By Eric H. Shen, MD
Though not as common as some other types of cancer, pancreatic cancer is one of the most challenging cancers to diagnose and treat.
However, advances in medicine over the last decade have led to better diagnostic and treatment tools that improve the chance of a cure.
At the Center for Digestive Health at Penn Medicine Princeton Medical Center (PMC), physicians use advanced endoscopic techniques to help diagnose and treat a variety of gastrointestinal conditions and diseases, including pancreatic cancer.
Fast-Growing
The pancreas is a gland deep inside the abdomen that helps your body digest certain foods and keep blood sugar levels in the normal range.
Pancreatic cancer is a fast-growing cancer that occurs when normal cells in the pancreas mutate and start to grow uncontrollably.
Pancreatic cancer accounts for about 3% of all cancers in the United States and about 7% of all cancer deaths, according to the American Cancer Society.
In 2024, an estimated 66,440 people will be diagnosed with pancreatic cancer and about 51,750 will die from the disease.
No Early Symptoms
Pancreatic cancer often does not cause symptoms in its early stages. As the disease progresses, symptoms may include:
- Feeling overly tired all the time (fatigue).
- Yellowing of your skin or eyes (jaundice).
- Loss of appetite.
- Nausea.
- Pain in the upper abdominal and mid-back regions.
- Unintentional weight loss.
- A sudden, unexpected diagnosis of diabetes.
Because symptoms of pancreatic cancer are typically subtle, doctors often detect the disease in later stages, when the disease poses a greater threat.
Reach out to your doctor if you notice one or more symptoms of pancreatic cancer, especially if symptoms linger or get worse over weeks or longer.
Risk Factors
Researchers have not yet determined the exact causes of pancreatic cancer, but they have identified certain factors that may increase your risk. These include:
- Older age. Pancreatic cancer usually develops after age 65.
- Unhealthy diet. Eating a lot of red and processed meats and fewer vegetables may put you at greater risk.
- Excessive weight. Obesity increases your risk for developing pancreatic cancer.
- Smoking. Heavy smoking may contribute to the development of pancreatic cancer.
- Chronic pancreatitis, a long-term inflammation of the pancreas, usually due to chronic alcohol consumption.
- Family history. If one or more of your family members have had pancreatic cancer, you may be at increased risk.
- Genetics. Inherited gene mutations may cause as many as 10% of pancreatic cancers, according to the American Cancer Society.
- Pancreatic cysts. Pre-cancerous cysts carry a small risk of turning into aggressive pancreatic cancer.
While there is no standard screening method for the early detection of pancreatic cancer, if you have been found to be at high risk for the disease your doctor may recommend a combination of genetic testing and annual imaging tests to screen for the disease.
Diagnosis and Treatment
The first step in diagnosing pancreatic cancer is a thorough physical exam and review of your symptoms. If pancreatic cancer is suspected, your doctor may recommend one or more tests, including imaging tests, blood tests, and a biopsy.
Treatment for pancreatic cancer is complex and may include surgery, chemotherapy, immunotherapy, targeted therapy and radiation. Surgery offers the best chance to cure pancreatic cancer.
At the Center for Digestive Health at PMC, two endoscopic procedures — endoscopic ultrasound and endoscopic retrograde cholangiopancreatography — play an important role in the diagnosis and treatment of pancreatic cancer.
Endoscopic ultrasound (EUS) combines endoscopy and ultrasound to produce detailed images of the pancreas and surrounding structures. It allows for the visualization of small tumors that may not be detected by other imaging modalities. The test is done with a small probe on the tip of an endoscope, which is a thin flexible tube that a gastroenterologist uses to look inside the digestive tract. In addition, EUS enables the gastroenterologist to obtain biopsy samples of a tumor, aiding in the diagnosis and staging of the cancer. Endoscopic ultrasound is considered more accurate than other imaging modalities for the diagnosis of pancreatic cancer.
The procedure can also be performed to screen for pancreatic cancer in patients who are considered high risk.
Endoscopic retrograde cholangiopancreatography (ERCP) helps diagnose and treat problems in the liver, gallbladder, bile ducts and pancreas. For patients with pancreatic cancer, ERCP enables the gastroenterologist to look at the pancreatic ducts and bile ducts to see if they are blocked; narrowed or dilated; which could be caused by a tumor. The test enables the gastroenterologist to take tissue samples, place stents to open the duct and relieve blockages or perform other therapeutic interventions.
Both EUS and ERCP are highly specialized procedures that require the gastroenterologist to have specialized training. Patients undergo moderate sedation and most have the procedures as an outpatient and can go home the same day.
The Center for Digestive Health at PMC has earned recognition from the American Society for Gastrointestinal Endoscopy (ASGE) as a unit that promotes quality in endoscopy. The ASGE Endoscopy Unit Recognition Program honors facilities that have demonstrated a commitment to specialized training and adherence to ASGE guidelines on privileging, quality assurance and reprocessing, as well as the infection control guidelines of the Centers for Disease Control and Prevention.
In addition, gastroenterologists with the Center for Digestive Health at PMC are part of a multidisciplinary team at the Penn Medicine Princeton Cancer Center at PMC, which provides care for pancreatic cancer, from diagnosis through recovery. 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.
To find a gastroenterologist with Penn Medicine Princeton Health, call (888) 742-7496 or visit www.princetonhcs.org/directory.
Eric H. Shen, MD, is board certified in gastroenterology and is the co-director of the Center for Digestive Health at Penn Medicine Princeton Medical Center.
