February 11, 2021
Pancreatic cancer is a rare and deadly type of cancer with poor survival. It has the 3rd-lowest survival rate of all types of cancer. The American Cancer Society estimates 57,600 people will be diagnosed with pancreatic cancer in 2020.
There is no way to prevent pancreatic cancer. However, you may be able to lower your risk of developing pancreatic cancer. As with all forms of cancer, the earlier the diagnosis, the better the outcome is likely to be.
We will discuss the reasons why this rare form of cancer is so deadly, risk factors, diagnosing the disease, treatment options and how to prevent pancreatic cancer.
What is the pancreas?
The pancreas is a gland in the abdomen that plays a role in the body's digestive system. One portion of the gland is situated between the stomach and the spine, which makes surgery difficult.
The pancreas is made of 2 different types of cells: exocrine cells and endocrine cells. The exocrine glands, comprised of exocrine cells, make an enzyme that helps the body to digest fats. This enzyme is created in the pancreas and released from the pancreas into the small intestine via a system of pancreatic ducts.
The endocrine cells in the pancreas create the hormones that help control levels of blood sugars, like glucagon and insulin. These hormones are released directly into the bloodstream by the pancreas.
Pancreatic cancers can develop when either exocrine or endocrine cells begin to grow out of control. Due to the location of the pancreas deep inside the abdomen, there is no screening test to check for pancreatic cancer. Even if a tumor begins developing in the pancreas, a doctor cannot detect it by simply palpating the abdomen.
What is pancreatic cancer?
There are 2 types of pancreatic cancer: exocrine cancers and pancreatic neuroendocrine tumors. The vast majority — about 95% — of all pancreatic cancer cases are exocrine cancers.
Exocrine cancers are known as adenocarcinomas. These typically begin in the ducts of the pancreas that attach to the lower intestine. When cancer begins in the exocrine cells that create digestive enzymes, these are known as acinar cell carcinomas.
There are other forms of pancreatic cancer that are even rarer, but we will focus on adenocarcinoma since it is the most common.
Why is pancreatic cancer so aggressive?
Only 8.5% of pancreatic cancer patients are still alive 5 years after diagnosis. Why are the survival rates so low for this rare form of cancer?
Time of diagnosis is one reason. The early stages of pancreatic cancer do not typically present any symptoms. If the cancer is isolated in the pancreas in the early stages, the chance for a positive outcome is greater. Only 10% of diagnoses are in the early stages.
There is no screening test for pancreatic cancer. The most common way a person is diagnosed is after the cancer has metastasized and spread to other parts of the body, causing symptoms such as:
- Sudden weight loss
Another reason why pancreatic cancer is difficult to treat is due to the organ's location. The pancreas sits behind the stomach and surrounded by several vital blood vessels. This makes surgery particularly challenging.
Finally, pancreatic cancer is highly likely to spread to other parts of the body. When a patient is eventually diagnosed, chemotherapy is often the only treatment available.
What are the risk factors for pancreatic cancer?
Around 90% of pancreatic cancers are the result of a genetic mutation that occurs during a person's lifetime (the cancer is not inherited). The remaining 10% of pancreatic cancers are genetically inherited. The following have been identified as potential risk factors — and can increase your risk of developing pancreatic cancer:
- Age: The majority of cases happen after age 45. More than 90% of cases happen after age 55.
- Gender: Pancreatic cancer is diagnosed more often in men than women.
- Race or ethnicity: African Americans are impacted by pancreatic cancer more often than other races. People of Ashkenazi Jewish decent are at higher risk as well.
- Smoking: Tobacco use increases the risk of pancreatic cancer. Smokers are 2-3 times more likely to develop pancreatic cancer.
- Obesity: Obese or overweight people are more likely to develop pancreatic cancer and to die from it.
- Diet: A diet that is high in fat leads to an increased risk.
- Alcohol: Heavy alcohol use can lead to repeat inflammation of the pancreas (pancreatitis), which increases the risk of pancreatic cancer.
- Diabetes: Diabetes is a risk factor for pancreatic cancer, whether it is juvenile onset or developed in adulthood.
- Genetics: If 2 or more immediate relatives (parents, children or siblings) have been diagnosed with pancreatic cancer, you are at greater risk of developing it yourself.
- Liver conditions: Cirrhosis of the liver, caused by heavy alcohol use, can increase your risk for pancreatic cancer. There is also a link between a previous hepatitis B infection and a later diagnosis of pancreatic cancer.
- Chronic pancreatitis: Can lead to an increased risk of pancreatic cancer.
How is pancreatic cancer diagnosed?
Jaundice — a yellowing of the eyes or skin — is usually an indication of a liver problem, which can be related to pancreatic cancer. Your doctor will ask questions about your lifestyle, medical history and more.
If the liver and/or gallbladder are swollen due to pancreatic cancer, your doctor might be able to feel this irregularity while palpating your abdomen. Imaging tests will likely be ordered. This is the most effective way to determine a pancreatic cancer diagnosis (or to rule it out).
