Pancreatic Cancer
Pancreatic cancer occurs when abnormal cell growth occurs in the pancreas, forming a malignant tumor. These cells continue growing out of control until they spread to other parts of the body. Pancreatic cancer has a lower overall survival rate because it’s often diagnosed late. This guide will help you learn more about pancreatic cancer risks, symptoms, treatment and survival rates.
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What Is Pancreatic Cancer?
Pancreatic tumors occur when the body’s normal process of breaking down old cells and forming new cells doesn’t work correctly. Extra cells left in the pancreas form tumors.
Some tumors are abnormal but don’t invade other parts of the body. These are benign tumors. Tumors become cancerous, or malignant, when they continue to grow and spread into other tissues and organs.
Pancreatic cancer is rare, according to the Pancreatic Cancer Action Network. It is more likely to affect people that are at least 65 years old.
In 2022, about 62,210 people will be diagnosed with pancreatic cancer, and 49,830 people will die from it, according to the American Cancer Society.
- Slightly less common in women than in men.
- About three percent of all cancers in the United States are pancreatic cancers.
- People’s average lifetime risk of pancreatic cancer is 1 in 64.
- Average age at time of diagnosis is 70.
- On average, pancreatic cancer has a 10 percent five-year survival rate.
- Treatment for pancreatic cancer includes surgery, radiation therapy, targeted therapy, chemotherapy, immunotherapy and pain control.
Why Is Pancreatic Cancer So Deadly?
Pancreatic cancer is rare but deadly. This cancer spreads easily, and about 85 percent of patients aren’t diagnosed before the cancer has spread, according to Dr. Conan Kinsey, a pancreatic cancer specialist at Huntsman Cancer Institute (HCI) and University of Utah Health.
At this stage, pancreatic cancer is more difficult to treat and options are limited. In addition, surgery to remove tumors is difficult to perform because several blood vessels and organs surround the pancreas.
Symptoms
Part of the reason why doctors have a difficult time diagnosing pancreatic cancer is that patients don’t often have symptoms in early stages. By the time symptoms appear, the tumor has grown.
“We need to do a better job of educating people and providers to be more alert when symptoms arise. Too many people are not having their symptoms recognized.”
Symptoms vary depending on where the tumor grows on the pancreas. For example, if the tumor grows on the head of the pancreas — the part closest to the liver — people may experience jaundice, or yellowing of the skin and eyes. Tumors on the middle or tail of the pancreas are more likely to cause pain and weight loss.
Rarely, pancreatic cancer can destroy insulin-making cells on the pancreas and cause sudden onset diabetes with no apparent cause.
- Dull pain in the upper abdomen or middle of upper back that comes and goes and may worsen while lying down
- Jaundice (yellowing of the skin and eyes) that can occur when the tumor blocks the bile duct
- Unintentional or significant weight loss
- Gastrointestinal problems (nausea, vomiting, loss of appetite, indigestion, bloating or swelling of abdomen)
- Unexplained fatigue
- Sudden onset diabetes (rare)
Causes & Risk Factors
There is no single cause of pancreatic cancer, and researchers aren’t sure exactly what causes it. Scientists believe that DNA damage, or mutation, is the root cause of the cancer. Mutations can occur because of inherited genes, because of harmful behaviors or they may happen by chance.
People can control some risk factors for pancreatic cancer, such as lifestyle and smoking. Others such as age, race, gender and genetics can’t be controlled.
- Age – Anyone can get pancreatic cancer, but 90 percent of people who get this cancer are older than 55.
- Diabetes – People with diabetes have an increased risk for pancreatic cancer, especially if they have had it for a long time.
- Family history – Pancreatic cancer can be hereditary and run in families. People with 2 or more immediate family members (siblings, children or parents) or 3 or more family members with pancreatic cancer have an increased risk, according to the American Society of Clinical Oncology.
- Gender – Pancreatic cancer is slightly more likely in men than women.
- Obesity – Overweight or obese people have a higher risk of a pancreatic cancer diagnosis.
- Diet and alcohol use – A high-fat diet and heavy alcohol use increase the risk for pancreatic cancer.
