Everything You Need to Know About Pancreatic Cancer

Table of Contents

Overview
Signs and Symptoms
Risk Factors
Screening and Prevention
When to See a Doctor
Diagnosis
Types
Prognosis
Complications
Treatments
Living with Pancreatic Cancer
Frequently Asked Questions
Outlook

Overview

The pancreas is an abdominal organ located just behind the lower part of the stomach, which consists of a head, neck, body, and tail. It releases enzymes that aid digestion and hormones that help manage your blood sugar.

Pancreatic cancer represents three percent of all cancers diagnosed in the United States. In fact, it is the ninth most common cancer in women and 10^th most common cancer in men. Additionally, pancreatic cancer is the fourth leading cause of cancer-related death. It accounts for seven percent of all deaths attributable to cancer in a year.

Signs and Symptoms

Generally, pancreatic cancer is seldom diagnosed early. This is since its signs and symptoms are often vague or just go unnoticed. As a result, significant signs and symptoms of pancreatic cancer often only present at an advanced stage. For instance, when it has spread to other parts of the body. This late onset of symptoms makes pancreatic cancer difficult to treat — let alone cure.

Jaundice — yellowing of the skin and whites of the eyes — is often a telltale sign of pancreatic cancer. It is caused when the cancerous tumor blocks the common bile duct, which releases bile into the intestine to help us digest food. Jaundice may be accompanied by itching, dark urine, and light-colored stools.

Other signs and symptoms of pancreatic cancer may include:

• Upper abdominal pain, which may or may not radiate to the back, and/or garden variety back pain;
• Fatigue and/or weakness;
• Unintended weight loss with or without nausea and/or vomiting;
• New-onset diabetes, and;
• Unprovoked blood clots, known clinically as deep vein thrombosis.

Risk Factors

No one knows the exact cause of pancreatic cancer. Despite that, there are well-established risk factors for the disease. Some risk factors for pancreatic cancer are amenable to change, while other risk factors cannot be changed.

Modifiable Risk Factors

Risk factors that can be changed include:

• Smoking: Cigarette smoking accounts for almost 25 percent of pancreatic cancers.
• Being Overweight/Obese: If your body mass index is greater than or equal to 30 kg/m², you are almost 20 percent more likely to develop pancreatic cancer.
• Diabetes: Individuals with type 2 diabetes are at increased risk for pancreatic cancer, while it is not known if type 1 diabetes increases your risk.
• Chronic Pancreatitis: This condition represents constant inflammation of the pancreas and is most commonly attributable to heavy alcohol consumption.
• Occupational Exposure to Certain Chemicals: If you work in the dry cleaning or metalworking industry, workplace exposure to certain chemicals may increase your risk of developing pancreatic cancer.

Non-Modifiable Risk Factors

Risk factors that cannot be changed include:

• Advancing Age: 66 percent of those diagnosed with pancreatic cancer are over the age of 65. The average age of 70 at the time of diagnosis.
• Gender: Men are slightly more likely to develop pancreatic cancer.
• Race: African Americans are slightly more likely to develop pancreatic cancer.
• Family History of Pancreatic Cancer: If you have a first-degree relative diagnosed with pancreatic cancer, you are at increased risk for the disease. However, most individuals diagnosed with pancreatic cancer do not have a family history.
• Inherited Genetic Syndromes: Examples include breast and ovarian cancer syndrome, Lynch syndrome, and familial atypical multiple mole melanoma syndrome.

Screening and Prevention

Currently, no medical society or other group recommends routine screening for pancreatic cancer. This is mostly attributable to the fact that there are no approved screening tests for the early diagnosis of pancreatic cancer.

Measuring levels of carbohydrate antigen 19-9 may be useful in monitoring disease activity and response to treatment. Unfortunately, it is not a suitable screening test for pancreatic cancer, as it has high rates of falsely positive tests.

