Main function of the pancreas

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The Pancreas Center

Location of the Pancreas | Functions of the Pancreas | Diseases of the Pancreas | Next Steps

The pancreas is an organ located in the abdomen. It plays an essential role in converting the food we eat into fuel for the body’s cells. The pancreas has two main functions: an exocrine function that helps in digestion and an endocrine function that regulates blood sugar.

Location of the Pancreas

The pancreas is located behind the stomach in the upper left abdomen. It is surrounded by other organs including the small intestine, liver, and spleen. It is spongy, about six to ten inches long, and is shaped like a flat pear or a fish extended horizontally across the abdomen.

The wide part, called the head of the pancreas, is positioned toward the center of the abdomen. The head of the pancreas is located at the juncture where the stomach meets the first part of the small intestine. This is where the stomach empties partially digested food into the intestine, and the pancreas releases digestive enzymes into these contents.

The central section of the pancreas is called the neck or body.

The thin end is called the tail and extends to the left side.

Several major blood vessels surround the pancreas, the superior mesenteric artery, the superior mesenteric vein, the portal vein and the celiac axis, supplying blood to the pancreas and other abdominal organs.

Almost all of the pancreas (95%) consists of exocrine tissue that produces pancreatic enzymes for digestion. The remaining tissue consists of endocrine cells called islets of Langerhans. These clusters of cells look like grapes and produce hormones that regulate blood sugar and regulate pancreatic secretions.

Functions of the Pancreas

A healthy pancreas produces the correct chemicals in the proper quantities, at the right times, to digest the foods we eat.

Exocrine Function:

The pancreas contains exocrine glands that produce enzymes important to digestion. These enzymes include trypsin and chymotrypsin to digest proteins; amylase for the digestion of carbohydrates; and lipase to break down fats. When food enters the stomach, these pancreatic juices are released into a system of ducts that culminate in the main pancreatic duct. The pancreatic duct joins the common bile duct to form the ampulla of Vater which is located at the first portion of the small intestine, called the duodenum. The common bile duct originates in the liver and the gallbladder and produces another important digestive juice called bile. The pancreatic juices and bile that are released into the duodenum, help the body to digest fats, carbohydrates, and proteins.

Endocrine Function:

The endocrine component of the pancreas consists of islet cells (islets of Langerhans) that create and release important hormones directly into the bloodstream. Two of the main pancreatic hormones are insulin, which acts to lower blood sugar, and glucagon, which acts to raise blood sugar. Maintaining proper blood sugar levels is crucial to the functioning of key organs including the brain, liver, and kidneys.

Diseases of the Pancreas

Disorders affecting the pancreas include pancreatitis, precancerous conditions such as PanIN and IPMN, and pancreatic cancer. Each disorder may exhibit different symptoms and requires different treatments.

Pancreatitis is inflammation of the pancreas that occurs when pancreatic enzyme secretions build up and begin to digest the organ itself. It can occur as acute painful attacks lasting a matter of days, or it may be a chronic condition that progresses over a period of years.

Learn more about pancreatitis, its causes, and treatment options.

Precursors to Pancreatic Cancer

The exact cause of pancreatic cancer is still unknown, but there are known risk factors that increase the risk of developing the disease. Cigarette smoking, a family history of pancreatic cancer or hereditary cancer syndromes, and chronic pancreatitis are some of these factors. In addition, certain pancreatic lesions such as Intraductal Papillary Mucinous Neoplasms (IPMNs) and Pancreatic Intraepithelial Neoplasia (PanIN) are considered precursors to pancreatic cancer.

Read more about the precursors to pancreatic cancer.

Pancreatic Cancer

The most common form of pancreatic cancer is pancreatic adenocarcinoma, an exocrine tumor arising from the cells lining the pancreatic duct. A far less common form, endocrine tumors, account for less than 5% of all pancreatic tumors and are sometimes referred to as neuroendocrine or islet cell tumors.

Learn more about different forms of pancreatic cancer and their treatments.

Next Steps

If you or someone you care for is dealing with a pancreatic condition, the Pancreas Center is here for you. Whether you need a diagnosis, treatment, or a second opinion, we have an entire team of experts ready to help.

Call us at (212) 305-9467 or use our online form to get in touch today.

Related Services

  • Pancreatic Cancer Care Program
  • Pancreatitis Program
    See all Programs & Services ”

Related Topics

  • Pancreatic Cancer
  • Pancreatic Cysts
  • Pancreatitis
  • Pancreatectomy
  • Chemotherapy for Pancreatic Cancer
  • Endoscopic Treatment for Pancreatic Disease
  • Non-Invasive Tests for Pancreatic Cancer
  • Palliative Procedures
  • Surgery for Pancreatic Cancer
  • Whipple Procedure (Pancreaticoduodenectomy)
  • Total Pancreatectomy with Autologous Islet Cell Transplantation
    See all Related Topics ”

12 Facts About the Pancreas

You could live without your pancreas, but it wouldn’t be easy. For one, you would need to give yourself insulin shots on a daily basis because you would develop diabetes. A helping of enzyme pills would also be needed to help you digest food. It’s clear that the 6-inch-long pancreas, located behind your stomach, has crucial functions—and that’s why diseases like pancreatic cancer and pancreatitis are often so devastating. Here are a few other important facts to know about the pancreas.

1. Pancreas means “all flesh” in Greek.

Around 300 BCE, a surgeon in ancient Greece named Herophilus became the first person to formally describe the pancreas as a gland. However, the organ didn’t get its name until about 400 years later, when another Greek surgeon and anatomist named Ruphos dubbed it the pankreas, meaning “all flesh”—possibly because of its lack of bone or cartilage. (The plural of pancreas, by the way, is pancreata or pancreases.) Later, in the 16th century, people started referring to a dish of cooked calf or lamb pancreas as “sweetbreads.” That name possibly stems from bræd, the Old English word for “flesh.”

