The lifetime risk of developing pancreatic cancer is about 1 in 71 (1.41%). It is about the same for both men and women.
According to the
American Cancer Society whose most recent estimates for pancreatic cancer in the United States
are for 2012:
- About 43,920 people (22,090 men and 21,830 women) will be diagnosed with pancreatic cancer.
- About 37,390 people (18,850 men and 18,540 women) will die of pancreatic cancer.
Pancreatic cancer is an abnormal growth of the cells of the pancreatic duct; the tube that drains the juices made by the pancreas to aid digestion in the small intestine. The pancreas also makes hormones, such as insulin and glucagon. The hormones go directly into the bloodstream to help the body use and store the energy it gets from food. The pancreas is located behind the stomach.
Types of pancreatic tumors:
Exocrine Tumors are the most common type of pancreatic cancer. About 95% of cancers of the exocrine pancreas are adenocarcinomas. These cancers usually begin in the ducts of the pancreas, but they sometimes develop from the cells that make the pancreatic enzymes.
Endocrine Tumors of the pancreas are uncommon. As a group, they are known as pancreatic neuroendocrine tumors (NETs), or sometimes as islet cell tumors. There are several subtypes of islet cell tumors; one example is an Insulinoma tumor.
It is very important to distinguish between exocrine and endocrine cancers of the pancreas. They have distinct risk factors and causes, have different signs and symptoms, are diagnosed using different tests, are treated in different ways, and have different prognoses.
Source: American Cancer Society - What is Pancreatic Cancer?.
News
Smoking, heavy drinking linked to earlier onset of pancreatic cancer
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U-M Cancer Center gets $10.7M grant to study colon, pancreas cancers
Researchers ID promising pancreatic cancer screening marker
Risk Factors
No one knows the exact causes of pancreatic cancer. Doctors can seldom explain why one person gets pancreatic cancer and another does not. However, it is clear that this disease is not contagious. No one can "catch" cancer from another person.
Research has shown that people with certain risk factors are more likely than others to develop pancreatic cancer. A risk factor is anything that increases a person's chance of developing a disease.
Studies have found the following risk factors:
The risk of developing pancreatic cancer increases with age. Almost all patients are older than 45 years. Nearly 90% are older than 55 years and more than 70% are older than 65. The average age at the time of diagnosis is 72.
Gender:
Men are slightly more likely to develop pancreatic cancer than are women. This may be due, at least in part, to increased tobacco use in men.
The difference in pancreatic cancer risk was more pronounced in the past (when tobacco use was much more common among men than women), but the
gap has closed in recent years.
Race:
African Americans are more likely to develop pancreatic cancer than whites. The reasons for this are not clear, but it may be due in part to
higher rates of smoking and diabetes in men and being overweight in women.
Cigarette smoking:
The risk of getting pancreatic cancer is 2 to 3 times higher among smokers. Scientists think this may be due to cancer-causing chemicals in
cigarette smoke that enter the blood and damage the pancreas.
Diabetes:
Exocrine pancreatic cancer is more common in people with this disease. The reason for this link is not known. Most of the risk is found in
people with type 2 diabetes.
Obesity and physical activity:
Very overweight (obese) people are more likely to develop exocrine pancreatic cancer, as are people who don't get much physical activity.
Exercise lowers the risk of this cancer.
Chronic pancreatitis:
Chronic pancreatitis is a long-term inflammation of the pancreas. This condition is linked with an increased risk of pancreatic cancer,
but most patients with pancreatitis never develop pancreatic cancer. The link between chronic pancreatitis and pancreatic cancer is strongest
in smokers.
Cirrhosis of the liver:
Cirrhosis is a scarring of the liver. It develops in people with liver damage from things like hepatitis and alcohol use. People with
cirrhosis seem to have an increased risk of pancreatic cancer.
Occupational exposure:
Heavy exposure at work to certain pesticides, dyes, and chemicals used in metal refining may increase the risk of developing
pancreatic cancer.
Family history:
Pancreatic cancer seems to run in some families. In some of these families, the high risk is due to an inherited syndrome (explained below:
"Genetic syndromes"). In other families, the gene causing the increased risk of pancreatic cancer is not known.