Most clinicians agree that there is no way to prevent pancreatic cancer. However, low-dose aspirin has been the most promising preventative agent. It has shown to significantly reduce the risk of pancreatic cancer in a dose-dependent manner.

Additional measures include:

• Quitting smoking;
• Minimization or abstinence from alcohol;
• Regular exercise, and;
• Maintaining a healthy weight.

These measures may reduce your risk of developing pancreatic cancer but not necessarily prevent it.

When to See a Doctor

If you develop any signs and symptoms — especially jaundice as this is an abnormal occurrence in any adult — you should see your doctor for an investigation. As signs and symptoms of pancreatic cancer often do not appear until the later stages of the disease, that visit to your doctor should not be delayed. Early detection gives those diagnosed with pancreatic cancer the best possible chances for survival.

Although pancreatic cancer is not preventable, your doctor will be able to discuss strategies that have the potential to dramatically decrease your risk.

Diagnosis

Your doctor will start by taking a medical history. This delves into your symptoms by pinpointing location, onset, duration, and exacerbating/relieving factors. After this process, a physical examination looking for any signs of pancreatic cancer will be carried out. Lastly, your blood may be drawn for testing to reveal any abnormalities.

Based on these variables, your doctor may choose one or more imaging studies to verify the presence of a tumor in your pancreas. They may choose an ultrasound, computed tomography scan, magnetic resonance imaging, and/or positron emission tomography scan.

If there is indeed a tumor in your pancreas, a biopsy will be needed to obtain a definitive diagnosis of pancreatic cancer. Biopsies may be completed using different techniques, which are determined on a case-by-case basis. The most used method for biopsy is fine-needle aspiration. This is where your doctor inserts a needle through the skin, into the abdomen, and ending up in the diseased portion of the pancreas. Other methods that allow for the completion of biopsies include endoscopic retrograde cholangiopancreatography, endoscopic ultrasound, and laparoscopy.

Types

Based on the biopsy, pancreatic cancer is classified according to which part of the pancreas it affects. The classifications of pancreatic cancer are:

• Exocrine: The part of the pancreas that makes digestive enzymes.
• Endocrine: The part that makes hormones.

Exocrine Pancreatic Cancer

Pancreatic adenocarcinoma is the most common exocrine pancreatic cancer. It accounts for 95 percent of cases.

Other less common types of exocrine pancreatic cancers include:

• Acinar cell carcinomas;
• Adenosquamous carcinomas;
• Squamous cell carcinomas;
• Giant cell carcinomas, and;
• Small cell carcinomas.

Endocrine Pancreatic Cancer

Endocrine pancreatic cancers are rare. They are categorized by the type of hormone they produce. These categories are:

• Insulinomas from cells producing insulin;
• Glucagonomas from cells producing glucagon;
• Gastrinomas from cells producing gastrin;
• VIPomas from cells producing vasoactive intestinal peptide (VIP), and;
• Somatostatinomas from cells producing somatostatin.

Prognosis

After the definitive diagnosis of pancreatic cancer, your doctor will want to assign a stage to your cancer. Staging your cancer provides important information as to the extent of cancer in your body and its anticipated response to treatment. In general, the higher the stage is, the more advanced the cancer. The more advanced the cancer is, the less responsive it will be to treatment.

Stages of Pancreatic Cancer

Pancreatic cancer has the following stages:

• Stage 0: There is a group of abnormal cells that are too early to classify as cancer. Often referred to as “pre-cancer” or carcinoma in situ.
• Stage I: The cancer is confined to the pancreas only.
• Stage II: The cancer has spread to adjacent abdominal structures or lymph nodes.
• Stage III: The cancer has spread to major lymph nodes.
• Stage IV: The cancer has spread to other major organs, such as the liver, lungs, or bone.

Five-Year Survival Rates

The staging of pancreatic cancer is important because your stage can be used to convey survival statistics or prognosis.

