Dr. Leslie Greenberg's Blog

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Pancreatic cancer is an uncommon AND deadly cancer.  It is the 12^th most common cause of cancer in the US and usually diagnosed at an advanced stage.  Only 3% of stage III patients are alive at 5 years.  Pancreatic cancer rarely affects those less than 45 years of age. There are both non-hereditary risk factors and hereditary (family-linked) risk factors.

• Nonhereditary risk factors for pancreatic cancer–
  • Occurs more often in men,
  • African Americans,
  • patients with a chronic pancreatitis,
  • diabetes,
  • cigarette smokers,
  • obesity and
  • physical inactivity.
• Hereditary risk factors
  • Those with a non-O blood type,
  • someone with a first-degree relative with pancreatic cancer, and
  • risk increases with each additional first-degree relative with pancreatic cancer, hereditary breast and ovarian cancer syndromes (like BRCA gene carriers, hereditary nonpolyposis colon cancer, atypical mole and melanoma syndrome, and Peutz-Jeghers).

Screening for pancreatic cancer.  Bad news…. There’s no effective screening for asymptomatic people or those at normal risk.  The US Preventive Services Task Force recommends against routine screening.  The International Cancer of the Pancreas Screening Consortium recommends that patients at increased risk of pancreatic cancer may have an endoscopic ultrasound or magnetic resonance cholangiopancreatography.  Although there is no consensus on when or how often this screening should be done.

What may bring you in to the doctor if you have pancreatic cancer?

• Nonspecific abdominal pain,
• weight loss, and/or
• jaundice.

There may also be enlargement of the liver, anorexia (meaning loss of appeteite), nausea, vomiting and diarrhea.

Presenting signs and symptoms relate to the tumor location.

• 70% of pancreatic cancers are at the head of the pancreas.  The symptoms that are associated with this location are weight loss, dark-colored urine and jaundice.
• 30% of pancreatic cancers are in the body or the tail of the pancreas and this may cause abdominal pain, weight loss, and loss of appetite.

How is pancreatic cancer diagnosed?

First off, your doctor should do a thorough medical history and physical exam.  There are no blood markers to reveal pancreatic cancer.  Imaging studies are depending on patient presentation and may include an abdominal ultrasound or CT scan.

Treatment.  First the cancer needs to be “staged.”  This is to decide if the cancer is resectable as the only curative strategy is surgical removal of the cancer.  Tumor markers are not useful from a diagnostic perspective, but cancer antigen 19-9 (CA 19-9) is useful in determining the prognosis.

If the tumor is unresectable, palliative care is the only option.  If the patient has chemotherapy, a clinical trial should be affiliated with the treatment.  Some chemotherapy regimens have been shown to prolong life by several months.