The range of imaging tests that can detect pancreatic cancer includes:
- Computed tomography (CT) scan
- Magnetic resonance imaging (MRI)
- Ultrasound (US)
- Cholangiopancreatography (CP)
- Positron emission tomography (PET) scan
A CT scan is one of the most effective imaging tests for examining the pancreas. The scan takes detailed cross-sectional images of the body, allowing your doctor to get a good look at the pancreas for abnormal growths. Other types of tests may be used depending on how your doctor wants to approach the diagnosis.
Cholangiopancreatography is extremely useful in diagnosing pancreatic cancer. It allows a doctor to get a direct look at the pancreas and the pancreatic ducts, which are the most likely locations for cancer cells to develop. There are several specific CP tests that can be performed to reach a pancreatic cancer diagnosis:
- Endoscopic retrograde CP: This test uses an endoscope, a rubber tube with a camera at the end, that is inserted down the throat. The doctor guides the tube down the esophagus to the opening of the small intestine. By taking X-rays during this test, your doctor can locate narrowing or blockage of the ducts that lead from the pancreas to the digestive system. The doctor can even insert a small brush through the endoscope to take a cell biopsy. If a tumor is blocking a pancreatic duct, your doctor can place a stent through the endoscope to keep that duct open.
- Magnetic resonance CP: This MRI scan is done specifically to examine the pancreatic ducts, although it does not allow for biopsy or stent placement.
- Percutaneous transhepatic CP: A needle is guided through the abdomen and into a bile duct within the liver. A contrast dye is injected so that X-rays can be taken as the dye passes through the ducts. This is an invasive test, so it is only used if an endoscopic retrograde CP test cannot be performed.
Another way to obtain cell samples for a biopsy is through fine needle aspiration. The doctor will use images from a CT scan or ultrasound to guide a needle directly into the pancreas to take a tumor sample.
Surgical biopsies are not commonly performed to diagnose pancreatic cancer. A minimally invasive "keyhole surgery" is sometimes used. A small abdominal incision is made and then a laparoscope with a light and camera is guided into the abdomen. This type of surgery is useful if the doctor wants to examine other organs or take biopsy samples from several locations to reach a diagnosis.
Biopsy samples are sent to a laboratory for examination to confirm the diagnosis of pancreatic cancer. If they are cancerous, further testing of the cells can be done to search for certain genetic mutations. Knowing this can open up additional treatment options.
How to prevent pancreatic cancer
While there is no way to prevent pancreatic cancer, you can control certain risk factors that make you more likely to develop pancreatic cancer. Some risk factors, such as your genetic makeup, age or race, cannot be changed. But there are several things that you can do to reduce your risk of pancreatic cancer.
The earlier that a person is diagnosed with any type of cancer, the better their treatment outcomes will be. Regular health screenings at the recommended ages for men and women are important. Pancreatic cancer is extremely aggressive and can spread to other parts of the body. If cancer is detected in a different type of screening, it could lead back to pancreatic cancer as the origin.
Important regular screenings include an annual physical, self-exam for skin cancer, a regular colon cancer screening starting at age 45 and a colonoscopy once every decade beginning at age 50. In addition, testicular self-exams for men, and breast self-exams for women should be performed.
Women should have a PAP test every 3 years from age 21 to 30 and a combined HPV/PAP test at 30. Yearly mammogram screening should begin at around age 40.
Men should have an annual testicular cancer physical exam between the ages of 15 and 35. Prostate cancer checks for men (PSA screenings) should begin at age 55.
Now is the perfect time to quit smoking if you are concerned about pancreatic cancer prevention. Smoking is more dangerous than any other single risk factor for developing pancreatic cancer. Smoking can double or triple your risk of developing pancreatic cancer when compared to nonsmokers.
Lose weight or maintain a healthy weight
Obesity is a major risk factor in developing pancreatic cancer. Overweight individuals are at increased risk as well. A regular exercise regimen combined with a balanced diet can help you maintain a healthy weight and may reduce your risk of pancreatic cancer.
Experts recommend 30 minutes of physical activity a day:
- 150 to 300 minutes of moderate exercise a week, such as walking
- 75 to 150 minutes of strenuous exercise a week, such as jogging, aerobics or swimming
- Strength training twice weekly, such as weight lifting or resistance exercise
Why choose The University of Kansas Cancer Center for pancreatic cancer diagnosis and treatment?
The University of Kansas Cancer Center, 1 of 71 National Cancer Institute-designated cancer centers in the nation, has a dedicated team of gastrointestinal (GI) cancer specialists. This multidisciplinary team of GI specialists is committed to developing new and improved methods to treat pancreatic cancer. Our goal is to improve outcomes and survival rates for people with pancreatic cancer. We do this by developing personalized treatment plans and applying the latest technology, clinical and surgical expertise and compassionate care in the treatment of this highly aggressive form of cancer.