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Pancreatic Cancer


Pancreatic cancer affects the pancreas, the organ responsible for making insulin, and is one of the deadliest cancers. Some type 2 diabetes medications like Byetta and Victoza are linked to this type of cancer.

There are two types of pancreatic cancer. The most common kind is called exocrine cancer. These tumors grow in the ducts that carry the digestive juices produced by the pancreas. The second, and rarer, form of pancreatic cancer is called endocrine cancer, and it begins in the cells that produce hormones like insulin. These cells are called islet cells.

In 2013, the National Cancer Institute estimated that more than 45,000 Americans would be diagnosed with pancreatic cancer, and more than 38,000 would die from it.

Because pancreatic cancer doesn't produce symptoms early, it is difficult to diagnose at earlier stages. The symptoms are also vague and can be easily missed. They include: yellowing of the skin or eyes, pain in the abdomen or back, weight loss and fatigue.

If pancreatic cancer is suspected, a doctor can perform several types of imaging tests, a blood test or a biopsy to determine if tumors are malignant. The standard treatment options for pancreatic cancer include a combination of chemotherapy, radiotherapy and surgery.

Pancreatic Cancer Risk Factors

There are a number of risk factors that increase a person's chances of developing pancreatic cancer, including diabetes. While doctors aren’t sure why certain people get the disease and others don't, these risk factors increase the likelihood of developing it.

Pancreatic cancer risk factors include:
Smoking Diabetes
Pancreatitis Obesity

In addition to these risk factors, there are certain medications that may increase the risk for pancreatic cancer, including some medications used to treat type 2 diabetes.

Some drugs that are linked to a possible increased risk of pancreatic cancer include:
Januvia/Janumet Byetta/Bydureon
Victoza Onglyza

People who took these type 2 diabetes medications who were diagnosed with pancreatic cancer later filed lawsuits against the makers of these drugs for failure to warn of the risks.

Diagnosing Pancreatic Cancer

If the patient has symptoms that indicate pancreatic cancer, the doctor will usually start with a blood test. A number of additional tests can then be used to examine the pancreas for tumors.

Diagnostic tests may include:
Abdominal ultrasound. This technology uses sound waves that bounce off the pancreas and create a picture on a video monitor.
Abdominal X-rays. Doctors may take X-rays of the abdomen to check for abnormalities in the pancreas.
Computerized tomography (CT). This is a non-invasive test similar to an X-ray that can reveal damage and tumors in the pancreas. Patients drink a special liquid that highlights the intestines so they are not mistaken for tumors.
Endoscopic ultrasound (EUS). The doctor passes a thin, flexible tube down the patient's throat, into the stomach and into the small intestine to check for tumors in the pancreas and bile ducts.
Positron emission tomography (PET) scan. Radioactive sugar is injected into the bloodstream and is absorbed by any fast-growing cancer cells that may be present. Afterward, a special camera can detect the radioactive areas in the body.

In addition, a biopsy of the pancreatic tissue may be taken. In a biopsy, the doctor will use a thin needle to take a small piece of tissue from the pancreas. The piece of tissue is then sent to the lab, where a pathologist will look for cancer cells in the tissue sample.

Pancreatic Cancer Staging

In order to decide on the proper treatment, it is necessary for the doctor to diagnose the stage of the cancer. The stage of the cancer indicates how far the tumor has spread and how big the tumor is.

To determine the stage of pancreatic cancer, the doctor may order CT scans or sonograms. Another test a surgeon may perform is a laparoscopy. In this test, which is done under anesthesia, the doctor will look inside the abdomen by inserting a thin tube with a camera on the end of it. This allows the doctor to see if the cancer has spread from the pancreas to the abdomen.

In pancreatic cancer, the liver, abdomen and the lymph nodes are commonly affected when the cancer spreads.

Pancreatic cancer is classified as one of four stages:
Stage I: The tumor is only in the pancreas.
Stage II: The tumor has spread out of the pancreas into the nearby tissues or lymph nodes, but not the blood vessels.
Stage III: The tumor has spread into the nearby blood vessels.
Stage IV: Tumors affect distant organs such as the liver and the lungs.

Treatments for Pancreatic Cancer

Like most cancers, pancreatic cancer is usually treated with radiology, chemotherapy, surgery or a combination of these.

The most common type of surgery used to treat pancreatic cancer is called a Whipple procedure. This surgery is used to remove a tumor in the head of the pancreas. Sometimes the entire pancreas may be removed, along with other organs such as the gallbladder, bile duct, duodenum or part of the stomach.

Diabetes Medications Linked to Pancreatic Problems

Some people who took diabetes drugs that belong to the class of drugs known as incretin therapies, DPP-4's or GLP-1's, developed pancreatitis or pancreatic cancer. Studies linked these drugs to a higher risk of these diseases.

In one of the most compelling studies, led by A.E. Butler and colleagues at UCLA, researchers studied the pancreases of deceased organ donors with diabetes. One group had taken incretin therapies and the other had not. They found pre-cancerous cells in the pancreases of patients who took incretin therapies.

However, controversy still exists regarding these drugs and the dangers they pose to the pancreas. Two industry-funded clinical trials showed no pancreatic risk. The U.S. Food and Drug Administration (FDA) says there is not enough evidence to warrant any warnings for pancreatic cancer.