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What You Should Know About Pancreatic Cancer
November 3, 2020
We can’t see or feel the pancreas—it’s located in the upper abdomen, behind the stomach and next to the small intestine. But the well-hidden organ plays a vital role 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 routine medical exams,” explains Allison 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 cancer may 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 who focuses on the multi-disciplinary care of patients with pancreatic disease, cites a recent Gastroenterology paper on the worldwide burden of pancreatic cancer. In an analysis of 48 countries, researchers found an increasing incidence and mortality in pancreatic cancer, especially seen in women and people over 50, but also in younger people.
In the United States, the incidence of pancreatic cancer generally peaks 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 common in black patients than in white patients.
The term "pancreatic cancer" typically refers to cancer that develops in the cells that line the pancreatic ducts –it’s called pancreatic ductal adenocarcinoma, and represents about 85% of all pancreatic cancers.
Sympotoms of Pancreatic Cancer
“Most commonly, this type of pancreatic cancer presents with weight loss, abdominal pain, and jaundice, which is a yellowing of the eyes and the skin,” Dr. Yang says. “Sometimes metastatic disease already may 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 cancer can spread 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 head on the right side of the abdomen, which connects with the small intestine; the neck/body, which is the central part of the pancreas; and the tail, which extends to the left side of the body.
Sixty to 70% 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, or has spread to other organs.
Sometimes patients don’t notice the symptoms, Dr. Yang says, but they can include jaundice, weight loss, and upper abdominal pain that radiates to the sides and straight through to the back. About 28 percent of patients report steatorrhea (oily stools), which can happen when the pancreas no longer makes enzymes that break down our food.
Diabetes & Pancreatic Cancer
A diabetes diagnosis can sometimes be the first sign of pancreatic cancer, Dr. Yang explains.
“This is difficult because diabetes is common in the age group in which pancreatic cancer occurs. However, a new diagnosis 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 the first sign 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 risk factors associated with pancreatic cancer can include cigarette smoking (which decreases after cessation of tobacco use). Some studies have also have suggested a link between obesity and a lack of physical activity with pancreatic cancer.
Dietary factors have been suggested, Dr. Yang says, but those studies are largely inconclusive. The Western diet--high in saturated fat and smoked/processed meats--has been linked to pancreatic cancer in some studies. Data around alcohol ingestion also are conflicting.
Patients with certain types of pancreatic cysts also are at greater risk for pancreatic cancer. These cysts are usually incidentally found on imaging studies done for other reasons, and they should 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. It’s not for the “average” patient, and it’s an individualized discussion for each patient because screening depends on the patient's specific personal and family history.
“Doctors often encourage screening in patients with a family history at age 50, or 10 years younger than the youngest relative with pancreatic cancer,” Dr. Yang says.
It may begin earlier for patients with a family history of the following genetic mutations:
Screening usually includes a type of MRI that allows doctors to visualize the pancreatic ducts, and an endoscopic ultrasound.
Though there are not any proven ways to prevent pancreatic cancer, for the general health of the organ, doctors recommend a healthy diet, moderate exercise, minimizing alcohol, and avoiding tobacco.
Find out more about Weill Cornell Medicine’s resources for screening and treatment of pancreatic cancer.