Raymond Wadlow, MD, is an oncologist at Inova Schar Cancer. He is board-certified in medical oncology and internal medicine and has a special interest in gastrointestinal oncology.
Pancreatic cancer is considered a rare disease, accounting for only 3 percent of all cancers in the U.S. And yet, this cancer has the highest mortality rate of all the major cancers, with a five-year survival rate of just 13 percent.
These statistics are alarming — but there is hope. I’ve been treating and studying pancreatic cancer for 20 years, and I’m excited to say that breakthroughs in screening and treatment are on the horizon.
What is Pancreatic Cancer?
Your pancreas is a small, teardrop-shaped organ behind your stomach. It makes digestive enzymes and hormones that help you digest food and regulate your blood glucose (sugar).
The most common type of pancreatic cancer is pancreatic adenocarcinoma, which accounts for about 95 percent of pancreatic cancers. This type of pancreatic cancer affects the exocrine cells, which make digestive juices, and has the lowest survival rates.
Another type of pancreatic cancer, known as a pancreatic neuroendocrine tumor (P-NET), forms in the endocrine cells in your pancreas. These cells produce insulin and other hormones that control blood sugar. While most P-NETs have a higher survival rate than pancreatic adenocarcinoma, they are also much more rare.
Spotting the Signs
Pancreatic adenocarcinoma can be difficult to detect in the early stages because symptoms are often vague. The signs of pancreatic cancer may be mistaken for a food intolerance, irritable bowel syndrome, or another non-cancerous condition. Some people don’t have any symptoms until the cancer becomes more advanced.
Pancreatic adenocarcinoma symptoms include:
- Fatigue
- Jaundice (yellowing of the skin and eyes)
- Loss of appetite
- Nausea
- New onset of diabetes
- Pain in the abdomen, back, or side
- Weight loss without an obvious cause
Lowering Your Risk of Pancreatic Cancer
Pancreatic cancer is complex, and many cases have no obvious cause. It usually affects people over age 50, and conditions like diabetes and chronic pancreatitis increase one’s risk. Certain gene mutations, or changes, may also increase a person’s risk of getting this disease by up to 20 percent.
You can’t control all the risk factors of pancreatic cancer. However, you can lower your chances of getting the disease if you:
- Don’t smoke (or quit if you do smoke)
- Limit or avoid alcohol
- Work toward a healthy weight if you have obesity
Diagnosing Pancreatic Cancer
At this time, there is no screening test that detects pancreatic cancer in its earliest stages. Instead, healthcare providers order medical tests to determine the cause of a person’s symptoms. These tests include:
- Blood tests: A blood test can help diagnose or rule out other conditions and provide information about your overall health. A blood test alone does not diagnose the disease, but it’s an important first step in determining the cause of any symptoms.
- Genetic testing: A genetic test involves collecting a sample of your blood or saliva and testing it for genetic mutations. Genetic testing may be an option for people with a strong family or personal history of certain cancers, like pancreatic, breast, or colon cancer.
- Imaging tests: Tests like a computed tomography (CT) scan, magnetic resonance imaging (MRI), and endoscopic ultrasound (EUS) take pictures of the inside of your body. We may recommend imaging tests if an individual has symptoms of pancreatic cancer and other conditions have been ruled out. If there is a known gene mutation, imaging tests for screening may be needed even if there are no symptoms.
If imaging tests show a possible tumor on your pancreas, doctors may perform a biopsy (tissue sample). Many pancreatic biopsies don’t require major surgery and can be done using an endoscopy procedure or a thin needle to collect the cells.
How Do Doctors Treat Pancreatic Cancer?
Treating pancreatic cancer usually involves a combination of therapies, including:
- Chemotherapy: Chemotherapy is a type of medicine that can destroy cancer cells and stop them from spreading. Several chemotherapy drugs can treat pancreatic cancer, and we often use a combination of medications for better results.
- Radiation therapy: During radiation therapy, beams of energy kill cancer cells. External beam radiation therapy is the most common radiation therapy for pancreatic cancer. The treatment is painless and similar to getting an X-ray.
- Surgery: In cases of pancreatic adenocarcinoma, surgeons may remove all or part of the pancreas. Some people also need a Whipple procedure, which involves removing the gallbladder, part of the stomach, and part of the small intestine. Pancreatic cancer surgery is complex, so having an experienced team is crucial. The surgical team should customize care based on the size and location of the tumor, the patient’s overall health, and several other factors.
- Targeted therapy: These drugs attack specific genes in the cancer cells to stop them from growing and dividing. Targeted therapy drugs work differently from chemotherapy. We customize this therapy based on the specific traits of each tumor.
Why Your Care Team Matters
Pancreatic cancer usually involves several different treatments, so having a multidisciplinary cancer program is crucial. At Inova, patients have access to a team of specialists, including medical oncologists, radiation oncologists, surgeons, geneticists, and dietitians. Our team regularly meets and discusses each patient’s case. Then, we work together to optimize their treatment plan.
Inova also believes that comfort and support are an important part of cancer care. Life can be stressful when you or a loved one is facing pancreatic cancer. Our free Inova Peterson Life With Cancer program offers support with services like acupuncture, counseling, and massage therapy. This program offers evidence-based care that can be life-changing for patients and their families.
Leading-edge Pancreatic Cancer Research at Inova
Pancreatic adenocarcinoma is a devastating disease, but I believe research can turn the tide. I’m proud to be a Principal Investigator and Chair of the Cancer Outcomes Committee in a worldwide clinical trial for pancreatic cancer screening. The trial, known as Pancreatic Cancer Early Detection (PRECEDE), is a multi-site, global study enrolling 10,000 participants through 2030. The Inova Saville Cancer Screening and Prevention Center is one of about 50 sites worldwide participating in PRECEDE.
The PRECEDE clinical trial aims to increase the five-year survival rate of pancreatic cancer from 12 percent to 50 percent. We can achieve these results through a better understanding of the genetics of the disease and earlier diagnosis.
PRECEDE is studying screening methods in people with a higher risk of pancreatic cancer, including those with:
- Genetic mutations linked to pancreatic cancer
- Family history of pancreatic cancer
- Personal history of chronic pancreatitis or pancreatic cysts
Participants receive regular blood and imaging tests to look for pancreatic cancer in its early stages. The results from PRECEDE will help us determine which genetic mutations lead to a higher risk of this cancer. We are also studying which screening tests work best for high-risk patients.
Hope for the Future
At Inova, we’re optimistic that earlier detection could lead to longer, healthier lives for people with this cancer. When someone is diagnosed with pancreatic cancer through this screening program, we follow them throughout their treatment and beyond. Ultimately, our number one goal is to prove that early detection leads to better outcomes.
If you or a loved one is facing pancreatic cancer, a multidisciplinary cancer team can make a world of difference. Learn more about the exceptional care we provide Inova Gastrointestinal Cancer Program.
Feature image, stock.adobe.com
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