Let’s face it: The pancreas is a behind-the-scenes organ most of us don’t know — or think — much about. However, for a small percent of the population, cancer of the pancreas is a very serious diagnosis.
The pancreas is a digestive organ that helps break down food and produces the hormone insulin, which regulates blood sugar. Because it’s located deep in the abdomen, it’s hard to feel it or to see it.
Pancreatic cancer is relatively rare. According to the National Cancer Institute, approximately 54,000 people in the U.S. will be diagnosed with pancreatic cancer in 2017, accounting for about 3.2 percent of all new cancer cases.
Despite being relatively rare, pancreatic cancer is the No. 4 cause of cancer death, says Dr. Debashish Bose, a surgical oncologist at Orlando Health UF Health Cancer Center. He says it has the potential to move up to the No. 2 cause of cancer death due to improvements in treatment of other types of cancer.
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Who Is at Risk?
Smoking, being overweight or obese, eating a diet high in red meat and age are all risk factors. So is a history of chronic pancreatitis (inflammation of the pancreas) due to alcoholism or other rare, benign reasons, Bose says. Having diabetes may also be a risk factor, and Bose says new onset diabetes may be a potential sign of pancreatic cancer. However, he says, the majority of people with pancreatic cancer have no identifiable risk factors.
What Are the Symptoms of Pancreatic Cancer?
People with pancreatic cancer tend not to have symptoms, at least early on, which is why about 85 percent of patients are diagnosed with metastatic disease, Bose says. When signs are important, they include abdominal pain, unexplained weight loss and jaundice (yellowing of the skin) due to the obstruction of the bile duct at the head of the pancreas.
If symptoms are present, people can live with them for several months without a diagnosis being made, says Dr. Diane Simeone, director of the Pancreatic Cancer Center at Perlmutter Cancer Center at NYU Langone Health. Often, they believe these vague symptoms are due to another, less serious cause. Occasionally, patients are diagnosed with pancreatic cancer because they have an abdominal CT scan for an unrelated reason.
Unfortunately, pain can be a big issue for those with the disease. “Pancreatic cancer generates a desmoplastic reaction, or a significant scarring response, as part of tumor formation. These cancers tend to be quite invasive, wrapping around key blood vessels and involving nerves in and around the pancreas,” Simeone says, adding that pain affects a significant number of patients. The primary symptom for other patients is jaundice, or yellowing of the eyes.
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How Is Pancreatic Cancer Treated?
“Pancreatic cancer is one of the most difficult cancers to treat,” Simeone says. Only about 15 percent are amenable to surgical resection (removal) up front. And even with surgery, about 75 percent of patients have a recurrence of cancer within five years post-surgery. “This is probably due to occult [hidden] metastatic disease,” she says. The five-year survival rate with surgery in stage 1 pancreatic cancer is about 30 percent compared to about 95 percent with other types of stage 1 cancers, such as breast or colon cancer. “Pancreatic cancer clearly has a more aggressive, distinct biology and metastasizes quite early.”
Some patients present with locally advanced pancreatic cancer, where there’s no evidence on scans that their cancer has spread, but it grows and has started to wrap around blood vessels in the pancreas, Simeone says. While these patients may be candidates for surgery, they’re typically treated with chemotherapy or a combination of chemotherapy and radiation first to attempt to downsize the tumor. If there’s extensive involvement of the blood vessels, it’s usually not removable because surgery will damage the vessels.
Simeone says oncologists are increasingly learning there are sub-types of pancreatic cancer, as there are with other types of cancer. “The molecular differences in these cancers may confer different prognoses, and the tumors may respond to therapies in different ways,” she says. Treating cancer sub-types with specific classes of drugs can mean a more favorable response for some patients.
Simeone says pancreatic cancer has traditionally been very resistant to chemotherapy and radiation, more so than other cancers, so there is a significant effort underway to conduct clinical trials to develop therapies that are more effective. “It’s very exciting,” she says. “We’re creating innovations in clinical trials. It’s a new collaborative model of institutions working together to leverage the Food and Drug Administration, pharmaceutical companies and institutes to advance treatments. Fewer than 5 percent of pancreatic cancer patients go on clinical trials, so it’s very difficult to get new, effective therapies to patients quickly.”
Part of this push for new therapies includes taking a biopsy of the tumor and analyzing it (gene sequencing and immune analysis) both at diagnosis and at another point in treatment to see if the treatment is working and why (or why not). “We want to deeply study every patient to get smarter [about caring for these patients],” Simeone says. “It’s not acceptable that we’re still dealing with a single-digit survival rate for this disease. A lot of patients are quite ill [at diagnosis]. We need to take care of them with a team of experts and manage patients’ symptoms so they can go on clinical trials.”
[See: 16 Health Screenings All Women Need.]
If you’re diagnosed with pancreatic cancer, ask your doctor if you quality for a clinical trial.
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What You Should Know About Pancreatic Cancer originally appeared on usnews.com