Learning that you or a loved one has cancer is never welcome news, but pancreatic cancer is an especially difficult diagnosis. Notorious for showing up in advanced stages, it has fewer successful treatment options than many other types of cancer.
Who is at risk for the disease?
Pancreatic cancer can happen to anyone, but it is more common in men, African Americans, people older than 65, people with diabetes and people with recurrent pancreatitis, or inflammation of the pancreas, usually related to alcohol use. Smoking is a major risk factor; the risk is about twice as high in smokers compared with people who have never smoked. Those with obesity (with a body mass index of 30 or more) are also at increased risk. Eating a diet high in fat and low in fruits and vegetables is a risk factor.
Because pancreatic cancer remains a rare disease affecting only an estimated 3 percent of Americans over the course of their lifetimes, there are no screening guidelines for the general population that might help detect pancreatic cancer before symptoms begin, as there are with breast, prostate and colorectal cancers. However, if you do have a strong family history of cancer, especially close relatives diagnosed with cancers of the breast, ovaries or pancreas before age 50, talk to your doctor about genetic testing. Patients who have a genetic mutation that increases their lifetime risk of pancreatic cancer may qualify for yearly screening with periodic bloodwork, dedicated imaging of their pancreas, and specialized endoscopy for a closer look.
What are the signs and symptoms of pancreatic cancer?
The pancreas is a fish-shaped organ in the abdomen that releases enzymes that help the body digest and absorb food and makes hormones that help control blood sugar. The bile duct travels through the head of the pancreas. Symptoms occur when growths in the pancreas start pressing on the bile duct or neighboring organs and nerves. It’s hard to catch these early, but it’s not impossible.
Pancreatic cancer often begins silently, but when symptoms do appear, they may include:
- Progressive pain in the upper abdomen or the back
- Yellowing of the eyes or skin (jaundice) often accompanied by itchy skin, dark urine and clay colored stool
- New onset diabetes or worsening glucose control in patients who already have diabetes
- Unexplained, unintentional weight loss
- Loss in appetite, nausea, or vomiting
Don’t take a chance if you have any of these symptoms and can’t explain why. Talk to your doctor about what you can do to investigate further. Remember that basic blood tests and imaging like ultrasound do not usually pick up rare diseases. If your symptoms are severe or do not get better, you may need additional tests or procedures, or a referral to a specialist.
What is the most effective treatment for pancreatic cancer?
Pancreatic cancer is primarily treated with a combination of surgery, chemotherapy, and radiation, depending on the patient. In the past, surgery was often the first route taken, but more recently doctors have found success using chemotherapy to stabilize and sometimes shrink the tumor before operating. Chemotherapy can also target any cancer cells that have left the area outside the pancreas that cannot be seen on an imaging scan or be removed with surgery.
Pancreatic cancer surgery: What is a Whipple procedure?
Pancreatic surgery is a major undertaking and is generally reserved for patients who have early stage tumors and are physically healthy. Removal of the head of the pancreas is called the Whipple procedure, and it also includes removing nearby structures such as a portion of the intestine, the gallbladder, the end of the bile duct and surrounding lymph nodes. Then, the intestine must be sewn back to the pancreas, bile duct and stomach to allow normal digestion. Surgery for the pancreatic tail also involves removing the spleen, and can often be performed robotically to help minimize postoperative pain.
What is the prognosis?
Of all patients diagnosed with pancreatic cancer at any stage five years ago, it is estimated that 13% are alive today. Although that may sound like a grim statistic, it is actually one that gives us hope — as it is much improved from the same survival rate 10 years ago. Patients that are lucky enough to get to surgery on average live up to 3 years, with some achieving long term survival for decades.
Researchers are actively working on novel approaches for pancreatic cancer, including new combinations of chemotherapy, targeted treatment that attacks tumors on a molecular level, immunotherapy which boost the immune system’s ability to fight cancer, as well as cancer vaccines which may help the body remember and fight the cancer cells in the future. Those treatments are still being investigated but offer a glimmer of hope to help patients live longer.
What do you do if you’ve been diagnosed?
First, take a breath. This is a journey, not an ending. Find your team. This means recruiting close and calm family members and friends to support you, and also identifying a group of doctors who treat pancreatic cancer in a high-volume center. Northside Hospital Cancer Institute’s Liver and Pancreas Program is recognized as a Center of Excellence in pancreatic cancer treatment by the National Pancreas Foundation. Here, specialists in complex cancer surgery, medical oncology, radiation oncology, radiology and pathology meet regularly to discuss each patient’s case and next steps. That way, each patient benefits from more than a dozen expert medical opinions, coming together to create a comprehensive plan of care.
Learn more about pancreatic cancer treatment at Northside.
