What are the main risk factors for pancreatic cancer?
They include the development of type 2 diabetes later in life, obesity, smoking, alcohol use, a history of pancreatitis, and hereditary factors. Pancreatic cancer is much more common in African Americans — in fact, the incidence rate for African Americans is the highest of any racial or ethnic group, according to the National Cancer Institute. And there are also some very rare familial syndromes (passed on genetically) that can lead to pancreatic cancer.
With respect to diabetes, it could be that individuals develop diabetes and then the cancer forms or that the cancer is forming because of other risk factors and the cancer leads to the late-onset diabetes. Many patients who are diagnosed with pancreatic cancer had developed diabetes within the preceding couple of years. In fact, one out of every 125 people with new-onset diabetes develops pancreatic cancer within three years of their diagnosis.
What are the common symptoms?
Back pain, particularly back pain that wakes someone up at night, is a classic symptom. Other common symptoms are weight loss, abdominal pain, and jaundice (the yellowing of the eyes and skin), which results when the tumor blocks the bile ducts.
The problem is that these symptoms can be attributed to other, more common diagnoses. People think it’s gas, constipation, or irritable bowel syndrome, which causes pain and other digestive symptoms. As a result, the cancer is most often diagnosed late, meaning that it has already metastasized, or spread, to other parts of the body when it’s found. Also, the symptoms don’t happen until the cancer that’s growing in the pancreas is fairly large.
Less common symptoms include the development of blood clots out of the blue and the development or worsening of depression.
How is pancreatic cancer detected?
Currently there is no screening test. However, we are on our way to having one, probably in the next few years. There is an ongoing clinical trial investigating a blood test called CancerSEEK, which is funded by the Lustgarten Foundation and Stand Up To Cancer, that identifies mutations and cancer proteins in the blood associated with pancreatic cancer and other cancers. Before a screening test can be approved for wide use, you have to evaluate it in thousands of patients, and that is happening.
Right now the disease is usually detected when someone finally comes to their physician with symptoms and gets further workup. That will most likely include blood tests that show if their pancreatic enzymes and liver function tests are elevated. Ultimately, they get imaging tests, which pick up the mass in the pancreas and/or sites where the cancer has spread. Once the cancer is found, a biopsy is needed.
How can people increase the chances of an earlier diagnosis if they have pancreatic cancer?
If you’re experiencing something worrying and you go to the doctor and they tell you it’s nothing or something else, but the symptoms persist, go back or see a new doctor and be an advocate for yourself. People know their bodies best. It’s also extremely important to tell your doctor if pancreatic cancer runs in your family.
What are the treatments for pancreatic cancer?
Surgery to remove the tumor in conjunction with other treatments like chemotherapy and radiation are the only known cure for pancreatic cancer. I and others who treat this disease believe that this is a systemic disease, meaning that the cells have already entered the bloodstream as it has been growing. So if you just cut it out and don’t treat the bloodstream, which is what chemotherapy does, then there’s a significant risk of it returning.
However, because pancreatic tumors are found so late, only about 15% to 20% of people diagnosed with the disease are eligible for surgery. The majority of cases are not operable because the tumor is so large or it’s in a place that is encroaching upon the major blood vessels that course through the pancreas. Cancer that has already spread through the body is also not operable, and systemic therapy is used, which has been shown to extend survival. The rate of recurrence can be as high as 80% even if you have surgery.