2. The pancreas has a head and a tail.

The pancreas has four main parts: the head, neck, body, and tail. The widest part is the head, which is attached to the first part of the small intestine, known as the duodenum. In cases where a pancreatic tumor is present, the head is usually the part that’s affected. However, according to one study from 2008, people with tumors in the body or tail of the pancreas had lower survival rates than those with cancer in the head of the pancreas.

3. The man who discovered the pancreatic duct may have been murdered for his work.

The pancreatic duct is a tiny tube that runs the length of the pancreas and carries digestive juices to the duodenum. Although the ancient Greeks knew about the pancreas, its function and anatomy weren’t fully understood for centuries. That started to change in 1642, when German anatomist Johann Georg Wirsung discovered the pancreatic duct after performing a dissection on a man who had been hanged for murder. He named it the “duct of Wirsung” after himself, which may have upset some people. Wirsung was murdered the following year, allegedly over a disagreement as to who had actually discovered the duct.

4. It functions as both an endocrine and exocrine gland.

Although food never enters the pancreas, the organ does play a key role in digestion. It produces pancreatic fluid, which gets piped through the pancreatic duct to the duodenum. Once it’s in the digestive tract, the enzymes in the fluid help break down fat, protein, and carbohydrates. By sending a substance through ducts to other parts of the body, it functions as an exocrine gland. At the same time, it also functions as an endocrine gland by secreting two hormones directly into the bloodstream to help control blood sugars. Insulin is released when you have too much sugar, and glucagon is released when you don’t have enough sugar.

5. The pancreas can “taste” sugar.

The pancreas has taste receptor cells that let it sense the presence of sugar. It can “taste” artificial sweeteners, too. However, unlike the taste buds on our tongue, it doesn’t relay these sensations back to the brain. Instead, this sensory information helps the pancreas balance out the hormones and maintain healthy glucose levels in the body.

6. Diabetes is the result of damage to pancreatic cells.

For reasons that remain a scientific mystery, people with type 1 diabetes have immune systems that attack the insulin-producing cells in their pancreas. This prevents the cells from making insulin, and without insulin, other cells can’t access the glucose in the bloodstream for energy. Sugar then builds up unhealthily in the bloodstream. People with type 2 diabetes, on the other hand, can still produce some insulin, but it’s not enough. Their cells become resistant to insulin (often as a result of obesity), which causes glucose to accumulate in the bloodstream.

7. The pancreas can digest itself.

Pancreatitis refers to the inflammation of the pancreas, but more alarmingly, what’s actually happening is that the digestive enzymes in the gland are going rogue and “digesting the pancreas itself,” according to Medline Plus. Heavy alcohol consumption is the most common cause of the disease, but other causes may include gallstones, cystic fibrosis, or high levels of fats or calcium in the blood. Most people with acute pancreatitis end up in the hospital, and it often goes away in a couple of days. Chronic pancreatitis can result in more serious complications.

8. Scorpion stings can cause pancreatitis.

The venom of a Brazilian scorpion, Tityus serrulatus, can cause pancreatitis, according to researchers at North Carolina State University. One particular enzyme in the venom attacks certain proteins in the gland, which impairs the pancreatic cells’ functions and leads to inflammation. In a separate study of a related species (T. stigmurus), researchers found that “acute pancreatitis due to scorpion is usually transient self-limited … but it could progress to hemorrhagic pancreatitis and lead to death.”

9. Ruth Bader Ginsburg beat the odds and survived pancreatic cancer.

Ten years after she recovered from colon cancer, Ruth Bader Ginsburg received bad news following a routine check-up in 2009: She had pancreatic cancer. Fortunately, surgeons were able to remove the tumor, and at 85 years old (and counting), Ginsburg is now the oldest Justice on the U.S. Supreme Court. However, most people with pancreatic cancer aren’t so lucky. Although it’s less prevalent than skin, breast, and prostate cancers, it’s one of the deadliest. Just 8 percent of pancreatic cancer patients in the U.S. live longer than five years, according to the American Cancer Society.

James Cleary, an oncologist at the Dana-Farber Cancer Institute in Boston, says it’s very hard to catch in the early stages. “The reason pancreatic cancer can be so difficult to catch is number one, it’s a fast-moving cancer and can grow very rapidly,” he tells Mental Floss. “And number two, it can grow in a spot where you don’t get any symptoms until it’s too late.” In some cases, the cancer may start in the pancreas and spread to the liver or lining of the abdomen without any symptoms showing up.

10. Pancreatic surgery is extremely difficult to pull off.

Sometimes, patients with pancreatic cancer will undergo a complicated surgery called a Whipple procedure, which involves the removal of the head of the pancreas, part of the small intestine, the gallbladder and bile duct, and sometimes part of the stomach, too. However, very few people with pancreatic cancer are candidates for surgery—even if the cancer hasn’t yet spread to neighboring organs. That’s because cancer cells sometimes surround important blood vessels, making it “a tricky area” to operate on, according to Cleary. “The pancreas plays a really important role in digestion, and because of that, it’s very close to several important blood vessels and it’s very close to the stomach and small intestine,” he says.

11. There are genetic components to pancreatic cancer.

More than 90 percent of pancreatic cancers involve a mutation of the KRAS gene, which is also responsible for about half of all human cancers, according to Cleary. However, a drug hasn’t been invented yet to turn this particular gene off. “Finding a way to make a drug successfully target KRAS is one of holy grails of oncology,” Cleary says. “It is of such great importance to oncology that a Nobel Prize could be awarded to whoever figures out how to make effective KRAS targeted therapy.”