- Race and ethnicity – Black people and people of Ashkenazi Jewish heritage are also more likely to develop pancreatic cancer.
- Smoking – Pancreatic cancer is 2 to 3 times more likely to develop in people who smoke.
Medications and Pancreatic Cancer Risk
Some studies show certain prescription medications may increase or decrease pancreatic cancer risk, including diabetes drugs such as metformin, blood pressure drugs called short-acting calcium channel blockers and the weight loss drug Belviq (lorcaserin).
One 2012 study by Michael Bodmer and colleagues in The American Journal of Gastroenterology found metformin use was associated with a decreased pancreatic cancer risk in women, but insulin and sulfonylureas were linked to an increased risk.
A 2018 study by Zhensheng Wang and colleagues found short acting calcium channel blockers increased the risk of pancreatic cancer in post-menopausal women.
In February 2020, the U.S. Food and Drug Administration requested Belviq be withdrawn from the U.S. market because clinical trial data showed more patients taking lorcaserin were diagnosed with pancreatic, colorectal and lung cancer.
Keep in mind that these findings don’t necessarily mean you will get cancer if you take these drugs. If you are concerned, talk to your medical provider about all medications, supplements and vitamins you take.
Diagnosis & Prognosis
Pancreatic cancer is diagnosed using a physical examination, lab tests and imaging tests. Some of these tests will also be used to see how far the cancer has spread. This is called cancer staging.
- Ultrasound
- Ultrasounds use sound waves to form pictures of the pancreas. An endoscopic ultrasound uses a thin, flexible device called an endoscope to look inside the digestive tract and looks for tumors. This technique is useful for diagnosing pancreatic cancer.
- Biopsy
- A biopsy is a procedure where doctors take a small piece of the tumor or cells from bile or pancreatic ducts to examine in a lab.
- Blood tests
- Examining blood for high or low levels of certain substances, such as tumor markers, can indicate disease. CA 19-9 and carcinoembryonic antigen (CEA) are tumor markers for pancreatic cancer.
- CT scan (CAT scan)
- CT scans use radiation to take detailed pictures of the pancreas and can show if cancer has spread to nearby organs. CT scans are better for looking at the pancreas than magnetic resonance imaging (MRI).
- Endoscopic retrograde cholangiopancreatography (ERCP)
- During ERCP, doctors pass a thin, lighted tube called an endoscope through the mouth and inject a special x-ray dye into the pancreatic ducts. X-rays can check for tumors or blockages. Doctors may also take biopsy samples during ERCP.
- PET scan (positron emission tomography scan)
- PET scans use a special form of radioactive glucose (sugar) injected into the vein to find malignant tumor cells. Tumor cells use more glucose than normal cells, and they will show up brighter when scanned. It’s useful for seeing how far cancer has spread.
- Physical exam and medical history
- Your medical provider will check for any unusual lumps or other signs of disease. They will also ask you about your medical and family history.
Prognosis and Survival Rates
The stage of the cancer determines the prognosis, or how serious the cancer is and the chances of survival. Pancreatic cancer is an aggressive cancer, and its survival rate is lower than most cancers.
The most popular way of measuring survival is the five-year survival rate from the National Cancer Institute. This rate shows how likely it is that people with a certain stage of pancreatic cancer will live five years after diagnosis.
- Overall average survival rate – 10 percent
- Cancer that hasn’t spread outside the pancreas (localized) – 39 percent
- Cancer that has spread to nearby tissues and organs (regional) – 13 percent
- Cancer that has spread to far away organs or tissues – 3 percent
Pancreatic Cancer Types
Exocrine Pancreatic Cancer
About 95 percent of pancreatic cancers are exocrine cancers that form in the exocrine cells and ducts in the pancreas.
Adenocarcinoma
Adenocarcinoma, a type of exocrine cancer, is the most common type of pancreatic cancer and it makes up about 90 percent of all diagnoses. These cancerous cells occur in the lining of pancreatic ducts. Symptoms include abdominal pain, weight loss and nausea. Some patients may have joint pain and skin rashes.
Adenosquamous Carcinoma
This type of cancer makes up one to four percent of exocrine cancers. It’s a more aggressive tumor with a poor prognosis.
