More than 37,000 Americans will be diagnosed with pancreatic cancer in 2007, according to the American Cancer Society.

Pancreatic cancer is considered one of the more challenging cancers to treat. However physicians and researchers at Duke Comprehensive Cancer Center are working together to create new and improved treatment options for patients.

We spoke with Johanna Bendell, MD, a gastrointestinal oncologist at the Duke University Medical Center, about pancreatic cancer.

What does the pancreas do?

Bendell: The pancreas is an organ about six inches long, found near the stomach, backbone, liver, and intestine, that helps with digestion. The pancreas serves two main purposes: the first is to make insulin to regulate blood sugar, and the other is to secrete enzymes to break down food, especially fatty food. It is an important organ but people can live without it by taking medicines that replace the insulin and enzymes given off by it.

What causes pancreatic cancer?

Bendell: There has been a great deal of research done to determine the cause of pancreatic cancer, but there is no definite agent, except smoking. Those who smoke are two to three times more likely to develop pancreatic cancer than those who do not. However, non-smokers still develop the disease. For reasons we don’t know, individuals who have diabetes have a slightly increased risk of developing pancreatic cancer. Also, individuals with chronic pancreatitis, a disease of the pancreas, are at increased risk of developing the disease.

What are the symptoms of pancreatic cancer?

Bendell: Unfortunately, at the early stages of pancreatic cancer, when the tumor is small and easier to treat, there are usually no symptoms. When the tumor gets larger, the patient may have jaundice, with yellow skin especially around the eyes. Other symptoms include abdominal pain, weight loss, and fatigue. Some patients develop diabetes. Pancreatic cancer can be very difficult to diagnose because many conditions have these same symptoms, and the tumors aren’t always detectable on even the best scans.

What are the treatment options?

Bendell: Surgery is the only way to cure pancreatic cancer -- however, only 20 percent of patients are eligible for surgery. If the tumor has a particular location or if the disease has metastasized, surgery may not be an option. At Duke, most patients who have surgery receive chemotherapy and radiation first since that course of treatment may improve the chance of removing the tumor completely. After surgery, most patients in the United States receive chemotherapy or a combination of chemotherapy and radiation. Those with a local but inoperable disease may receive either chemotherapy or chemotherapy with radiation. Those with a metastasized cancer (cancer that has spread to other parts of the body) receive only chemotherapy.

What does the future look like for the disease?

Bendell: I’m really excited about the research we are conducting at Duke. We are investigating different cell proteins using genomics to better understand pancreatic cancer. We are also working on a project using biomarkers to determine how pancreatic cancer differs among individuals. We are using a large collection of blood samples to develop blood tests -- similar to PSA tests for prostate cancer -- which may help us determine who is at an increased risk for developing pancreatic cancer. These tests, if proven effective, may be able to detect the disease at an earlier stage when it is easier to treat. There is great research being conducted here at Duke, and I’m optimistic about improving the prognosis for patients with pancreatic cancer.