Changing Course in Pancreatic Cancer

Small, yet significant, advances are reshaping pancreatic cancer treatment.

There are several types of pancreatic cancer, but they fall into two major categories: exocrine and endocrine. Approximately 95 percent of pancreatic cancers begin in the exocrine cells in the ducts of the pancreas and sometimes in the cells that make pancreatic enzymes that aid digestion. Within this category, there are a number of tumor types, but about 95 percent are adenocarcinomas. Endocrine tumors, also known as pancreatic neuroendocrine tumors (PNETs), are slower growing and develop in the islet cells, which produce hormones, such as insulin. These cancers are rare, accounting for less than 4 percent of pancreatic cancers. While treatment varies depending on the specific tumor type and stage, the prognosis for PNETs is usually better than for exocrine cancers.

The Role of Diet and Diabetes

Most cases of pancreatic cancer appear to be sporadic, in that they occur in patients who do not have an inherited predisposition. Smoking, by far, is the most common modifiable risk factor, accounting for about 20 percent of cases. Some studies have found that diet can play a role, in that high consumption of processed red meat and fats might increase pancreatic cancer risks, while fruits, vegetables and dietary fiber might have a protective effect, but more research is necessary to confirm those results. Being obese has also been linked with a higher risk.

Other risk factors include long-term inflammation of the pancreas (chronic pancreatitis) and certain inherited syndromes caused by genetic abnormalities. Diabetes can be a risk factor and a symptom of pancreatic cancer. “Diabetes or glucose intolerance often predates pancreatic cancer by several months,” says Diane M. Simeone, director of the Pancreatic Cancer Center at the University of Michigan in Ann Arbor. “We are trying to understand in more detail what the link is between diabetes and pancreatic cancer, and this could help us develop an early detection test.”

Of all people age 50 or older who have diabetes, one in 100 will receive a diagnosis of pancreatic cancer within three years of their diabetes diagnosis, according to Simeone. “We need to be able to take that information and better differentiate which individuals should get a further workup for pancreatic cancer.”

Detection and Diagnosis Can Be Daunting

Pancreatic cancer can often be challenging to diagnose, as patients do not typically have symptoms when the disease is in its early stages. When symptoms develop, they are generally vague and can be attributed to other illnesses. Pain is a common symptom, which often occurs in the abdomen or the middle of the back. The pain can be unrelenting, especially at night. Individuals may also experience weight loss, jaundice and digestive problems, such as indigestion, nausea and poor appetite. Stool may become lighter and turn pale or light grayish, while urine may become darker.

About half of patients have metastatic disease at the time of diagnosis; while a third have regional spread. “Early detection would be a huge advance for pancreatic cancer,” Simeone says. “And there are high-risk groups that could benefit from a screening test.”

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