By Elsa Pichardo, MD
The American Cancer Society estimates that more than 62,000 people will be diagnosed with pancreatic cancer this year, and one out of every 64 Americans will develop the disease in their lifetime.
There often are no definitive signs that someone has pancreatic cancer, which is why alerting your doctor to any changes in your health is so important.
When the disease is detected at a less advanced stage, surgery, chemotherapy, or sometimes radiation, can be effective. When the cancer is found at a later stage, treatment becomes more complex.
From diagnosis through recovery, Penn Medicine Princeton Cancer Center at Princeton Medical Center provides a multidisciplinary approach to care for pancreatic cancer. As part of Penn Medicine, the experts at Princeton Cancer Center work with teams at the Abramson Cancer Center, a world leader in cancer research, patient care and education.
About Pancreatic Cancer
The pancreas is a gland deep inside the abdomen that helps your body digest food and keeps blood sugar levels steady. Pancreatic cancer is a fast-growing cancer that occurs when normal cells in the pancreas mutate and start to grow uncontrollably.
Doctors classify pancreatic cancer into two main types:
• Exocrine cancers arise from exocrine gland cells inside the pancreas. These cells aid the digestion process. Exocrine cancers (mostly adenocarcinoma) make up most pancreatic cancers.
• Pancreatic neuroendocrine tumors (NETs) develop from islet cells within the pancreas. These islet cells make hormones that keep blood sugar levels steady. NETs make up less than 5% of all pancreatic cancers.
There are currently no reliable screening tests for pancreatic cancer.
Risk Increases with Age
As you age, the risk of developing pancreatic cancer increases. In fact, almost all patients with pancreatic cancer are older than 45, and the average age at the time of diagnosis is 70, according to the American Cancer Society.
Pancreatic cancer is somewhat more common in men than in women, and there is a higher incidence of pancreatic cancer among African Americans.
Risk factors for pancreatic cancer rise after age 50 and can include:
• Smoking. Cases of pancreatic cancer are roughly twice as high among people who smoke compared to those who have never smoked, according to the American Cancer Society.
• Diabetes. Pancreatic cancer is more common in people with Type 2 diabetes.
• Chronic pancreatitis. This long-term inflammation of the pancreas increases the risk of developing pancreatic cancer. Chronic pancreatitis is commonly associated with heavy alcohol use and smoking.
• Being overweight. People with a body mass index of 30 or more are about 20% more likely to develop pancreatic cancer than those who are not obese, according to the American Cancer Society.
• Exposure to certain chemicals. Ongoing exposure to certain chemicals, such as pesticides and asbestos, may increase a person’s chances of developing pancreatic cancer.
While less common, the gene for pancreatic cancer can be inherited. People with two immediate family members who have experienced pancreatic cancer, such as a parent and sibling, should consult their primary care physician to discuss genetic testing.
Often No Clear Signs
There often are no clear signs of pancreatic cancer. Typically, by the time pancreatic cancer causes serious symptoms it has grown large or spread outside of the pancreas. In the later stages of pancreatic cancer, patients may experience symptoms that include:
- Abdominal or mid-back pain.
- Nausea and vomiting.
- Unexplained weight loss.
- A burning feeling in the stomach.
- Inability to digest fatty foods.
- Jaundice, a yellowing of the eyes and skin.
- Swelling in the gallbladder or liver.
If you have any of these symptoms or are concerned about your risk for pancreatic cancer, talk with your doctor.
Diagnosing
Unlike with some other types of cancer, there is no single diagnostic test that can tell if a patient has pancreatic cancer.
Diagnosis typically starts with a medical history and physical exam. Pancreatic cancers can sometimes cause swelling in the gallbladder or liver, which a doctor may be able to feel during a physician exam. A patient’s eyes and skin will also be checked for signs of jaundice (yellowing).
A definitive diagnosis requires a series of imaging scans, blood tests and a biopsy.
For instance, a CT scan typically provides a clear image of the pancreas. If cancer is present, the CT scan can help determine whether it has spread to other parts of the body. Other imaging, including MRI and ultrasound, can provide doctors with additional images of the pancreas.
In addition to imaging, blood tests can sometimes indicate whether pancreatic cancer is present and may help determine treatment options.
Ultimately, a biopsy is necessary to confirm whether a pancreatic growth is cancerous.
Often, a cyst or tumor is discovered during an unrelated CT scan for another condition, and the patient is then referred for further testing. It is important to remember that not all cysts are cancerous. In some cases, your doctor may recommend monitoring the cyst for changes rather than following a surgical approach.
Treating
Treatment for pancreatic cancer depends on the stage and location of the cancer as well as the patient’s overall health and personal preferences.
When surgery is recommended, depending on the tumor’s location within the pancreas it may be able to be performed laparoscopically, sometimes robotically, which offers smaller incisions and easier recovery.
If surgery is not an option initially, usually because of the size of the tumor, chemotherapy may reduce the tumor to allow for surgery.
Penn Medicine Princeton Cancer Center at Princeton Medical Center offers a range of surgical options to treat pancreatic cancer, including the Whipple procedure. The Whipple procedure is a complex surgery to remove tumors on the right side (the head) of the pancreas. During the procedure, the surgeon removes the head of the pancreas (the part next to the small bowel and bile ducts), part of the small intestine, part of the bile duct, the gallbladder and associated lymph nodes. Whipple procedures are the most common surgical treatment for pancreatic cancer.
Preventing
As the American Cancer Society notes, there are steps that everyone can take to lower their risk of developing pancreatic cancer.
- Don’t smoke.
- Eat a healthy diet that includes plenty of fruits, vegetables, and whole grains, and that limits or avoids red and processed meats, sugary drinks, and highly processed foods.
- Limit alcohol use.
- Maintain a healthy weight.
- Stay physically active.
To find a physician affiliated with Penn Medicine Princeton Health, call 888-742-7496, or visit princetonhcs.org.
Elsa Pichardo, MD, is board certified in general surgery and is fellowship trained in hepatobiliary and pancreas surgery. She is a member of the Medical Staff at Penn Medicine Princeton Health.
