About Pancreatic Cancer

Preventative steps can help lower your risk of pancreatic cancer. These include eating a healthy diet, limiting alcohol consumption, maintaining a healthy weight and limiting your exposure to toxic chemicals.

Risk factors that can increase your chances of getting pancreatic cancer include age, gender and race as well as conditions like diabetes, chronic pancreatitis, and cirrhosis of the liver.

Studies have found that the following risk factors are associated with pancreatic cancer.

• Age: Most cases of pancreatic cancer are found in individuals over the age of 60.
• Smoking has been associated with a two-three fold increased risk of pancreatic cancer. Cigarette smoke contains a large number of carcinogens and is one of the leading causes of many cancers, so it is not surprising that it factors into pancreatic cancer.
• Diabetes: A new diagnosis of diabetes or worsening diabetes in older patients is a potential sign of pancreatic cancer.
• Gender: More men than women are diagnosed with pancreatic cancer.
• Race: Studies in the United States have shown that pancreatic cancer is more common in the African-American population than it is in the Caucasian population.
• Family History: The risk of developing pancreatic cancer triples if a parent or sibling had the disease.
• Chronic Pancreatitis: Chronic (persisting over a long period of time) pancreatitis, particularly inherited chronic pancreatitis, increases the risk of later developing pancreatic cancer.

Cancer of the pancreas is a genetic disease which means that it is caused by changes (or mutations) in DNA. Investigators in The Elkins Pancreas Center are intensely studying these changes. When DNA is damaged, changes occur in the growth of cells. These cells may grow out of control and eventually form a tumor (a mass of malignant cells). These changes can be inherited or they can be acquired. The inherited changes explain why pancreatic cancer runs in some families, and the acquired changes can be the result of random chance or by exposure to carcinogens such as those found in cigarette smoke.

Pancreatic cancer is hard to detect and diagnose for many reasons. When pancreatic cancer is in its early stages, the patient does not usually feel signs or symptoms. When signs are present, they can be associated with many other illnesses. The pancreas is hidden behind other organs, such as the stomach, liver, small intestine, spleen and gallbladder, making it difficult to visualize on radiology tests, and difficult to feel during a physical exam.

Possible signs and symptoms include:

• Jaundice (yellowing of skin and the whites of the eyes)
• Severe itching
• Dark urine and/or light-colored stool
• Pain in the upper or middle abdomen, sometimes penetrating to the back
• Unexplained weight loss
• Loss of appetite
• Fatigue
• Nausea and vomiting

There are no established guidelines for the screening of pancreatic cancer. However, those at high-risk for pancreatic cancer, due to genetic predisposition, may benefit from pancreatic cancer screening. A series of tests and procedures may be done during a patient’s evaluation.

High-risk individuals with a genetic predisposition for pancreatic cancer, patients who have been diagnosed with chronic pancreatitis, and patients over the age of 50 with new onset diabetes should be screened.

Tests
Some of the tests used to screen for pancreatic cancer are:

• MRI (Magnetic Resonance Imaging)
• EUS (Endoscopic Ultrasound)
• ERCP (Endoscopic Retrograde Cholangiopancreatography)
• CT Scan (Computed Tomography)
• Laparoscopy and biopsies
• Checking your blood for tumor markers
• Genetic testing

Benign tumors are not cancer. Usually, doctors can remove them. In most cases, benign tumors do not come back after they are removed. Cells from benign tumors do not spread to tissues around them or to other parts of the body. Most important, benign tumors are rarely a threat to life.

Malignant tumors are cancer. They are generally more serious and may be life threatening. Cancer cells can invade and damage nearby tissues and organs. Also, cancer cells can break away from a malignant tumor and enter the bloodstream or lymphatic system. That is how cancer cells spread from the original cancer (primary tumor) to form new tumors in other organs. The spread of cancer is called metastasis.

Most pancreatic cancers begin in the ducts that carry pancreatic juices. Cancer of the pancreas may be called pancreatic cancer or carcinoma of the pancreas.

A rare type of pancreatic cancer begins in the cells that make insulin and other hormones. Cancer that begins in these cells is called islet cell cancer or neuroendocrine cancer.

When cancer of the pancreas spreads (metastasizes) outside the pancreas, cancer cells are often found in nearby lymph nodes. If the cancer has reached these nodes, it means that cancer cells may have spread to other lymph nodes or other tissues, such as the liver or lungs. Sometimes cancer of the pancreas spreads to the peritoneum, the tissue that lines the abdomen.

When cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary tumor. For example, if cancer of the pancreas spreads to the liver, the cancer cells in the liver are pancreatic cancer cells. The disease is metastatic pancreatic cancer, not liver cancer. It is treated as pancreatic cancer, not liver cancer.

When the physicians talk about staging, they are referring to determining the size of the tumor and if it has spread or not. This information is then used to determine the best treatment. In the case of pancreatic cancer, the size of the tumor and whether or not it involves important blood vessels determines if it can be surgically removed. Pancreatic cancer is staged on the TNM system (also called tumor - node - metastasis system).

This describes the size of the tumor (T), if the lymph nodes are involved (N), and if it has spread to other areas of the body (M).

The stage of your cancer will affect your treatment plan. The stage is determined by the size of the tumor and if it has spread to other parts of the body.

Once staging is defined, treatments can include:

• Surgery
• Radiation therapy
• Chemotherapy
• Palliative care

Patients also have access to National Cancer Institute-sponsored clinical trials.