Colloid Carcinoma
Colloid carcinomas make up about one to three percent of exocrine pancreatic cancers. These tumors start as a benign cyst. It’s easier to treat and doesn’t tend to spread.
Squamous Cell Carcinoma
This type of cancer is very rare and forms in the pancreatic ducts. These tumors are made up of squamous cells that aren’t usually found in the pancreas. Most of the time doctors don’t discover this cancer until it has already spread.
Neuroendocrine Pancreatic Cancer
This type of pancreatic cancer makes up less than five percent of all pancreatic cancers. It forms in the endocrine gland of the pancreas responsible for regulating blood sugar.
Pancreatic Cancer Stages
Pancreatic cancer staging described how far the cancer has spread from the original tumor site.
According to the American Society of Clinical Oncology, doctors most commonly classify pancreatic tumors using four categories: resectable, borderline resectable, locally advanced and metastatic.
These categories help doctors determine a treatment plan.
- Resectable
- Resectable cancers have not spread outside the pancreas. Doctors can remove these tumors. Only about 10 to 15 percent of patients are diagnosed at this stage.
- Borderline Resectable
- Borderline resectable tumors are not impossible to remove, but they are difficult. Doctors will often try chemotherapy and radiation to shrink the tumor before surgery. Sometimes cancer cells may be left behind.
- Locally Advanced
- Locally advanced cancer has spread to areas around the pancreas and cannot be surgically removed because it has grown into nearby organs or other structures. But it hasn’t spread to distant parts of the body such as the lungs or bones. Up to 40 percent of patients are diagnosed with this stage.
- Metastatic
- The tumor has spread beyond the area of the pancreas and to other organs, such as the liver, lungs, or distant parts of the abdomen. Up to 55 percent of patients are diagnosed with this stage
Treatment
Some people can survive pancreatic cancer with treatment, but on average only one in 100 people survive five years after diagnosis.
Early stage cancer that doctors can completely remove with surgery has the best prognosis. Later stage pancreatic cancer treatments can help delay tumor growth and help patients live longer.
“We need both better screening and better treatments. It’s not either/or. Even if we have great screening tools, we will also need effective therapies.”
Surgery
Most pancreatic cancers have spread by the time doctors diagnose them, and only about 20 percent of people can have surgery. To shrink tumors, doctors may recommend chemotherapy and radiation before surgery.
Depending on the location of the tumor, doctors will remove parts of the pancreas, all of the pancreas or the whole pancreas and parts of surrounding organs.
Radiation Therapy
Radiation uses high-energy particles or x-rays to destroy cancer cells. The type of radiation therapy most used on pancreatic cancer is called external-beam radiation therapy.
The standard regimen consists of daily, low dose treatments for about five to six weeks. Patients may receive shorter, high-dose treatments — called stereotactic body radiation (SBRT) or cyberknife — for as few as five days.
Chemotherapy
Chemotherapy uses intravenous or oral drugs to kill cancer cells. It’s given in cycles with a rest period in between. Patients may use one drug or a combination of drugs.
FDA-approved chemotherapy drugs for pancreatic cancer include: Xeloda (capecitabine), Eloxatin (oxaliplatin), Gemzar (gemcitabine) and Abraxane (nab-palitaxel).
Targeted Therapy
Targeted therapy targets specific genes, proteins or the tissue environment related to cancer growth. It limits damage to healthy cells and blocks the growth of cancer. Doctors use these treatments in combination with chemotherapy.
Targeted therapy drugs FDA-approved for pancreatic cancer include: Viktravi (larotrectinib), Lynparza (olaparib) and Tarceva (erlotinib).
Immunotherapy
Immunotherapy, or biologic therapy, boosts the body’s immune system to fight cancer. Anti-PD-1 immunotherapy drugs such as Keytruda (pembrolizumab) may be used to treat certain types of pancreatic cancers.
Prevention
Because pancreatic cancer is so deadly, prevention is important. Even if there is no sure way to prevent pancreatic cancer, people can lower their risk by making lifestyle changes.
- Quit smoking or don’t start smoking
- Maintain a healthy weight through a healthy diet and exercise
- Avoid drinking alcohol
- Stay away from chemicals on the job
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