Pancreatic Cancer

What is pancreatic cancer?

Pancreatic tumors are sometimes discovered during imaging studies (MRI or a CT scan) performed to investigate the onset of new symptoms or during evaluation for another condition. They may also be identified during screening for families with a known history of pancreatic cancer.

The pancreas produces fluids that help digest (break down) food and hormones, such as insulin, to help control blood sugar levels.

• The digestive fluids are produced by exocrine pancreas cells, and the hormones are produced by endocrine pancreas cells. About 95 percent of pancreatic cancers begin with the exocrine cells, and are called pancreatic ductal adenocarcinoma or other types of carcinomas.
• Another type of pancreatic tumor is called a pancreatic endocrine tumor, and these tumors originate from the endocrine cells. Making the distinction between these two kinds of pancreatic cancer is important, as patients with these two tumor types are treated differently.

Pancreatic cancer is a very complex condition to treat, since symptoms are often not apparent until the cancer has advanced to the point where it has spread beyond the pancreas. It is the fourth leading cause of cancer-related death in the United States.

But now, more than ever, patients with pancreatic cancer have good reason to be optimistic about their futures. We are at the frontier of promising new therapies to treat this disease. In the past 10 years, our knowledge about pancreatic cancer has increased dramatically, and our treatment approaches have improved. This is partly due to an increased ability to remove tumors surgically, and also due to new chemotherapy programs that are more effective.

Incidence

Nearly 45,000 people in the United States are diagnosed with pancreatic cancer every year. Most people are diagnosed after the age of 55 years, and 71 years is the median age at diagnosis.

Risk factors

Risk factors for pancreatic cancer include:

• Pancreatic cysts
• Smoking
• Long-standing diabetes
• Chronic pancreatitis (inflammation of the pancreas, especially in people who smoke)
• Age (55+ years)
• Obesity
• Race (African-Americans are more likely to develop pancreatic cancer than white, Hispanic, or Asian-Americans)
• Family history of pancreatic cancer
• Genetic factors; one or more inherited genetic mutations, including as part of the following familial cancer syndromes:
  • Hereditary pancreatitis, multiple endocrine neoplasia type 1 syndrome, hereditary breast-ovarian cancer (HBOC), hereditary nonpolyposis colon cancer (HNPCC; Lynch syndrome), von Hippel-Lindau syndrome, ataxia-telangiectasia, and the familial atypical multiple mole melanoma syndrome (FAMMM).
   

Signs and symptoms

The majority of symptoms arise because of the tumor's location in the pancreas and the relationship of the pancreas to other organs:

• Jaundice (a painless yellowing of the skin and in the whites of the eyes)
• Dark yellow urine
• Pain in the upper or middle part of the abdomen and back
• Unexplained weight loss
• Loss of appetite
• Vomiting, diarrhea
• New development of diabetes
• Fatigue
• Light-colored stool and general itchiness

Genetic Risk Assessment for Pancreatic Cancer

Our dedicated genetics team has specialized expertise in the evaluation and management of patients with a personal history or family history of pancreatic cancer. In some cases, identifying a genetic syndrome may impact the care of a patient with pancreatic cancer or their family members.

Genetic screening is available to all of our patients and is particularly important if you have family members who were diagnosed with pancreatic cancer at a young age or have a strong family history of:

• Breast or ovarian cancer
• Gastrointestinal cancer
• Melanoma
• Multiple benign colon polyps
• Chronic pancreatitis

In the Dana-Farber Brigham Cancer Center's Center for Cancer Genetics and Prevention, an in-depth risk assessment is performed. The risk assessment includes a detailed family lineage analysis, genetic evaluation using state-of-the-art molecular tests, and tailored cancer screening and prevention recommendations for you and your family members. If we find a genetic syndrome that could contribute to developing pancreatic cancer, we can coordinate a screening regimen.

Evaluations are provided by the Center for Cancer Genetics and Prevention.