Mutations of DNA repair genes occur in up to 20 percent of pancreatic cancer cases. Some of these mutated genes, like BRCA1 and BRCA2, can run in families. This is why some families have several members who end up suffering from pancreatic cancer. Jimmy Carter, for example, lost his father, brother, and two sisters to pancreatic cancer. His mother had breast cancer that migrated to her pancreas. PARP inhibitors (drugs that block a particular enzyme) have been used to target DNA repair genes in breast and ovarian cancers, and there is now hope that they may also be effective in treating pancreatic cancer.

12. An aggressive form of chemotherapy is helping pancreatic cancer patients live longer.

A chemotherapy regimen called FOLFIRINOX has made significant improvements in the care of pancreatic cancer patients ever since it was introduced in 2010 as a treatment for patients with metastatic disease. Before 2010, “It was very, very rare to see anyone with metastatic cancer living longer than one year,” Cleary says. With FOLFIRNOX, it’s not uncommon to see patients with metastatic pancreatic cancer living two years. A huge step forward came in June 2018 when researchers from France found that giving FOLFIRINOX after surgery could increase survival by a median of 20 months longer compared to the standard chemotherapy. Now, researchers are conducting trials to see if FOLFIRINOX can effectively be administered before a patient undergoes surgery. Considering that most patients aren’t eligible for surgery at diagnosis, pre-operative FOLFIRINOX could shrink the pancreatic tumor and increase the number of patients that are able to safely receive surgery.

Pancreas: Functions and possible problems

Problems with the pancreas can affect the whole body.

If the pancreas does not produce enough digestive enzymes, for example, food will not be properly absorbed. This can lead to weight loss and diarrhea.

The islets of Langerhans are responsible for regulating blood glucose. Too little insulin production will increase the risk of diabetes, and blood glucose levels will rise.

Pancreatitis

Share on PinterestA flareup in pancreatitis can cause abdominal pain.

Pancreatitis refers to an acute or chronic inflammation of the pancreas. It can lead to secondary diabetes.

Inflammation can occur if the main duct from the pancreas is blocked by a gallstone or tumor.

Pancreatic juices will accumulate in the pancreas, causing damage to the pancreas. The pancreas may start to digest itself.

Pancreatitis can happen as a result of mumps, gallstones, trauma and the use of alcohol, steroids, and drugs.

Acute pancreatitis is rare, but it needs immediate medical attention.

Symptoms include:

  • intense abdominal pain, tenderness, and swelling
  • nausea and vomiting
  • fever
  • muscle aches

Immediate treatment is normally with fluids and painkillers. Patients often do not want to eat at the beginning, but if the pancreatitis is mild, they will start to eat again relatively quickly.

If a secondary infection has occurred, surgery may be necessary.

Chronic pancreatitis can develop if acute pancreatitis happens repeatedly, resulting in permanent damage.

The most common cause is alcohol abuse, and it mostly affects middle-aged men.

Symptoms include:

  • persistent pain in the upper abdomen and back
  • weight loss
  • diarrhea
  • diabetes
  • mild jaundice

Hereditary pancreatitis can happen if there is an inherited problem in the pancreas or the intestine. A person under 30 years of age may experience repeated acute pancreatitis, leading to a chronic condition.

It is a progressive condition that can lead to permanent damage. The person may experience pain, diarrhea, malnutrition or diabetes. Treatment aims to control pain to replace lost enzymes.

Genetic testing is available for patients who may be at risk.

Pancreatic cancer

Cancer can develop in the pancreas. The exact cause is often unknown, but it is often linked to smoking or heavy drinking.

Other risk factors include:

  • diabetes
  • chronic pancreatitis
  • liver problems
  • stomach infections

Symptoms include:

  • pain in the upper abdomen as the tumor pushes against the nerves
  • jaundice, a yellowing of the skin and eyes and darkening of the urine as the cancer interferes with the bile duct and the liver
  • loss of appetite, nausea, and vomiting
  • significant weight loss and weakness
  • pale or gray stool, and excess fat in the stool

Symptoms may not appear until the cancer is in the advanced stages. By then, it may be too late for successful treatment. The prognosis for pancreatic cancer tends to be poor.

Treatment usually involves surgery, chemotherapy, radiation, or a combination these.

Palliative treatment will focus on reducing the pain.

Pancreatic cancer is the fourth most common cause of cancer in men in the United States (U.S.) and the fifth in women. Over 37,000 new cases are diagnosed each year.

Diabetes

Type 1 diabetes is an autoimmune disease. It occurs when the immune system attacks and destroys the beta cells in the pancreas so that they can no longer produce insulin. The exact cause remains unknown, but it may be due to genetic and environmental factors, including viruses.

Type 2 diabetes begins when the body’s muscle, fat, and liver cells become unable to process glucose. The pancreas reacts by producing extra insulin, but in time, it cannot produce enough insulin. The body can no longer control blood glucose levels.

Other problems that can occur include:

  • Exocrine pancreatic insufficiency (EPI): The pancreas does not produce enough enzymes
  • Pancreatic cysts: These can be removed by surgery if there is a risk of cancer
  • Pancreatic fluid collections: Resulting from a range of conditions, this can lead to pain and fever
  • Zollinger-Ellison syndrome: A tumor known as a gastinoma develops in the pancreas or duodenum

The Digestive Process: What Is the Role of Your Pancreas in Digestion?

Your pancreas plays a big role in digestion. It is located inside your belly (abdomen), just behind your stomach. It’s about the size of your hand. During digestion, your pancreas makes pancreatic juices called enzymes. These enzymes break down sugars, fats, proteins, and starches. Your pancreas also helps your digestive system by making hormones. These are chemical messengers that travel through your blood. Pancreatic hormones help regulate your blood sugar levels and appetite, stimulate stomach acids, and tell your stomach when to empty.

