What You Should Know About Pancreatic Cancer
We can’t see or feel the pancreas—i’s located in the upper abdomen,behind the stomach and next to the small intestine.ܳٳɱ-organplays aٲrole in our digestive system by producing enzymes to break down food and hormones that help regulate our blood sugar.
“Given its location deep inside the body, tumors on the pancreas usually cannot be felt during routinemedicalexams,”explainsAllison Yang, MD, MPH,assistant professor of medicine at Weill Cornell Medical College and Attending Physician at New York Presbyterian Hospital/Weill Cornell Medical Center.“Pancreatic cancermay not cause symptoms until the cancer has grown to be very large or spread to other organs.”
Prevelance of Pancreatic Cancer
Dr. Yang,a clinical gastroenterologist whofocuseson the multi-disciplinary care of patients with pancreatic disease,citesarecentpaperon the worldwide burden of pancreatic cancer. In an analysis of 48 countries,researchersfound an increasing incidence and mortality in pancreatic cancer,especially seen in women and people over 50, bܳalsoin younger people.
In the United States, the incidence of pancreatic cancergenerallypeaks between the ages of 65 to 69 for men, and between the ages of 75 and 79 for women, Dr. Yang explains. Pancreatic cancer is rare before the age of 45;is slightly more common in men than in women, and also slightly more commonin black patients than in white patients.
The term "pancreatic cancer"typicallyrefers to cancer that develops in the cells that line the pancreatic ducts–i’s calledpancreatic ductal adenocarcinoma,and represents about 85% of allpancreaticcancers.
Symptoms of Pancreatic Cancer
“Most commonly,this type of pancreatic cancerpresentswith weight loss, abdominal pain,and jaundice, which is ayellowing of the eyes and the skin,” Dr. Yang says.“Sometimes metastatic diseasealreadymay be present at the time of diagnosis.”
Metastatic disease occurs when cancer breaks away from its original site to form new tumors and spread.This cancercanspread to the liver, the lining of the abdominal cavity, the lungs and,less commonly,to the bone.
The pancreas is divided into three parts:the headon the right side of the abdomen, whichconnectswiththe small intestine;the neck/body, whichisthecentral part of the pancreas;and the tail, whichextends to the left side of the body.
Sixty to70% of pancreatic cancers are in the head of the pancreas,and typically cause jaundice by blocking the bile ducts,and weight loss, Dr. Yang says, and adds: “The pain of pancreatic cancer tends to have a gnawing quality and is usually in the upper abdomen,and may radiate straight through to the back. Pancreatic cancer is also associated with the development of blood clots,and sometimes with a new onset of diabetes.
About five percent of the time,she says,we see cancer in the neuroendocrine cells that make hormones such as insulin,which regulates blood sugar. These are called pancreatic neuroendocrine tumors.
Tumors on the pancreas usually cannot be felt during routine exams and may not cause symptoms until the cancer has grown to be large,orhasspread to other organs.
Sometimes patients don’t notice the symptoms, Dr. Yang says, but they can includejaundice, weight loss,andupperabdominal painthat radiates to the sides and straight through to the back. About 28 percent of patients report steatorrhea (oily stools), whichcan happen when the pancreas no longer makes enzymes that break downourfood.
Ƶ & Pancreatic Cancer
A diabetes diagnosis can sometimesbethe first sign of pancreaticcancer, Dr. Yang explains.
“This is difficult because diabetes is common in the age group in which pancreatic cancer occurs. However, anewdiagnosis of diabetes--especially in a patient with no other risk factors for diabetes,such as obesity--may warrant at least a conversation about other risk factors for or symptoms of pancreatic cancer.”
And occasionally,pancreatitis or inflammation of the pancreas is ٳfirstsign of pancreatic cancer. This is due to obstruction of the pancreatic duct by the tumor itself. Rarely,she says,a pancreatic cancer is found incidentally on a CT scan done for some other reason.
Risk Factors for Cancer
One riskfactorsassociated with pancreatic cancer can include cigarette smoking(whichdecreases after cessation of tobacco use). Some studies have alsohavesuggested a link between obesity andalack of physical activity with pancreatic cancer.
Dietary factors have beensuggested,Dr. Yang says,butthosestudies are largely inconclusive. The Western diet--high in saturated fat and smoked/processed meats--has been linked to pancreatic cancer in some studies.Dataaround alcohol ingestion alsoare conflicting.
Patients with certain types of pancreatic cysts alsoareatgreaterrisk for pancreatic cancer. These cysts are usually incidentally found on imaging studies done for other reasons,andtheyshould be managed with surveillance imaging to monitor for change.
Dr. Yang adds: “The medical community has more to learn. For example, we don’t know yet why pancreatic cancer is more common in patients with diabetes, pancreatic cysts, and chronic pancreatitis.”
The practice of screening for pancreatic cancer is a delicate balance, Dr. Yang says.I’s not for the “average” patient, and i’sanindividualized discussion for each patientbecausescreening depends onthe patient's specific personal and family history.
“Doctors often encourage screening in patients with a family historyat age 50,or 10 years younger than the youngest relative with pancreatic cancer,” Dr. Yangsays.
It may begin earlier for patients withafamily history of the followinggenetic mutations:
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Screening usuallyincludesa type of MRI that allowsdoctorsto visualize the pancreatic ducts,andanendoscopic ultrasound.
Though there are not any provenways to prevent pancreatic cancer,forٳgeneral healthof the organ, doctorsrecommend a healthy diet, moderate exercise, minimizing alcohol,and avoiding tobacco.
Find out moreaboܳƵ’s resources forscreening and treatmentofpancreatic cancer.