Pancreatic cancer is one of the most silent yet aggressive forms of cancer, as well as one of most difficult to treat. November is Pancreatic Cancer Awareness Month, which aims to raise awareness and understanding of pancreatic cancer causes and treatments.
Pancreatic cancer is cancer that begins in the pancreas, an endocrine gland about six inches long located in your upper abdomen. The pancreas produces enzymes that break down food to help with digestion and hormones called insulin and glucagon that help regulate your blood sugar levels.
There are two types of pancreatic cancer: exocrine and endocrine tumors.
Exocrine tumors of the pancreas form in the lining of the pancreatic ducts and spread quickly. These tumors are more common and are the fourth leading cause of cancer-related deaths in the United States.
Endocrine tumors of the pancreas develop in the cells that produce hormones. They’re much rarer than exocrine tumors and grow much more slowly, but still require early treatment.
Pancreatic cancer rarely develops before age 45, but the risk increases sharply after that, peaking between the ages of 65 to 69 for men and 75 to 79 for women. It’s more common in men than women and in people of African-American descent.
“The biggest risk factor, and one that we can control, is smoking. The good news is if you stop smoking, your risk for pancreatic cancer can decrease. It takes about 10 to 15 years to get to be the same as someone who’s never smoked, but you can get there,” says Dr. Fisher.
Other lifestyle factors that can increase the risk include:
- A poor diet
- Being overweight
- High alcohol intake
Genetics can play a role in the development of pancreatic cancer. About 5-10% of individuals with pancreatic cancer have a family history of the disease. The risk increases with each first-degree relative (e.g., parent or sibling) who has had it. Some genetic syndromes also may increase risk. Genetic screening may be recommended in some cases.
“Exactly who should be screened and when is complicated and evolving. We recommend all patients with a family history of pancreatic cancer or a syndrome that's associated with it discuss screening with their physician,” says Dr. Fisher.
“All patients with pancreatic cancer should be screened for a genetic component if they have relatives such as siblings or children who may be at risk.”
Early pancreatic cancer signs can be subtle. The most common include:
- Abdominal pain
- Weight loss
- Jaundice (yellowing of the eyes or skin)
There may be increasing pain or progressive weakness, fatigue or loss of appetite, as well as nausea or vomiting. Many of these symptoms also occur with common illnesses, but if you experience more than one of these symptoms for more than a few days, it’s a good idea to call your doctor and identify the cause.
A CT scan or an MRI is usually the first step in diagnosing pancreatic cancer. The diagnosis is then confirmed with a biopsy.
Dr. Fisher adds that many patients who have pancreatic cancer often develop diabetes for the first time several months before the cancer diagnosis. However, since most patients with diabetes never develop pancreatic cancer, it’s not practical to screen every new diabetes patient.
“To solve this problem, we partner with local biotech companies to develop new and very sensitive screening tests to help determine which patients should have further testing to screen for pancreatic cancer, and which are more likely to benefit from surgery and other treatments,” he says.
Every patient’s cancer journey is unique, and the multidisciplinary team at Scripps helps patients make decisions about their care.
Surgery may be an option if the cancer has not spread beyond the pancreas. The extent of the surgery depends on where the tumor is located; a small tumor on the edge of the pancreas may be cut out, but in most cases, more extensive surgery is needed to remove part of the pancreas, the blood vessels that feed it, and possibly the nearby organs. Surgery is typically followed by chemotherapy or radiation therapy.
If the cancer has spread beyond the pancreas, treatment involves chemotherapy and/or radiation without surgery.
“We also have a number of experimental trials available to patients who don’t respond to first-line therapy or don't tolerate chemotherapy,” says Dr. Fisher.
“Every patient has a clinical nurse navigator who helps them make appointments, contact members of their care team, and coordinate the care provided by all their physicians. This covers all aspects of care from the routine to the latest clinical trials.”