Pancreatic enzymes

Your pancreas creates natural juices called pancreatic enzymes to break down foods. These juices travel through your pancreas by tubes called ducts. They empty into the upper part of your small intestine called the duodenum. Each day, your pancreas makes about 8 ounces of digestive juice filled with enzymes. These are the different enzymes:

  • Lipase. This enzyme works together with bile, which your liver produces, to break down fat in your diet. If you don’t have enough lipase, your body will have trouble absorbing fat and the important fat-soluble vitamins (A, D, E, K). Symptoms of poor fat absorption include diarrhea and fatty bowel movements.

  • Protease. This enzyme breaks down proteins in your diet. It also helps protect you from germs that may live in your intestines, such as certain bacteria and yeast. Undigested proteins can cause allergic reactions in some people.

  • Amylase. This enzyme helps break down starches into sugar, which your body can use for energy. If you don’t have enough amylase, you may get diarrhea from undigested carbohydrates.

Pancreatic hormones

Many groups of cells make hormones inside your pancreas. Unlike enzymes that are released into your digestive system, hormones are released into your blood. They carry messages to other parts of your digestive system. Pancreatic hormones include:

  • Insulin. This hormone is made in cells of the pancreas known as beta cells. Beta cells make up about 75% of pancreatic hormone cells. Insulin is the hormone that helps your body use sugar for energy. Without enough insulin, your sugar levels rise in your blood and you develop diabetes.

  • Glucagon. Alpha cells make up about 20% of the cells in your pancreas that make hormones. They make glucagon. If your blood sugar gets too low, glucagon helps raise it by sending a message to your liver to release stored sugar.

  • Gastrin and amylin. Gastrin is mainly made in the G cells in your stomach, but some is made in the pancreas It stimulates your stomach to make gastric acid. Amylin is made in beta cells and helps control appetite and stomach emptying.

Common pancreatic problems and digestion

Diabetes, pancreatitis, and pancreatic cancer are 3 common problems that affect the pancreas. Here is how they can affect digestion:

  • Diabetes. If your pancreatic beta cells don’t make enough insulin or your body can’t use the insulin your pancreas makes, you can develop diabetes. Diabetes can cause gastroparesis. This means the digestive system works more slowly than it should. Diabetes also affects what happens after digestion. If you don’t have enough insulin and you eat a meal high in carbohydrates, your sugar can go up and cause symptoms such as hunger and weight loss. Over the long term, it can lead to heart and kidney disease, among other problems.

  • Pancreatitis. Pancreatitis happens when the pancreas becomes inflamed. It is often very painful. In pancreatitis, the digestive enzymes your pancreas make attack your pancreas and cause severe abdominal pain. The main cause of acute pancreatitis is gallstones blocking the common bile duct. Too much alcohol can cause acute pancreatitis and pancreatitis that does not clear up. This is known as chronic pancreatitis. Pancreatitis affects digestion because enzymes are not available. This leads to diarrhea, weight loss, and malnutrition. About 90% of the pancreas must stop working to cause these symptoms.

  • Pancreatic cancer. About 19 out of 20 pancreatic cancers begin in the cells that make enzymes for digestion. Not having enough pancreatic enzymes for normal digestion is very common in pancreatic cancer. Symptoms can include weight loss, loss of appetite, indigestion, and fatty stools.

Your pancreas is important for digesting food and managing your use of sugar for energy after digestion. If you have any symptoms of pancreatic digestion problems, such as loss of appetite, abdominal pain, fatty stools, or weight loss, call your healthcare provider. If you have a family history of pancreatitis or pancreatic cancer, let your provider know.

All About the Pancreas: Anatomy, Function, and Its Connection to Diabetes

The pancreas, which is an important part of your digestive tract, has two critical roles.

The pancreas is located behind the stomach in the upper-left area of the abdomen. Teguh Mujiono/

Your pancreas is an organ that’s part of both the digestive system and the endocrine system.

The digestive system, which breaks down food into tiny components that are then absorbed into the body, is made up of numerous organs in addition to the pancreas, including the mouth, esophagus, stomach, and small and large intestines.

The endocrine system is a collection of many different endocrine glands, such as the thyroid gland, testes, and pituitary gland, which secrete hormones directly into the bloodstream.

Anatomy of Your Pancreas

Your pancreas is located in the upper left area of your abdomen, behind your stomach and near your duodenum, the first section of your small intestine.

The organ measures about 6 inches long and weighs about one-fifth of a pound.

Looking somewhat like a sweet potato, the pancreas is made up of a bulbous head and neck, a tubular body, and a narrow, pointy tail.

The pancreas contains a tubelike structure called the main pancreatic duct, which runs from the tail to the head of the organ.

The gallbladder’s bile duct enters at the top of the pancreas’s head to connect to the main pancreatic duct. The joined ducts exit from the pancreas’s head and connect to the duodenum.

Some people also have an additional pancreatic duct, sometimes known as the duct of Santorini, which connects to another part of the duodenum.

RELATED: 9 Common Digestive Conditions From Top to Bottom

What Does the Pancreas Do?

Your pancreas has two main responsibilities: It helps the body digest food, and it helps regulate blood sugar.

More than 95 percent of the pancreas’s mass is made up of cells and tissues that produce pancreatic juices containing digestive enzymes such as amylase, lipase, elastase, and nucleases. (1)

Each of these enzymes breaks down a specific type of substance; for instance, amylase breaks down carbohydrates, lipase breaks down fats, and elastase breaks down proteins.

The pancreatic juices, along with bile from the gallbladder, empty into the small intestine at the duodenum, where they assist in digesting food.