Genetic syndromes:
Inherited gene mutations are abnormal copies of certain genes that can be passed from parent to child. These abnormal genes may cause as
many as 10% of pancreatic cancers and can cause other problems as well. Examples of the genetic syndromes: Hereditary breast and ovarian
cancer syndrome, Familial melanoma, Familial pancreatitis, Hereditary non-polyposis colorectal cancer, Peutz-Jeghers syndrome, Von Hippel-Lindau
syndrome.
Stomach problems:
Infection of the stomach with the ulcer-causing bacteria Helicobacter pylori (H. pylori) may increase the risk of getting pancreatic cancer.
Some researchers believe that excess stomach acid may also increase the risk.
Diet:
Some studies have found a link between pancreatic cancer and diets high in fat, or those that include a lot of red meat, pork, and
processed meat (such as sausage and bacon). Others have found that diets high in fruits and vegetables may help reduce the risk of
pancreatic cancer. But not all studies have found such links, and the exact role of diet in relation to pancreatic cancer is still under study.
Coffee:
Some older studies have suggested that drinking coffee might increase the risk of pancreatic cancer, but more recent studies have not
confirmed this.
Alcohol:
Most studies have not found a link between alcohol use and pancreatic cancer. But heavy alcohol use can raise the risk of diabetes, liver
cirrhosis, and chronic pancreatitis, which are risk factors for pancreatic cancer.
Source: American Cancer Society -
What are the risk factors for pancreatic cancer?.
Detection/Screening
If you have symptoms that suggest cancer of the pancreas, your doctor will try to find out what's causing the problems.
Patients with symptoms suspicious for pancreatic cancer will undergo tests to determine the cause of these symptoms. In addition to a physical exam, blood and other lab tests, below are some tests and procedures used for diagnosis:
Ultrasound of the abdomen
An ultrasound can identify a tumor or mass in the pancreas or bile duct system that may be causing blockage or jaundice.
Endoscopic Ultrasonography (EUS)
The EUS test is done with a lighted tube that is inserted through the mouth and placed into the stomach. Ultrasound images of the pancreas are
obtained through the stomach wall. It is highly sensitive for diagnosing pancreatic cancer. EUS is particularly useful for detecting small
(less than two centimeters) tumors which may not be well visualized by CT. It can also identify tumors that may involve important blood vessels.
The procedure can provide details about the arteries and veins next to the pancreas. A biopsy with a small or 'fine' needle aspiration (FNA)
of the tumor may also be performed during an EUS to diagnose pancreatic cancer. Intravenous sedation is used for this procedure.
ERCP (endoscopic retrograde cholangiopancreatography)
An ERCP is done with a lighted tube called an endoscope to look at the bile ducts. It can also be used to place a stent or tube to open a
blocked bile duct for drainage. Intravenous sedation is most commonly used for this procedure. The patient is not awake during the test.
This procedure helps to determine what is causing the blockage.
Some causes of these blockages include ampullary tumors, cholangiocarcinoma (bile duct cancer), inflammation or cancer of the pancreas. Bile duct juice and tissue samples may be obtained and sent to the pathologist to evaluate for cancer cells.
Computed Tomography (CT)
The CT scan can show small tumors as well as important blood vessels that the tumor might be growing into or around. A CT scan can also look at
surrounding organs for spread (metastasis) of the cancer into the lymph nodes, liver and other areas. The doctor may suggest a pancreatic mass CT
to be done at the U-M for the first clinic visit to better assess the tumor for size, location and involvement of surrounding vessels and organs.
This is a special CT scan done at the Cancer Center that examines the pancreas very closely. A special dye is used for the CT, to give additional
information to the radiologist; therefore a temporary IV (intravenous catheter) will be placed prior to the scan.
Interventional Radiology
In some cases the radiology department can perform needle biopsies using the CT or ultrasound technique to locate the mass (tumor) and obtain a
tissue sample through the abdomen for a diagnosis. At the U-M Interventional Radiology department, there are specialists who may be consulted to
do one of these procedures.
Source: U-M Comprehensive Cancer Center - Diagnosing Pancreatic Cancer.
Symptoms
Early cancer of the pancreas often doesn't cause symptoms. When the cancer grows larger, you may notice one or more of these common symptoms:
Jaundice
The head of the pancreas is located close to the common bile duct and small bowel (duodenum) so tumors located in the head of the pancreas may grow
and block these structures. Bile duct blockage can lead to jaundice in 70-85% of patients with tumors in the head of the pancreas. Symptoms of
jaundice include:
- yellowing of the skin
- yellowing of the whites of the eyes
- light-colored (clay colored) bowel movements
- dark-colored urine
- itching
Nausea, Vomiting, Weight Loss
Stomach emptying can be delayed when the small bowel is compressed. This causes a feeling of fullness and contributes to symptoms of nausea and
vomiting. These symptoms are initially present in 35-45% of patients with pancreatic cancer. Patients sometimes have a loss of appetite and
nausea that leads to weight loss.
