Understanding the increase in pancreatic cancer


By 2030, pancreatic cancer will be the second deadliest cancer in the United States. This is according to a new report by the Pancreatic Cancer Action Network. Fatal instances of pancreatic cancer are projected to surpass prostate and even breast cancer in the next 15 years. If these projections hold true, only lung cancer will be deadlier.

One reason for this increase is that pancreatic cancer is difficult to treat. The cancer affects a small organ hidden deep inside the abdomen, making detecting and reaching the cancer challenging. While we get better and better at detecting and treating other cancers, pancreatic cancer still lags behind.

The pancreas is an organ that produces important hormones, including insulin, and also produces enzymes that aid in digestion.

Unlike other cancers, pancreatic cancer is usually very aggressive. It grows rapidly and spreads easily to other parts of the body. The percentage of people who will contract pancreatic cancer is not going to go up; however, the percentage of those patients who will die will outpace deaths from other, more easily treated cancers.

What are the symptoms of pancreatic cancer?

One of the best tools we have in fighting pancreatic cancer is early detection. The sooner we can spot a tumor, the more likely we will be able to treat it successfully. Unfortunately, pancreatic cancer does not have many symptoms, and many of them are brushed off as something minor.

The signs of pancreatic cancer depend on where the cancer is located. If the cancer is in the head of the pancreas, near where it connects with the digestive system, it can cause a constriction of the bile duct. When the duct is constricted, a patient can show signs of jaundice. This usually presents itself as a yellowing of the skin and the whites of the eyes. This type of cancer can also cause abdominal pain, back pain, and unexpected weight loss.

If the cancer is located farther down into the body of the pancreas, away from the bile duct, symptoms are rare but can include abdominal pain and weight loss. A subtle symptom I have seen in some patients is the development of new onset diabetes later in life, past the age of 50. This can signal that a tumor is present in the pancreas.

What are the best treatments for pancreatic cancer?

When the cancer appears to be contained, surgical removal is the best and only potentially curative option. Containment is determined by an abdominal scan, either CT or MRI. The quality of the scan is important to precisely assess the extent of disease and the proximity to nearby organs and structures.

The location of the cancer largely determines what type of surgery is needed. Tumors located at the head of the pancreas usually require an operation called a pancreaticoduodenectomy, or Whipple procedure. This is fairly complicated surgery, requiring about five hours in the operating room. The area in the body where the pancreas connects to the digestive system is an anatomical crossroads. There are many ducts and organs in that area, so removing cancer there is a delicate process. The Whipple procedure used to be fairly risky, but here at UT Southwestern and at other medical centers we have gained the surgical experience to dramatically reduce the risk of the procedure.

For tumors located in the body of the pancreas, we usually perform a distal pancreatectomy – where we remove only the affected part of the pancreas, as opposed to the whole organ. This procedure can often be performed with a laparoscopic procedure that requires only small incisions.

What is the future of pancreatic cancer research?

The challenge of treating pancreatic cancer is that once it is detected, it’s usually at an advanced stage. Even among cancers which are operable, many of these patients can have a recurrence of the cancer. Here at UT Southwestern, we are focused on developing early detection tests, as well as exploring genetic analysis and new drug development

With the intensive research that we and other institutions are taking on, we’re hoping that the prediction of pancreatic cancer being the number two killer by 2030 does not come true.