Clusters of cells called the islets of Langerhans make up much of the rest of the pancreas. These cell clusters release insulin, glucagon, and other hormones directly into the bloodstream, helping control the body’s blood sugar level.

Can You Live Without a Pancreas?

Yes. Only those with pancreatic cancer, severe cases of pancreatitis, or other diseases of the pancreas face the possibility of having to live without one.

In those cases, the entire pancreas would be removed, and you’d be prescribed drugs that could help your body carry out the functions previously handled by the pancreas (without a pancreas, for example, you would develop diabetes and become dependent on insulin shots to regulate your blood sugar level). But this procedure, called a pancreatectomy, is rarely done, and more often than not, only part of the pancreas is removed.

What Is the Relationship Between Diabetes and the Pancreas?

The pancreas releases insulin into the bloodstream after you eat. This hormone helps your body absorb sugar into the bloodstream so you can use it for energy.

Diabetes develops because there are problems either with the insulin cells in the pancreas or the pancreas’s ability to produce insulin.

In type 1 diabetes, your body’s immune system starts attacking the cells in the pancreas that make insulin, which means that you can’t make the hormone. Type 1 diabetes often develops in childhood. In type 2 diabetes, which usually develops in people in their forties or fifties, your pancreas doesn’t make enough insulin or has trouble making it.

With both types of diabetes, blood sugar can’t enter into the cells to be used for energy. As a result, the sugar stays in the bloodstream and can cause damage to certain tissues, which may lead to damage of the nerves and kidneys and even blindness.

Diabetes can be managed with injections of insulin. Exercise, weight loss, and a healthier diet can help manage your blood sugar level so that you might not need the insulin.

It’s not clear what exactly causes type 1 diabetes, but researchers think that genetics, environment, and perhaps even viruses may play a role. Being overweight or obese and sedentary, and having diabetes in the family, are some of the risk factors for type 2 diabetes.

RELATED: Simple Tips for Your Diabetes Diet

Does Diabetes Cause Pancreatic Cancer?

Having diabetes does not automatically put you at risk for pancreatic cancer, but there are cases in which there may be a relationship between the two.

Some research has found that having type 2 diabetes for five or more years has been associated with a two-fold increase in the risk for pancreatic cancer. (2) Other research suggests that if you develop diabetes for the first time after age 50, it may be a symptom of the disease, according to the Pancreatic Cancer Action Network. (3)

Scientists are still trying to confirm whether diabetes leads to cancer or whether cancer leads to diabetes. It may be that in some people, the cancer interferes with the functioning of the pancreas and therefore creates diabetes, (4) and in others, the diabetes may be creating inflammatory conditions that eventually become carcinogenic. (5)

But the number of people who have both diabetes and cancer is rare: Studies have estimated that only 1 to 2 percent of people with recently developed diabetes will develop cancer in three years. (6) In contrast, 20 to 30 percent of pancreatic cancers are caused by smoking, says the American Cancer Society. (7)

Pancreatic cancer itself is rare, according to the National Cancer Institute, which estimates that it represents 3.2 percent of all new cancer cases in the United States. In 2017, 53,670 people developed pancreatic cancer and 43,090 people died from the disease, according to the National Cancer Institute. (8)

Pancreatic cancer causes a number of symptoms:

  • Upper abdominal pain
  • Jaundice (yellowed skin and eyes)
  • Dark urine and pale stool
  • Loss of appetite
  • Weakness or extreme fatigue

Treatment options for pancreatic cancer include surgery, chemotherapy, targeted cancer therapy with drugs, and radiation therapy.

What Causes Pancreatitis?

Pancreatitis occurs when the pancreas becomes inflamed. Small gallstones that get stuck in the pancreatic duct and chronic heavy alcohol use are the two most common causes of pancreatitis.

Pancreatitis often causes symptoms, such as abdominal pain, fever, weakness, and nausea, and generally resolves within a few days with hospital treatment.

Additional reporting by Carlene Bauer.

Pancreatic cancer

Pancreatic cancer is cancer that starts in the pancreas, a gland that produces digestive juices and hormones.

The pancreas

The pancreas is part of the digestive system.

The pancreas is quite high up in your abdomen. It lies across your body where your ribs meet at the bottom of your breastbone, just behind your stomach. It is about 6 inches (15 centimetres) long and shaped like a leaf.

The pancreas has three parts:

  • the wide end is called the head
  • the thin end is called the tail
  • the bit in the middle is called the body

The pancreas is a large gland that makes digestive juices and insulin. The juices flow down a tube (pancreatic duct) into the duodenum. The duodenum is the first part of the small bowel, where it is joined to the stomach.

Another duct joins the duodenum. The bile duct comes down from the gallbladder and liver and joins the duodenum right next to the pancreatic duct. The place where the 2 bile ducts join and meet the bowel is called the ampulla of Vater.

What does the Pancreas do?

The pancreas produces digestive juices and insulin, as well as other hormones to do with digestion.

The part which produces the digestive juices is called the exocrine pancreas. The part which produces hormones, including insulin, is called the endocrine pancreas.

Cancers that develops from these two parts can behave differently and cause different symptoms.

What does the digestive system do?

The digestive system breaks up and digests food. After about 2 hours in the stomach, the partly digested food moves into the beginning of the duodenum.

When the food reaches the duodenum, the pancreas releases its digestive juices which flow down the pancreatic duct and mix with the food.

The juices contain enzymes that help to break down the food into very small fragments. These fragments are absorbed into the body through the small bowel.

How does the pancreas make insulin?

The pancreas makes insulin. Insulin keeps the level of sugar in the blood at a stable level. This means that the body cells get enough food, but not too much. The pancreas makes and releases more insulin if the level of sugar in the blood is high. If the level is too low, it releases less.