In advanced disease, up to 5% of patients have tumors that cause complete blockage of the small bowel. In this case, surgery may be done to bypass the blockage and improve digestion.
Fatigue
In more advanced disease, patients can have a feeling of being tired and fatigued. There are many causes of fatigue in patients with cancer.
Abdominal Pain
75-90% of patients with pancreatic cancer have abdominal pain. This may be described as cramping or gas-like pain. Pain may also spread, or
radiate, to the back and shoulders.
Blood Clots
There is an increased risk for blood clots in patients with pancreatic cancer. A blood clot can be a first symptom of pancreatic cancer.
The cancer itself causes changes in the blood that increases the risk for blood clots. Some clots have no symptoms, but swelling, pain
and redness can be present in the area of clot.
Diabetes
The onset of diabetes or difficulty in controlling blood sugar levels is also associated with pancreatic cancer. Diabetes may be diagnosed
before or after the diagnosis of pancreatic cancer. Diabetes occurs when the body does not produce enough of the hormone, insulin, or is
unable to use insulin properly. Insulin helps your body regulate the blood sugar level, so without it blood sugar levels are often high.
Pancreatic Insufficiency
The pancreas secretes digestive enzymes, or juices, into the small intestine. These juices help digest food in the intestines. Patients with
pancreatic cancer may not have adequate amounts of these enzymes, and food isn't digested normally. This is called pancreatic insufficiency.
Symptoms include diarrhea and cramping often after eating. This happens because food passes through the digestive tract not fully digested. As the indigestible food passes through, it pulls water into the intestines, causing diarrhea and cramping.
Source: U-M Comprhensive Cancer Center - Diagnosing Pancreatic Cancer.
Take action
Treatment options for people with cancer of the pancreas are surgery, chemotherapy, targeted therapy, and radiation therapy. You'll probably receive more than one type of treatment.
The treatment that's right for you depends mainly on the following:
- The location of the tumor in your pancreas
- Whether the disease has spread
- Your age and general health
At this time, cancer of the pancreas can be cured only when it's found at an early stage (before it has spread) and only if surgery can completely remove the tumor. For people who can't have surgery, other treatments may be able to help them live longer and feel better.
Source: National Cancer Institute -
What You Need to Know About Pancreatic Cancer®.
Join a Clinical Trial
UMClinicalStudies.org.
U-M Pancreatic Clinical Trials Enrolling
UMCC 2011.007:
A Phase II Study of Neoadjuvant FOLFIRINOX and FDR-Gemcitabine with Concurrent IMRT in Patients with Borderline Resectable Pancreatic Cancer
A Neoadjuvant Pharmacodynamic Study of RO4929097 (RO) in Pancreas Cancer.
Principal Investigator: Dr. Mark Zalupski.
UMCC 2011.036:
A Phase II Trial of Gemcitabine, Infusional 5-Fluorouracil and Cisplatin for Advanced Pancreatic and Biliary Cancers
Principal Investigator: Dr. Mark Zalupski.
RTOG 0848
A phase III trial evaluating both Erlotinib and chemoradiation as adjuvant treatment for patients with resected head of
pancreas adenocarcinoma.
Principal Investigator: Dr. Mary Feng.
Make a Donation for Pancreatic Cancer
Research
Raise Awareness about Pancreatic Cancer
Living with Cancer
Hirshberg Foundation for Pancreatic Cancer Research
Resources
University of Michigan Resources- U-M Multidisciplinary Pancreatic Clinic
- Diagnosing Pancreatic Cancer
- Treatment of Pancreatic Cancer
- Stem Cell Research and Pancreatic Cancer
- Pancreatic Information Guide
-
University of Michigan Health System, Health Library
National Resources
- American Cancer Society (ACS)
Pancreatic Cancer
- National Cancer Institute
- National Comprehensive Cancer Network (NCCN)
Pancreatic Adenocarcinoma [PDF] NOTE:
accessing this document requires registering on the NCCN website.
- Pancreatic Cancer Alliance
- Pancreatica
