Pancreatic cancer care

The pancreas is an organ that sits just behind the stomach. It makes insulin and other enzymes (digestive juices) that help digest food. The most common type of pancreatic cancer is called pancreatic adenocarcinoma, which starts in the exocrine cells of the pancreas.

At Allina Health, we will work with you from diagnosis to treatment and recovery. A highly experienced team of specialists will work closely with you to make sure you have the best possible care. This care will be coordinated by a nurse navigator, who will be your primary point of contact, relieving you of the burden and stress of managing your care.

We also believe your care includes focusing on your overall level of health from day one. To help you stay fully informed at all times, we’ll connect you with tools to manage our care, including the Allina Health account, which will allow you to track your appointments, review your test results and more.

The diagnosis of pancreatic cancer will start with a physical exam and a discussion about your health history and family history. You will then have some tests.

Blood tests are done to:

• assess liver function, particularly if you have jaundice (yellowing of the skin and whites of the eyes)
   
• determine your overall level of health by running a complete blood count (CBC) test
   
• check the level of cancer antigen CA 19-9 in the blood via a CA 19-9 tumor marker test (high CA 19-9 levels can indicate cancer).    

There are several imaging tests that may also be done. These include:

• CT (computed tomography) exam uses X-ray and a computer to get an in-depth look at your internal organs, tissues, blood vessels and bones.
   
• MRI (magnetic resonance imaging) uses a magnetic field to make three-dimensional (3-D) images of almost any part of your body. These images show the difference between normal tissue and abnormal tissue.
   
• EUS (endoscopic ultrasound) uses a thin, flexible scope with a camera on the end (endoscope) and ultrasound probe, which is inserted through the mouth, allowing a gastroenterologist (a specially trained doctor) to examine the pancreas and surrounding areas.  A biopsy may be done during this procedure.

•  PET (Positron Emission Tomography) scan is a three-dimensional (3-D) view of any part of your body. A small amount of radioactive material, known as a tracer, is injected into your bloodstream. The PET scan creates colored pictures of chemical changes that take place in body tissues.

Once diagnosed, your pancreatic cancer will be assigned a stage based on how far is has progressed. The stage is expressed in Roman numerals, with 1 being the earliest stage (at which the cancer hasn’t spread) and 4 being the most advanced (at which it has spread throughout the body).

Pancreatic cancer diagnosis is also labeled with a series of letters:

• T: This indicates the size of the tumor.
   
• N: This indicates whether the cancer has spread to nearby lymph nodes.
   
• M: This indicates whether the cancer has spread (metastasized) to other parts of the body.

At Allina Health, your pancreatic cancer care team will work closely with you to determine the best type of treatment. This treatment will depend on the stage of the cancer and your overall level of health. The most common types of treatment for pancreatic cancer include:

• Surgery to remove the cancer: This is done when the cancer has not spread too far and all the cancer can be removed. It can involve the Whipple procedure to remove the cancer at the head of the pancreas, a distal pancreatectomy to remove the tail and possibly a portion of the pancreas’ body or the removal of the entire pancreas (total pancreatectomy). The right surgery for you will depend on where the location of the tumor in your pancreas, the type and size of your tumor, and your overall health.
   
• Surgery to help manage symptoms: This is palliative surgery to alleviate symptoms when the cancer has spread and is unable to be removed.
   
• Endoscopic Retrograde Cholangio Pancreatography (ERCP) exam. This procedure is done in conjunction with an endoscopic ultrasound when a patient requires placement of a stent (special drain tube) for relief of obstruction/jaundice.
   
• Chemotherapy: This is the use of powerful medicines to destroy cancer cells, slow their growth or relieve pain. (Often used in combination with surgery.)

• Radiation therapy: This treatment uses high-energy radiation (X-rays) to shrink or destroy the cancer cells.
   
• A combination of both chemotherapy and radiation therapy.

Most people start by seeing their primary care provider. If your provider suspects pancreatic cancer, they will refer you to a team that will include a nurse navigator and specialty surgeons for next steps. Questions to ask your health care team:

• How treatable is pancreatic cancer?
• What stage of pancreatic cancer do I have?
• What is the most common/recommended treatment for my pancreatic cancer?
• How will treatment affect my daily life?
• Will treatment impact my fertility?
• Does pancreatic cancer spread?
• Can my pancreatic cancer be cured?
• What support resources are available to help me?
• Whom should I call if I have questions after I leave the office?

Before you have testing and treatment, check with your insurance provider to be sure of what is covered under your insurance plan and what you will need to pay for on your own.

Call your insurance provider any time you have questions about your coverage. You can do this by calling the number on your membership card.