You have diabetes if you don’t make enough insulin.

How common is pancreatic cancer?

Around 10,000 people are diagnosed with pancreatic cancer in the UK each year. It is the 11th most common cancer in the UK.

Who gets pancreatic cancer?

Pancreatic cancer is more common in older people. Almost half of all new cases are diagnosed in people aged 75 and over. Pancreatic cancer is uncommon in people under 40 years old.

It occurs equally in men and women.

In the past 10 years, pancreatic cancer rates have increased and it is thought they will continue to increase.

In England, pancreatic cancer is more common in people living in poorer areas. It is more common in White and Black people than in Asian people.

The pancreas has two functional components

The pancreas is really two glands that are intimately mixed together into one organ. The bulk of the pancreas is composed of “exocrine” cells that produce enzymes to help with the digestion of food. These exocrine cells release their enzymes into a series of progressively larger tubes (called ducts) that eventually join together to form the main pancreatic duct. The main pancreatic duct runs the length of the pancreas and drains the fluid produced by the exocrine cells into the duodenum, the first part of the small bowel.

The second functional component of the pancreas is the “endocrine” pancreas. The endocrine pancreas is composed of small islands of cells, called the islets of Langerhans. These endocrine cells don’t release their secretions into the pancreatic ducts, instead they release hormones, such as insulin and glucagon, into the blood stream, and these hormones in turn help control blood sugar (glucose) levels.

Acinar cells
Acinar cells are the exocrine (exo=outward) cells of the pancreas that produce and transport enzymes that are passed into the duodenum where they assist in the digestion of food.
Islets of Langerhans The islets of Langerhans are the endocrine (endo= within) cells of the pancreas that produce and secrete hormones such as insulin and glucagon into the bloodstream. The pancreatic hormones, insulin and glucagon, work together to maintain the proper level of sugar (glucose) in the blood. Blood sugar is used by the body for energy.

An understanding of the two functional components of the pancreas is important for two reasons.

First, as they grow large tumors of the pancreas will interfere with both of these important bodily functions. When tumors block the exocrine system, patients can develop pancreatitis and pain from the abnormal release of digestive enzymes into the substance of the pancreas instead of into the bowel, and they can develop digestive problems, such as diarrhea, from the incomplete digestion of food. When tumors destroy the endocrine function of the pancreas, patients can develop sugar diabetes (abnormally high blood sugar levels).

The second reason that the two functional components of the pancreas are important to understand is that tumors can arise in either component. The vast majority of tumors of the pancreas arise in the exocrine part and these cancers look like pancreatic ducts under the microscope. These tumors are therefore called “ductal adenocarcinomas,” or simply “adenocarcinoma,” or even more simply “pancreatic cancer.” Less commonly, tumors arise from the endocrine component of the pancreas and these endocrine tumors are called “pancreatic neuroendocrine tumors,” or “islet cell tumors” for short.

How does it all fit together?

The pancreas is an integral part of the digestive system, and the flow of the digestive system is often altered during the surgical treatment of pancreatic cancer. Therefore it is helpful to review the normal flow of food and the flow of digestive enzymes of the pancreas before reading about surgical treatment.

Food is carried from the mouth to the stomach by the esophagus. The esophagus is a tube that descends from the mouth down into the abdomen. In the abdomen, the esophagus empties into the stomach where digestive acids made by the stomach break down the food. From the stomach, the partially digested food flows directly into the first part of the small intestine, called the duodenum. It is here in the duodenum that bile from the liver and digestive enzymes from the pancreas enter the digestive system.

The duodenum then leads to the other parts of the small bowel, the jejunum and ileum, where further digestion of food takes place. The ileum then empties into the large bowel (also known as the large intestine), and finally completely digestive material passes out of the body through the anus.

What is bile?

Bile is important to understand because the flow of bile is often blocked by pancreatic cancers, and because the flow of bile is altered during surgery for pancreatic cancer. Bile is a greenish-yellow fluid that aids in the digestion of fats in food. After being produced by cells in the liver, the bile travels down through the bile ducts which merge with the cystic duct from the gallbladder to form the common bile duct. The gallbladder stores extra bile until needed. The common bile duct then passes through the head of the pancreas and joins the pancreatic duct to form the ampulla of Vater which then empties into the duodenum. The flow of bile is indicated by the green arrows.

Understanding that the tube (duct) carrying bile from the liver passes through the pancreas on its way to the intestine, helps us understand why some people with pancreatic cancer develop jaundice (an abnormal yellowing of the skin and eyes). Pancreatic cancers in the head of the pancreas (the bile duct passes through the head of the pancreas) can block the bile duct and in so doing can block the flow of bile out of the liver. The bile backs up and causes jaundice.

What is pancreatic fluid?

Instead of carrying bile, the pancreatic duct carries the fluid containing the digestive enzymes produced by the acinar cells (exocrine cells) of the pancreas. The main pancreatic duct is normally only one-sixteenth of an inch in diameter and it has many small side branches. The main pancreatic duct merges with the bile duct in the head of the pancreas to form the ampulla of Vater (a widening of the duct just before it enters the duodenum). Just as was true for bile, the flow of pancreatic fluid is often blocked by tumors of the pancreas, and altered by pancreatic surgery. The flow of pancreatic fluid is indicated by the dark yellow arrow.

What is the pancreas?

Cross-section of the gut

  1. Liver
  2. Gallbladder
  3. Oesophagus
  4. Stomach
  5. Pancreas
  6. Jejunum
  7. Rectum
  8. Anus
  9. Duodenum
  10. Large intestine
  11. Small intestine
  12. Appendix

The pancreas is an organ which is about the size of a hand.

