Pancreatic Cancer: A Rare and Little-Known Disease

Considering that pancreatic cancer is relatively rare (accounting for about 3% of all cancers in the U.S) it takes a very large toll. That's because the five-year survival rate is just 12% according to the American Cancer Society. And the low survival rate is due to the fact that more than 50% of all pancreatic cancer is at stage 4 (metastatic) when it's diagnosed, meaning it has already spread to other organs such as the liver or lungs. The statistics may be grim, but that's why it's important to learn more about this increasingly diagnosed cancer.

The pancreas is a small organ behind the lower part of the stomach that makes enzymes for food digestion and hormones (including insulin) that help regulate blood sugar. Pancreatic cancer starts with abnormal cell growth in the pancreas, most commonly in the cells that line the ducts that carry digestive enzymes out of the pancreas. This is known as pancreatic ductal adenocarcinoma, and accounts for 90% of all pancreatic cancer cases. Pancreatic neuroendocrine cancer is far less common (just 5% of all cases) and develops in hormone-producing endocrine cells or islet cells.

Because the pancreas is deep in the abdomen and hidden behind other organs, detecting and diagnosing tumors is very difficult. Imaging may be used to help find tumors, including computerized tomography (CT) scan, positron emission tomography (PET) scan, and magnetic resonance imaging (MRI). A blood test for tumor markers may also be used. However, the most accurate way to diagnose pancreatic cancer is by removing a tissue sample for a biopsy using an endoscopic ultrasound (EUS). Learn more about diagnosing pancreatic cancer.

Who's at Risk?

Every year, about 64,000 people will be diagnosed with pancreatic cancer in the U.S., and more than 50,500 will die from the disease. Historically, men have had a slightly higher risk, but a recent study indicated that rates are increasing faster among younger women, particularly black women. Risk factors known to increase the risk of pancreatic cancer include:

• Age. While rates are increasing among younger adults, almost all cases are still diagnosed in adults aged 45 or older, with about two thirds of all patients being 65 or older.
• Race. African Americans have a slightly higher risk.
• Family history. Although pancreatic cancer does seem to run in some families, most people who get it do not have a family history.
• Genetics. Inherited gene mutations may be responsible for up to 10% of pancreatic cancers. This includes the BRCA1 and BRCA2 genes for hereditary breast and ovarian cancer syndrome along with several others.
• Smoking. Up to 25% of pancreatic cancers are caused by cigarette smoking, and the risk is about twice as high for smokers compared to those who have never smoked. The risk begins to drop once a person stops smoking.
• Obesity. People with a BMI (body mass index) of 30 or more – which is the threshold for diagnosing obesity – are about 20% more likely to develop pancreatic cancer. Carrying extra weight around the waist also appears to increase risk, even in those with a BMI of less than 30. Diabetes. Having diabetes – particularly type 2 diabetes – increases your risk of pancreatic cancer, although researchers aren't sure why. It may be related to type 2 diabetes being far more common in overweight and obese people.
• Pancreatitis. Long-term inflammation of the pancreas, known as chronic pancreatitis, which is often associated with heavy drinking and smoking, also increases the risk of pancreatic cancer. Chemical exposure. Prolonged exposure to chemicals used in dry cleaning and metal working appears to increase risk.

As with many types of cancer, a poor diet, excessive alcohol consumption and a sedentary lifestyle may increase risk, but more studies are needed to prove this.

Symptoms

During the early stages of pancreatic cancer, symptoms may be subtle or even non-existent. That's one of the reasons so many patients aren't diagnosed until after the cancer has metastasized. As with all cancers, the prognosis is much better if the cancer is detected early, when it’s more treatable, so it's important to pay attention to these symptoms:

• Jaundice. Jaundice can be caused by many health issues that are far more common than pancreatic cancer, including gallstones, hepatitis, liver and bile disease. However, yellowing of the skin and whites of the eyes is often one of the first symptoms of pancreatic cancer. Dark urine, light-colored or floating stools and itchy skin are also symptoms of the bilirubin buildup that causes jaundice.
• Belly pain that spreads to back and sides. Cancers that start in the pancreas can grow and start to press on other organs, causing pain in the abdomen. It may also spread to nerves around the pancreas and cause back pain.
• Weight loss. People with pancreatic cancer often have very little appetite, which can lead to unintended and sometimes rapid weight loss.
• Blood clots. Sudden pain and swelling in a leg or arm could be a sign of a blood clot in a large vein, known as a deep vein thrombosis or DVT. Although blood clots can be caused by many other things, they are always dangerous since a piece can break off and travel to the lungs, causing a pulmonary embolism. If you have signs of a blood clot, always seek immediate treatment.

It's important to note that most of these symptoms are more often caused by other issues and not pancreatic cancer, but they all should be discussed with your doctor immediately.

Treatment

Treatment will depend on the stage of cancer (how far it's progressed), type, location, and health status of the patient. Because pancreatic cancer is rarely diagnosed at the earliest and most treatable stages, surgery is only an option in about 20% of all cases. Other treatments include chemotherapy, radiation therapy, immunotherapy, pain management and dietary changes. El Camino Health is also at the forefront of using targeted therapy – a combination of drugs designed to target specific molecules the cancer cells need to survive and spread. While the goal of treatment is always to get rid of the cancer, that may not be possible with anything beyond early-stage pancreatic cancer. In the majority of cases, the treatment focus will shift to improving quality of life. However, new treatment options are constantly being explored, and clinical studies are underway now to determine the potential of a novel vaccine designed to kill pancreatic cancer cells, along with advances in immunotherapy and targeted therapy.

Learn more about pancreatic cancer and treatment at El Camino Health.

This article first appeared in the November 2023 edition of the HealthPerks newsletter.