The following are five-year survival rates for certain categories of pancreatic cancer:

• Localized Disease Includes Stages 0, I, and IIA: 34 percent
• Regional Disease Includes Stages IIB and III: 12 percent
• Distant Disease Includes Stage IV: Three percent
• All Stages Combined: Nine percent

It is important to keep in mind that these five-year survival rates are by no means clear cut. They only apply to the stage of cancer at first diagnosis. As such, they do not take other factors — such as age, overall health, the response of cancer to treatment, and tumor grade — into consideration.

Lastly, if you have been recently diagnosed with pancreatic cancer, your prognosis may be better since these survival rates were obtained five years earlier. Your doctor is better equipped to discuss the nuances of the prognosis of your particular pancreatic cancer.

Complications

As pancreatic cancer progresses, it can lead to complications through several mechanisms. This includes:

• Pressure on adjacent organs/structures;
• Deficiency of hormones/substances produced by normal pancreatic cells;
• High metabolic demands of the cancer, or;
• The spread of the cancer.

The following may be complications of pancreatic cancer:

• Pancreatic Insufficiency: This occurs in 80 to 90 percent of patients with pancreatic cancer. It requires pancreatic enzyme replacement therapy for treatment.
• Bile Duct Obstruction: A very common complication of pancreatic cancer. It can lead to jaundice.
• Cachexia: Characterized by extreme weight loss, muscle wasting, and loss of appetite.
• Bowel Obstruction: Resulting from the growth of cancer cells pressing into the first portion of the small bowel.
• Diabetes: 85 percent of patients with pancreatic cancer will develop insulin resistance or full-blown diabetes.

Other potential complications of pancreatic cancer are:

• Weight loss;
• Nausea and vomiting;
• Chronic pain, and;
• Blood clots, which could dislodge and travel to the lungs causing a potentially life-threatening pulmonary embolism.

Treatments

Even though pancreatic cancer is usually diagnosed at an advanced stage, it is a treatable disease. The treatment of pancreatic cancer is highly influenced by the stage of cancer, but not totally dependent. Despite the absence of screening recommendations, early detection is key to provide the best chances of survival.

As with most cancers, the goals of treatment for pancreatic cancer are to eradicate cancer cells and prevent their spread to other parts of the body. In general, the treatments for pancreatic cancer may include surgery, chemotherapy, radiation therapy, and targeted therapy.

Surgery

If pancreatic cancer is confined to the pancreas, surgery may be an option. Depending on the location of the cancerous tumor, there are several surgical options for the removal of the diseased portion of the pancreas.

If the tumor is located in the head and/or neck of the pancreas, the Whipple procedure, or pancreaticoduodenectomy, is the surgical procedure of choice. It can be performed through open surgery, laparoscopic surgery, or robotic surgery. In this complex surgical procedure, the head of the pancreas, duodenum, gallbladder, and lower portion of the bile duct are removed. There is also a modified Whipple procedure. It removes a portion of the stomach in addition to those structures discussed previously.

If the tumor is located in the body or tail of the pancreas, a distal pancreatectomy is the surgical procedure of choice. This procedure removes the tail and/or body of the pancreas, with or without removal of the spleen.

Sometimes, the entire pancreas must be removed. This operation is referred to as a total pancreatectomy. Diabetes is assured with a total pancreatectomy as insulin is no longer produced naturally by your pancreas.

Other complications from the surgical treatment of pancreatic cancer may include

• Bleeding;
• Infections;
• Leaking from the surgical connections to the pancreas or bile duct, and
• Delayed emptying of the stomach.

Chemotherapy

Surgery may be unacceptable for individuals with advanced-stage pancreatic cancer. In this case, chemotherapy may be a therapeutic option to control the growth of cancer cells and prolong survival.

Chemotherapy drugs can be injected into veins or taken by mouth. They may be administered alone or in a combination of agents. These drugs may be administered before surgery to shrink a tumor or after surgery to reduce the risk of cancer recurrence.

Common side effects of chemotherapy include:

• Hair loss;
• Fatigue;
• Nausea and vomiting;
• Easy bruising and bleeding;
• Anemia;
• Loss of appetite, and;
• Increased susceptibility to infections.