Our picks for What does the pancreas do?

The digestive system

The gut (gastrointestinal tract) is the long tube that starts at the mouth and ends at the back …

Where is the pancreas?

The pancreas is in the upper tummy (abdomen) and lies behind the stomach and guts (intestines). The pancreas has a connection via a tube (duct) to the first part of the gut (known as the duodenum) which is connected to the stomach. This connecting duct allows the chemicals (enzymes) produced by the pancreas to pass into the intestines.

What does the pancreas do?

The pancreas has two main functions:

  • To make digestive chemicals (enzymes) which help us to digest food. Enzymes help to speed up your body’s processes.
  • To make hormones which regulate our metabolism. Hormones can be released into the bloodstream. They act as messengers, affecting cells and tissues in distant parts of your body.

About 90% of the pancreas is dedicated to making digestive enzymes. Cells called acinar cells within the pancreas produce these enzymes. The enzymes help to make proteins, fats and carbohydrates smaller. This helps the guts (intestines) to absorb these nutrients. The acinar cells also make a liquid which creates the right conditions for pancreatic enzymes to work. This is also known as pancreatic juice. The enzymes made by the pancreas include:

  • Pancreatic proteases (such as trypsin and chymotrypsin) – which help to digest proteins.
  • Pancreatic amylase – which helps to digest sugars (carbohydrates).
  • Pancreatic lipase – which helps to digest fat.

Approximately 5% of the pancreas makes hormones which help to regulate your body’s metabolism. These hormones are made by several different cells which clump together like little islands (islets) within the pancreas. The islets are called islets of Langerhans and there are about one million islets dotted about in an adult pancreas. The hormones made by the cells in the islets of Langerhans within the pancreas include:

  • Insulin – which helps to regulate sugar levels in the blood.
  • Glucagon – which works with insulin to keep blood sugar levels balanced.
  • Somatostatin – which helps to control the release of other hormones.
  • Gastrin – which aids digestion in the stomach.

How does the pancreas work?

  1. Gallblader
  2. Bile duct
  3. Opening of pancreatic and bile ducts into the duodenum
  4. Pancreas
  5. Pancreatic duct

The digestive chemicals (enzymes) made by the pancreas are controlled by the body’s nervous system and its hormones. When the body senses food in the stomach, electrical signals are sent to the pancreas via nerves. These signals stimulate the pancreas to put more enzymes into the pancreatic juice. Acinar cells respond by increasing the amount of enzymes they produce. The enzymes leave the cells and pass into tiny tubes (ducts). These ducts join together like branches of a tree to form the main pancreatic duct. The pancreatic duct drains the enzymes produced into the first part of the gut, known as the duodenum.

The enzymes are made in an inactive form so that they don’t digest the pancreas itself. Once they enter the intestines the enzymes are activated and can begin breaking food down.

The main hormones released by the pancreas are insulin and glucagon. These hormones help to regulate the amount of sugar found in the blood and the body’s cells. The body’s cells need energy to function. The most readily available form of energy is glucose, a type of sugar. Insulin helps to take glucose from the blood into the cells themselves. This allows the cells to function properly. Glucagon stimulates cells in the liver to release glucose into the blood when levels are low.

The pancreas carefully monitors the level of glucose in the blood. When levels of glucose are high in the blood, cells within the pancreas make insulin. Insulin gets released into the bloodstream where it causes glucose to move into cells. This decreases the amount of glucose in the bloodstream, lowering blood sugar levels. Low blood sugar levels stimulate the pancreas to make glucagon. Glucagon works on cells in the liver, causing the release of glucose. If sugar levels in the blood rise above normal, the pancreas stops releasing glucagon. Insulin may then be released to balance the system again.

This system helps to keep the level of glucose in your blood at a steady level. When you eat, levels of sugar in your blood rise and insulin helps to bring them down. Between meals, when your sugar levels fall, glucagon helps to keep them up.

Some disorders of the pancreas

  • Cancer of the pancreas
  • Diabetes – type 1
  • Pancreatitis – acute
  • Pancreatitis – chronic

Pancreas

Continued From Above…

Anatomy of the Pancreas

Gross Anatomy

The pancreas is a narrow, 6-inch long gland that lies posterior and inferior to the stomach on the left side of the abdominal cavity. The pancreas extends laterally and superiorly across the abdomen from the curve of the duodenum to the spleen. The head of the pancreas, which connects to the duodenum, is the widest and most medial region of the organ. Extending laterally toward the left, the pancreas narrows slightly to form the body of the pancreas. The tail of the pancreas extends from the body as a narrow, tapered region on the left side of the abdominal cavity near the spleen.

Glandular tissue that makes up the pancreas gives it a loose, lumpy structure. The glandular tissue surrounds many small ducts that drain into the central pancreatic duct. The pancreatic duct carries the digestive enzymes produced by endocrine cells to the duodenum.

Microscopic Anatomy

The pancreas is classified as a heterocrine gland because it contains both endocrine and exocrine glandular tissue. The exocrine tissue makes up about 99% of the pancreas by weight while endocrine tissue makes up the other 1%. The exocrine tissue is arranged into many small masses known as acini. Acini are small raspberry-like clusters of exocrine cells that surround tiny ducts. The exocrine cells in the acini produce digestive enzymes that are secreted from the cells and enter the ducts. The ducts of many acini connect to form larger and larger ducts until the products of many acini run into the large pancreatic duct.

The endocrine portion of the pancreas is made of small bundles of cells called islets of Langerhans. Many capillaries run through each islet to carry hormones to the rest of the body. There are 2 main types of endocrine cells that make up the islets: alpha cells and beta cells. Alpha cells produce the hormone glucagon, which raises blood glucose levels. Beta cells produce the hormone insulin, which lowers blood glucose levels.

