Dr Randy Pausch - Pancreatic cancer

What is the Pancreas?

The pancreas is a gland, about six inches long, located in the abdomen. It is surrounded by the stomach, small intestine, liver, spleen and gallbladder. It is shaped like a flat pear.
The wide end of the pancreas on the right side of the body is called the head. The middle sections are the neck and body. The thin end of the pancreas on the left side of the body is called the tail.

The uncinate process is the part of the gland that bends backwards and underneath the head of the pancreas. Two very important blood vessels, the superior mesenteric artery and superior mesenteric vein, cross behind the neck of the pancreas and in front of the uncinate process.

The pancreas has two main functions, the exocrine and endocrine functions.

Exocrine cells of the pancreas produce enzymes that help with digestion. When food enters the stomach, exocrine cells release digestive enzymes into a system of ducts which lead to the main pancreatic duct. The pancreatic duct empties the enzymes into the first portion of the small intestine called the duodenum, where the enzymes aid in the digestion of fats, carbohydrates and proteins in foods.

The second function of the pancreas is the endocrine function, which involves the production of hormones. Hormones are substances that are made in one part of the body and circulate in the bloodstream to influence a different part of the body. The two main pancreatic hormones are insulin and glucagon.

Islet cells (endocrine cells) within the pancreas produce and secrete insulin and glucagon into the bloodstream. Insulin serves to lower blood sugar levels while glucagon raises blood sugar levels. Together, these two main hormones work to maintain the proper level of sugar in the blood.

Types of Pancreatic Cancer 

All types of pancreatic cancer begin when abnormal cells grow out of control within the pancreas.  There are two types of cells in the pancreas, the exocrine cells and endocrine cells.  These cells also have different functions.
 
95% of pancreatic cancers are classified as exocrine tumors because they begin in the exocrine cells that produce enzymes to aid in digestion.  Click here to learn about types of exocrine tumors in the pancreas.

Accounting for less than 5% of all pancreatic tumors are endocrine tumors, also called neuroendocrine or islet cell tumors.  Islet cells of the pancreas produce hormones including insulin, glucagon and somatostatin.

A major function of these hormones is to control the amount of sugar in the blood.  Endocrine tumors may be benign or malignant and tend to be slower growing than exocrine tumors.  In addition, these tumors are categorized as functional (produce hormones) or nonfunctional (produce no hormones).  The majority of functional endocrine tumors are benign.  However, 90% of nonfunctional endocrine tumors are malignant, or cancerous.  Click here to learn about types of endocrine tumors in the pancreas.

Diet and Nutrition 

Many people with pancreatic cancer experience significant challenges in the area of diet and nutrition. 
With the diagnosis of pancreatic cancer, patients should incorporate a healthy diet and nutritional plan, developed together with a doctor or registered dietitian. 

The patient's nutritional goal should be to consume an adequate amount of fluids, calories, protein and vitamins each day to maintain a desirable weight and activity level.
Small, frequent meals throughout the day (five to six meals/snacks total), with each having a rich source of protein, are usually best tolerated. 

The primary nutrition goals of changes in diet are to:
- Prevent or reverse poor nutrition.
- Maintain dose and schedule of cancer treatments.
- Manage symptoms.
- Maintain or improve weight and strength.




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