Radiation Therapy

Another option for individuals with advanced-stage pancreatic cancer not amenable to surgery is radiation therapy. Radiation therapy uses high energy beams to kill cancer cells.

There are two types of radiation therapy that can be used to treat pancreatic cancer

1. External beam radiation
2. Intraoperative radiation

Radiation therapy is often combined with chemotherapy. It can also be administered before or after cancer surgery, often in combination with chemotherapy.

The most common early side effects of radiation therapy are fatigue and skin problems. Other side effects may include hair loss, nausea and vomiting, and diarrhea.

Targeted Therapy

Targeted therapy is relatively new in the treatment of pancreatic cancer. It uses drugs or other substances to specifically target cancer cells and destroy them. These drugs are designed not to harm normal cells and work in a different manner than standard chemotherapy drugs.

One such example of targeted therapy is erlotinib (Tarceva). It has been helpful in some individuals with advanced pancreatic cancer. Erlotinib is taken by mouth as a pill and often combined with the chemotherapeutic agent gemcitabine. Common side effects of erlotinib include:

• Fatigue;
• An acne-like rash on the face and neck;
• Loss of appetite, and;
• Diarrhea.

Living with Pancreatic Cancer

If you have or had pancreatic cancer, you may be interested in measures you can take right now to slow the growth of your cancer or reduce the risk of its recurrence.

Quit Smoking

If you are a smoker, it is imperative to quit. If you need help with smoking cessation, your doctor may be able to prescribe medications, such as bupropion (Zyban) or varenicline (Chantix).

Regular Exercise

If you are able, regular exercise should be an important part of your cancer treatment plan. Regular exercise is at least 30 minutes per day on most days of the week.

In addition to regular exercise, proper nutrition in the form of a well-balanced diet is beneficial.

Emotional Support

Since the diagnosis of such an illness can be devastating, seeking emotional support is important.

Take the time to develop a support network. You will certainly need someone to talk to about your disease. It may also be a good idea to connect with others whether through online or in-person support groups.

Lastly, consider hospice care, especially if you have advanced pancreatic cancer.

Frequently Asked Questions

Why Is Pancreatic Cancer So Lethal?

At nine percent, pancreatic cancer has one of the lowest overall five-year survival rates of any cancer.

It is often diagnosed at an advanced stage. In fact, 85 percent of pancreatic cancers already have spread to other parts of the body when diagnosed. This makes a surgical cure impossible.

Is There a Connection Between Breast and Ovarian Cancer and Pancreatic Cancer?

Yes, BRCA gene mutations — which are associated with breast and ovarian cancer syndromes — doubles your lifetime risk of developing pancreatic cancer. In fact, five percent of individuals with pancreatic cancer have this type of mutation.

Is There a Connection Between Pancreatitis and Pancreatic Cancer?

Yes, pancreatitis, the inflammation of the pancreas, is a well-known risk factor pancreatic cancer. However, most cases of pancreatitis are unrelated to pancreatic cancer.

Can Pancreatic Cancer Be Cured?

Yes, pancreatic cancer can be cured with surgery, chemotherapy, radiation therapy, and/or targeted therapy. This is especially true if detected early and confined to the pancreas.

Can I Live Without a Pancreas?

Yes, you can live without a pancreas. However, you will most likely develop diabetes. As a result, you will have to inject insulin daily and undergo pancreatic enzyme replacement therapy.

Outlook

Since patients typically have no symptoms until advanced stages of the disease, pancreatic cancer is extremely difficult to diagnose and treat. Although pancreatic cancer is a relatively rare malignancy and survival rates have been improving over the years, it is still considered largely incurable.

If you develop possible symptoms of pancreatic cancer or have risk factors that increase your risk of developing the disease, it is imperative to schedule an evaluation with your doctor. After all, there is proof that early diagnosis and treatment of pancreatic cancer provide the best outcomes for patients.