Physiology of the Pancreas

Digestion

The exocrine portion of the pancreas plays a major role in the digestion of food. The stomach slowly releases partially digested food into the duodenum as a thick, acidic liquid called chyme. The acini of the pancreas secrete pancreatic juice to complete the digestion of chyme in the duodenum. Pancreatic juice is a mixture of water, salts, bicarbonate, and many different digestive enzymes. The bicarbonate ions present in pancreatic juice neutralize the acid in chyme to protect the intestinal wall and to create the proper environment for the functioning of pancreatic enzymes. The pancreatic enzymes each specialize in digesting specific compounds found in chyme.

  • Pancreatic amylase breaks large polysaccharides like starches and glycogen into smaller sugars such as maltose, maltotriose, and glucose. Maltase secreted by the small intestine then breaks maltose into the monosaccharide glucose, which the intestines can directly absorb.
  • Trypsin, chymotrypsin, and carboxypeptidase are protein-digesting enzymes that break proteins down into their amino acid subunits. These amino acids can then be absorbed by the intestines.
  • Pancreatic lipase is a lipid-digesting enzyme that breaks large triglyceride molecules into fatty acids and monoglycerides. Bile released by the gallbladder emulsifies fats to increase the surface area of triglycerides that pancreatic lipase can react with. The fatty acids and monoglycerides produced by pancreatic lipase can be absorbed by the intestines.
  • Ribonuclease and deoxyribonuclease are nucleases, or enzymes that digest nucleic acids. Ribonuclease breaks down molecules of RNA into the sugar ribose and the nitrogenous bases adenine, cytosine, guanine and uracil. Deoxyribonuclease digests DNA molecules into the sugar deoxyribose and the nitrogenous bases adenine, cytosine, guanine, and thymine.

Blood Glucose Homeostasis

The endocrine portion of the pancreas controls the homeostasis of glucose in the bloodstream. Blood glucose levels must be maintained within certain limits so that there is a constant supply of glucose to feed the cells of the body but not so much that glucose can damage the kidneys and other organs. The pancreas produces 2 antagonistic hormones to control blood sugar: glucagon and insulin.

  • The alpha cells of the pancreas produce glucagon. Glucagon raises blood glucose levels by stimulating the liver to metabolize glycogen into glucose molecules and to release glucose into the blood. Glucagon also stimulates adipose tissue to metabolize triglycerides into glucose and to release glucose into the blood.
  • Insulin is produced by the beta cells of the pancreas. This hormone lowers blood glucose levels after a meal by stimulating the absorption of glucose by liver, muscle, and adipose tissues. Insulin triggers the formation of glycogen in the muscles and liver and triglycerides in adipose to store the absorbed glucose.

Regulation of Pancreatic Function

The pancreas is controlled by both the autonomic nervous system (ANS) and the endocrine system. The ANS has 2 divisions: the sympathetic and the parasympathetic.

  • Nerves of the sympathetic division become active during stressful situations, emergencies, and exercise. Sympathetic neurons stimulate the alpha cells of the pancreas to release the hormone glucagon into the bloodstream. Glucagon stimulates the liver to begin the breakdown of the energy storage molecule glycogen into smaller glucose molecules. Glucose is then released into the bloodstream for the organs, especially the heart and skeletal muscles, to use as energy. The sympathetic nerves also inhibit the function of beta cells and acini to reduce or prevent the secretion of insulin and pancreatic juice. The inhibition of these functions provides more energy for other parts of the body that are active in dealing with the stressful situation.
  • Nerves of the parasympathetic division of the ANS become active during restful times and during the digestion of a meal. Parasympathetic nerves stimulate the release of insulin and pancreatic juice by the pancreas. Pancreatic juice helps with the digestion of food while insulin stores the glucose released from the digested food in the body’s cells.

The endocrine system uses 2 hormones to regulate the digestive function of the pancreas: secretin and cholecystokinin (CCK).

  • Cells in the lining of the duodenum produce secretin in response to acidic chyme emerging from the stomach. Secretin stimulates the pancreas to produce and secrete pancreatic juice containing a high concentration of bicarbonate ions. Bicarbonate reacts with and neutralizes hydrochloric acid present in chyme to return the chyme to a neutral pH of around 7.
  • CCK is a hormone produced by cells in the lining of the duodenum in response to the presence of proteins and fats in chyme. CCK travels through the bloodstream and binds to receptor cells in the acini of the pancreas. CCK stimulates these cells to produce and secrete pancreatic juice that has a high concentration of digestive enzymes. The high levels of enzymes in pancreatic juice help to digest large protein and lipid molecules that are more difficult to break down.

Pancreatic Health Problems

If the ducts leading from the pancreas are blocked in some way — such as when a gallstone blocks the ampulla of Vater – pancreatic fluids can build up in the pancreas and may then become activated so that they digest the pancreas itself. This condition is known as acute pancreatitis. If the onset is gradual and longer-term, we call it chronic pancreatitis.

Pancreatic cancer has one of the direst prognoses of any of the types of cancer, in part because it tends to be very metastatic (it spreads rapidly) and because it is often undiagnosed at an early stage.

Pancreatic surgery can be quite problematic for several reasons:

  • The pancreas’ soft, spongy, tissue is very blood-rich, but its texture makes it extremely difficult to suture.
  • Tumors are often advanced by the time they are detected.

Due to the complexities, candidates for surgery are often strongly advised to seek their treatment in a facility that conducts a higher volume of such procedures.

Hereditary hemochromatosis and diabetes mellitus involve the pancreas as well. You can test for your inherited genetic risk of hemochromatosis using modern DNA health testing.

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