Pancreatic cancer is the fourth leading cause of death from cancer. Since 1993 the incidence of pancreatic cancer has remained stable in men while increasing slightly in women reflecting smoking trends in men and women. The typical patient with newly diagnosed cancer of the pancreas is 63 years old.
Factors that increase the risk of pancreatic cancer include smoking, diabetes and inflammation of the pancreas. The incidence of pancreatic cancer is higher among those who eat red meat and lower among those who eat a diet rich in fruits and vegetables. An inherited tendency to develop pancreatic cancer accounts for ten percent of cases. Some families with an inherited risk for developing pancreatic cancer have an increased risk for developing other types of cancer as well.
Most patients with newly diagnosed cancer of the pancreas will not achieve cure because cancer of the pancreas causes few symptoms while in an early stage. Symptoms of pancreatic cancer such as fatigue, depression, weight loss, poor appetite, nausea, vomiting and pain in the belly or back resemble symptoms of other illnesses. Adults with a five percent or higher risk of developing pancreatic cancer based on family history and gene findings can be screened for pancreatic cancer using a procedure called endoscopic ultrasound. This procedure provides a sharper image of small growths within the pancreas compared to those provided by CT or MRI scanning.
Treatments for pancreatic cancer include surgery, radiation therapy, chemotherapy and targeted therapy. For patients who undergo curative surgery the surgeon removes not only the cancerous part of the pancreas but also nearby organs including gallbladder, bile duct, part of the stomach and small intestine and possibly the spleen. Of patients with newly diagnosed pancreatic cancer, 80 percent cannot undergo surgery with curative intent either because pre-existing medical problems preclude having major surgery or because the cancer involves nearby tissues that cannot be removed. Of the remaining 20 percent of patients who undergo curative surgery half will die within 18 months because the cancer returns.
Giving chemotherapy and radiation therapy to pancreatic cancer patients who have undergone potentially curative surgery increases the likelihood that the cancer will not return. In patients for whom surgery is not an option, chemotherapy and radiation therapy can relieve symptoms by temporarily shrinking the cancer. When added to chemotherapy, targeted therapy improves survival of pancreatic cancer patients by retarding cancer growth while avoiding damage to normal cells. Targeted therapy will play an increasingly important role in the treatment of pancreatic cancer in the future.
Some patients with incurable pancreatic cancer develop pain from invasion of nerve networks that are important for digestion. When pain medicine does not provide adequate relief then disruption of these nerve networks using nerve blocks may provide dramatic results. If symptoms related to compression of nearby intestine, bile ducts or pancreatic ducts occur then stent placement or a bypass procedure may provide benefit.
New treatments for cancer of the pancreas are being tested in clinical trials. Some trials are designed for patients who are not responding to treatment while others are designed to decrease side effects or to prevent cancer from returning after completion of therapy. An exciting area of research explores the possibility of using the patient’s immune system to fight pancreatic cancer. This technique is called biologic therapy. Even if patients do not benefit directly by participating in clinical trials, they may still make an important contribution by helping doctors learn more about cancer of the pancreas.
Dr. Barton Paschal is certified by the American Board of Internal Medicine in the subspecialty of medical oncology and is staff member at Macon Cancer Center located in the Kahn Building at 190 Riverview Street in Franklin (828)369-4257 or 456-5214.
For more information call 1-800-4-CANCER or visit www.cancer.gov/cancertopics/pdq.