of its location deep in the abdomen, symptoms related to diseases of the pancreas often occur late in the natural history of the disease. 

Although it is generally taken as dogma that the prognosis in pancreas cancer is poor, it should be pointed out that in selected groups of patients, as many as 40 - 50 percent can be cured for five or more years. These optimistic forecasts depend on early diagnosis and treatment by individuals well-versed in the disease and technically capable in both surgical and other interventions.

Diagnosis

The diagnosis of diseases of the pancreas, both malignant and benign, usually requires sophisticated imaging studies such as CT scan and MRI, as well as diagnostic and therapeutic endoscopic procedures such as endoscopic retrograde cholangiopancreatography (ERCP), and/or endoscopic ultrasound (EUS). Both of these procedures are available at the Stanford Cancer Center.

Where necessary it is possible to perform biopsies of tumors or masses using the guidance of CT scan or ultrasound. Pathologists specializing in gastrointestinal disease are also available to assist in  pinpointing the type of tumor in each case.

Surgery

Cancer Center physicians are some of the world leaders in the types of complex pancreatic surgeries that are required to successfully treat patients with pancreatic cancer.

Often patients who are turned down for pancreatic procedures elsewhere go on to have them successfully performed at Stanford.

Stereotactic Radiosurgery

Stereotactic radiosurgery is a method of delivering highly accurate, focused doses of radiation to tumors while minimizing the dose to surrounding normal tissues.  Radiation oncologists and neurosurgeons have been using this technique for decades to treat brain tumors.  Improvements in targeting and delivering radiation to tumors have now allowed us to treat tumors outside of the brain.

Radioimmunotherapy

Stanford is a leader in initiating clinical trials of radioimmunotherapy — a technique that uses a cancer-specific antibody coupled with a radioactive atom to fight cancers. Most patients who have been treated with radioimmunotherapy at Stanford suffered from non-Hodgkin’s B-cell lymphoma. Currently, however, Stanford physicians are also involved in clinical trials for patients with pancreatic cancers.