Pancreatic and Biliary Cancer Program

Symptoms, Causes & Risk Factors

Symptoms of Pancreatic & Biliary Cancer

Most pancreatic cancers (over 90%) are called adenocarcinoma and are caused by exocrine tumors, which begin in the ducts of the pancreas. The remaining pancreatic tumors are called neuroendocrine tumors (NETs), or pancreatic NETs (PNETs).

Biliary or bile duct cancer can occur outside of the liver in the ducts as they leave the liver (extrahepatic cholangiocarcinoma), in the bile ducts inside the liver (intrahepatic cholangiocarcinoma) or inside the gallbladder (gallbladder cancer).

Unfortunately, most people don’t experience any symptoms of pancreatic cancer or bile duct cancer in the early stages. As the disease progresses, symptoms may include:

• Jaundice (yellowing of the skin)
• Tiredness
• Dark urine
• Pale colored or light colored feces
• Lighter feces
• Loss of appetite
• Nausea/vomiting
• Weight loss
• Itchy skin
• Blood clots in the body
• New or worsening diabetes (pancreatic cancer)

Causes & Risk Factors of Pancreatic & Biliary Cancer

Doctors don’t know what causes pancreatic cancer, but they do know that certain risk factors may put you at greater risk. These include:

• Smoking
• Obesity
• Having diabetes, especially type 2 diabetes
• Exposure to certain chemical (including those used by dry cleaners and metal workers)
• Chronic pancreatitis (usually associated with smoking and alcohol consumption)
• Bing male
• Being over 45
• Hereditary chronic pancreatitis (gene mutations are passed from parent to child)
• Other hereditary gene mutations (such as BRCA genes)

The symptoms for bile duct cancer also include smoking, obesity, diabetes, and exposure to certain toxins, but also include:

• Abnormalities where the pancreatic duct and bile duct meet
• Cirrhosis of the liver
• Chronic ulcerative colitis
• Inflammatory bowel disease (IBD)
• Bile duct stones or cysts (choledochal cyst disease)
• Clonorchiasis
• Hepatitis B or C
• Non-alcoholic fatty liver disease
• Inflammation or scarring blocks bile ducts (primary sclerosing cholangitis).

Prevention & Screening

As doctors don’t know what causes pancreatic and bile duct cancer, there is no way to prevent them. However, there are things you can do to reduce your risk of developing the diseases:

Pancreatic Cancer

• Don’t smoke
• Maintain a healthy weight
• Exercise regularly
• Maintain blood sugar levels if you are diabetic
• Avoid exposure to certain toxins.

Bile Duct Cancer

• Get vaccinated against hepatitis B
• Quit smoking and limit alcohol consumption
• Maintain a healthy weight.

Diagnosis & Treatment

Diagnosis of Pancreatic and Bile Duct Cancer 

It is usually difficult to detect pancreatic cancer in the early stages, as the organs cannot be felt by doctors in an exam. If cancer is suspected, imaging tests are ordered which take pictures of the internal organs and an endoscopic ultrasound can also be performed. This involves passing a thin tube with a camera into the stomach via the mouth, so the pancreas can be viewed, and an ultrasound-guided biopsy taken if necessary. A blood test may also be performed to look for a substance called carbohydrate antigen (CA) 19-9, a protein released by pancreatic cancer cells and known as a tumor marker.  
Diagnosing bile duct cancer usually involves: 

• Liver function: Tests check the blood for substances that may indicate your liver isn’t functioning or that there is a blockage in the bile duct. 
• Tumor marker: Tests that check blood or urine for substances that could indicate cancer. 
• Abdominal ultrasound: To obtain images of your pancreas, liver and gallbladder.  
• Magnetic resonance cholangiopancreatography (MRCP): An imaging exam using MRI to create detailed images of your liver, gallbladder, bile ducts, pancreas, and pancreatic duct. 
• Endoscopic retrograde cholangiopancreatography (ERCP): An endoscope which examines the bile ducts via the mouth and is passed into the small intestine while you are sedated. Contrast dye is used so the bile ducts show up on X-ray. If a blockage is found, a stent can be implanted to open it up. 
• Percutaneous transhepatic cholangiography (PTC): This creates X-rays like an ERCP, but the contrast dye is delivered by putting a needle into the liver and bile ducts.  
• Biopsy: A tissue sample can be removed during a PTC, ERCP or via a thin needle and sent for examination, if imaging and lab tests indicate cancer. 

Treatment of Pancreatic and Bile Duct Cancer 

Treatment for pancreatic and bile duct cancer will depend on many things, including the tumor’s location, which stage it is, your overall health and whether it has spread. 

Treatment options include:

Pancreatic Cancer

• Surgery: The pancreas or the cancerous part of the pancreas can be removed (called a pancreatectomy) as well as nearby lymph nodes. If the cancer is near the head of the pancreas, a Whipple procedure may be recommended which removes the head (the widest part) of the pancreas, the duodenum (the first part of the small intestine), the gallbladder, some of the bile duct and lymph nodes that are near. These surgeries can be performed with a minimally invasive approach using laparoscopic or robotic techniques. 
• Radiation therapy: High-dose radiation to kill the cancer cells. 
• Chemotherapy: Drugs are given to kill cancer cells. 
• Targeted therapy: Medication is targeted at certain genes or proteins which are helping the cancer grow.  

Bile Duct Cancer 

• Surgery: Either a partial hepatectomy which involves removing part of the liver or a total hepatectomy, which removes the whole liver and requires a transplant to replace it with one from a donor. 
  Ablation therapy: Allows the tumors to be destroyed without removing them. 
• Chemotherapy. 
• Targeted therapy. 
• Immunotherapy: Drugs are given which use the body’s own immune system to fight cancer cells.  
• Loco-regional therapy: Radioactive beads are injected into the blood vessel that is feeding the tumor.