Sarah Cannon - November 08, 2021

Pancreatic Cancer

The incidence of pancreatic cancer has slowly climbed each year since the early part of this century. It is the 11th most commonly diagnosed cancer and the third leading cause of cancer-related death in the United States. Gwen Spector BSN, RN, COCN Complex GI Oncology Nurse Navigator at Sarah Cannon Cancer Institute at Medical City Healthcare shares what you should know about pancreatic cancer.

There are two main types of pancreatic cancer. Pancreatic ductal adenocarcinoma (PDAC) is the most common type. It develops in the exocrine cells that line the ducts most commonly in the head of the pancreas. Pancreatic Neuroendocrine tumors (PNETs) start in the neuroendocrine cells of the pancreas.

Pancreas

The pancreas has a major role in helping the body digest food. It is both an organ and a gland. It is located in the upper abdomen (belly), behind the stomach and in front of the spine and has three main parts: the head, body and tail. The pancreas performs two major jobs for the body: an exocrine function and an endocrine function. Exocrine cells make enzymes to help digest food, and endocrine cells make and release hormones, like insulin, which controls the release of blood sugar (glucose).

Risk Factors

There are risk factors that can increase the chance of developing pancreatic cancer, including smoking, obesity, heavy alcohol use, chronic pancreatitis and increasing age. Additionally, African Americans and Ashkenazi Jews have a higher risk of pancreatic cancer than the average person. Family history and inherited genetic syndromes also increase the risk for pancreatic cancer. There can be a link between different cancers such as breast, ovarian and pancreatic cancers. In these cases there are changes (mutations) in genes such as BRCA 1 or 2. There are also some pancreatic cysts that can develop into cancer if not removed.

Screening, Diagnosis and Prevention

Genetic testing can be important in screening for and planning the treatment for pancreatic cancer. Genes are units of heredity made up of DNA, and are passed down from your family. Each cell in the body has numerous genes. The Pancreatic Cancer Action Network reports that up to 10% of people have an inherited genetic mutation (changes in one or more genes), and these mutations increase the risk for pancreatic cancer. The National Comprehensive Cancer Network (NCCN) recommends genetic testing (a blood test) and genetic counseling (speaking with a specialist), especially for everyone diagnosed with pancreatic cancer and their first-degree relatives. NCCN also recommends testing a sample from the tumor of people with advanced pancreatic cancer.

Symptoms of pancreatic cancer can be vague and often don’t appear until the cancer is in advanced stages. Symptoms include abdominal or back pain, jaundice (yellowing of the skin and/or eyes), pruritus (itching), poor appetite, unexplained weight loss and nausea and vomiting.

Diabetes has been linked to pancreatic cancer in more than one way. Having existing type 2 diabetes can increase the risk for getting pancreatic cancer, and a new diagnosis of type 2 diabetes can be a sign of pancreatic cancer. Diabetes can also occur after pancreatic surgery, especially if the entire pancreas is removed.

Pancreatic cancer can be hard to detect and diagnose, especially in the earlier stages of the disease. Most often it takes several tests to diagnose and stage pancreatic cancer. These tests include tumor markers (CA19-9) and imaging studies (CT scan, PET scan, MRI), as well as endoscopic tests, like Endoscopic Ultrasound (EUS) and Endoscopic Retrograde Cholangiopancreatography (ERCP), that evaluate the area of concern by allowing the doctor to take a sample of tissue to look for cancer. A diagnostic laparoscopy may also be done before surgical treatment to check for the spread of the cancer to other organs.

There is currently no universal screening for pancreatic cancer. People with a family history of chronic pancreatitis or a known gene mutation for pancreatic cancer should talk to their doctor about screening. This should start at age 50 or 10 years younger than the earliest pancreatic cancer diagnosis in the family. Screening for some genetic syndromes may need to start sooner. Screening tests commonly used are MRI and EUS.

Treatment

The goal of pancreatic cancer treatment is to cure the cancer if possible or to slow progression and provide symptom relief (palliative). The treatment depends on the stage and type of cancer. Treatment may include one or more of the following: chemotherapy, target therapy, immunotherapy, radiation and surgery. The surgeries may remove part or all of the pancreas and some surrounding organs. Not everyone is a candidate for surgical treatment, but clinical trials can also be an option for pancreatic cancer treatment.

There are problems that can occur from pancreatic cancer or treatment side effects. Two common problems are malnutrition and pain. It’s important to recognize these problems and manage them early.  Dietitians can help patients with a nutrition plan to improve weight, and  palliative care nurses or doctors can help with relieving physical symptoms, such as pain, as well as emotional and spiritual difficulties.

Awareness

Pancreatic Cancer and Neuroendocrine Tumor Awareness Month is every November. World Pancreatic Cancer Day is on the 3rd Thursday in November.

It is important to know that the information in this post, including Sarah Cannon’s recommendations for screening, is accurate as of the publishing date.

Resources:

Contact askSARAH for questions about pancreatic cancer

Hirshberg Foundation for Pancreatic Cancer Research

Lustgarten Foundation

National Comprehensive Cancer Network (NCCN)

The National Pancreas Foundation

Neuroendocrine Cancer Awareness Network

Pancreatic Cancer Action Network, Risk Factors

National Cancer Institute

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