Pancreatic cancer: Symptoms, signs, and treatment
February 17, 2016
Pancreatic cancer has a nasty reputation. I’m a surgeon who specializes in treating pancreatic cancer, so I’m acutely aware of the view that many people have about this disease: that it’s especially lethal, that the patient’s odds aren’t good, and that by the time it’s discovered, it’s too late.
It’s true that pancreatic cancer is a difficult disease, but we’re making significant advances in treating it, and there are some risk factors that we can modify.
One of the keys to battling this disease is to become attuned to changes within the body, because the earlier we can attack pancreatic cancer, the better. That means looking out for pancreatic cancer symptoms that affect the whole body along with those that affect just the gastrointestinal (GI) system.
Pancreatic cancer symptoms affecting the whole body
The pancreas is an abdominal organ with three parts (head, body, and tail), located adjacent to the stomach. It has two functions: it secretes hormones that help regulate sugar levels in our blood, and it secretes enzymes into the intestines to help break down fatty food so our bodies can use the nutrients.
Clearly, those two functions are vital to good health. Unfortunately, some of the signs and symptoms of pancreatic cancer are rather insidious and usually quite vague, which can make it hard to detect pancreatic cancer early on.
Consider these general symptoms, which can arise from pancreatic cancer in the body or tail of the pancreas:
- Vague abdominal pain as the cancer grows and presses on nearby organs
- Vague middle back pain as the cancer spreads to nerves surrounding the pancreas
- Unexplained weight loss
These general symptoms could be caused by any number of things and are usually not due to pancreatic cancer. But they warrant prompt attention from you and your physician because pancreatic cancer is a fast-moving, aggressive disease.
Tumors that start in the body or tail of the pancreas tend to be found later than those originating in the head of the pancreas. As a result, they tend to be much larger when finally discovered.
Probably the best early warning sign that we can point to is a new onset of diabetes, particularly in a non-obese patient, and especially one in their 50s or older. Additionally, an acute worsening of existing diabetes – meaning the need for a new medication when the condition had been stable for a long time – can be a symptom of pancreatic cancer and merits further evaluation.
Pancreatic cancer symptoms specific to the GI system
Along with general symptoms of possible pancreatic cancer, there are other signs of it specific to the GI system, and most of these emanate from the head of the pancreas. The most common are:
- Jaundice: Tumors block the bile duct, resulting in a yellowing of the skin and eyes
- Dark urine: Bile levels in the blood increase.
- Light-colored stools: The bile duct becomes blocked and doesn’t drain into the intestine, and thus the stool does not have any pigment.
Tumors that start in the head of the pancreas typically present earlier because of these more visible, specific symptoms.
Another gastro-specific symptom that warrants physician workup is unexplained pancreatitis. Pancreatitis is inflammation of the pancreas that occurs when food-digesting enzymes can’t get from the pancreas to the intestine due to blockage and instead begin digesting the pancreas itself. Pancreatitis is typically very, very painful, so it’s not a subtle condition.
Most cases of pancreatitis are not caused by pancreatic cancer – gallstones and the effects of alcohol are much more common causes. But if pancreatitis occurs out of the blue, or only involves half the pancreas, it should be a flag for further investigation.
Diagnosing pancreatic cancer
Unfortunately, there is no simple blood test that can detect pancreatic cancer. Developing such a test is a huge area of focus for our research. Typically, pancreas cancer is diagnosed using imaging, usually first with a CT scan of the abdomen. Sometimes that’s all that’s needed to give us our answer, but occasionally, further evaluation is needed with an endoscopic ultrasound and possibly a biopsy.
In any event, the presence of a solid mass in the pancreas is considered cancer until proven otherwise – not the other way around. A biopsy is not needed prior to referral to a specialist. Any patient who has a solid mass in his or her pancreas at imaging should be referred immediately for evaluation – typically to a pancreatic surgeon or gastroenterologist who specializes in pancreatic disease.
Risk factors for pancreatic cancer
Pancreatic cancer used to be a disease of people in their 60s or older. However, we’ve seen a shift recently, for reasons that aren’t entirely clear, with patients presenting earlier with pancreatic cancer. We do know though that avoiding or modifying certain lifestyle habits, we can reduce the risk of developing pancreatic cancer.
The most significant of these risk factors are:
- Tobacco use
- Alcohol use
- Weight management
Tobacco and alcohol are potential toxins to the pancreas by themselves. When used together, they significantly increase your risk even more. As for weight, we know that obesity and Type 2 diabetes often go hand-in-hand and put you at greater risk. Patients who are severely overweight have a 20 percent increased risk of developing pancreatic cancer in some studies. Incidentally, there haven’t been any clear studies to date that link specific foods (for example, red meat) to pancreatic cancer.
Simply put, to lower your risk for pancreatic cancer, don’t smoke, use alcohol only in moderation, and watch your weight.
There’s also a genetic component to pancreatic cancer. According to the American Cancer Society, about 10 percent of pancreatic cancers are due to inherited genes. While few pancreatic cancers appear to be linked to known mutations at the present time, we only know of about 20 percent of the likely mutations that may be responsible for the development of this terrible disease. By proactively engaging with our patients at risk and their families, we hope to bring solutions in the future for improved screening and treatment as we learn more.
Preventing pancreatic cancer
Imaging is the best tool for diagnosing pancreatic cancer, but it’s also useful for helping to prevent it. People get imaging tests so often these days for appendicitis, kidney stones, etc. As a proactive measure, we screen every patient who has abdominal imaging for the presence of a pancreatic cyst.
If a cyst is found, the patient is contacted by our pancreatic cancer prevention clinic. His or her case is reviewed by a multidisciplinary team that includes gastroenterologists who specialize in the pancreas, as well as a cancer genetics team, which reviews the patient’s family history. We then put the patient into a surveillance program if it’s determined he or she has an at-risk cyst.
It should be noted that pancreatic cysts are quite prevalent. In fact, they appear in about 40 percent of patients over the age of 65, although not all pancreatic cysts are precancerous. By putting patients who are at risk into a surveillance program, we can watch for small changes over time and take action before a cyst develops into cancer.
Hope for the future
Most of us know someone who has been affected by pancreatic cancer. Hearing those experiences, it may seem that it’s an unbeatable disease. Certainly, the numbers are not on our side – yet.
But we have seen two significant advances over the last decade or so that give us greater hope. First, surgical procedures have become much safer, meaning that we’ve been able to safely push the envelope as to what we can offer from a surgical perspective. That includes things like removing and reconstructing blood vessels around the pancreas, which we couldn’t do safely before, and which made potentially curative surgery not an option for some.
The second big advance has been the development of more effective combination chemotherapies. We’re also seeing more targeted therapies and immunotherapies. These new medical treatments enable us to target patients’ cancers, shrink them, and then bring more patients to surgery to hopefully remove the remaining disease. In fact, over the past few years, we’ve seen a two-to-threefold increase in the number of patients whose cancers were previously considered inoperable but now can be treated surgically following treatment with more effective chemotherapy.
Someday the odds will be on our side. With growing awareness of the symptoms, advancements in prevention and screening, and ever-expanding treatment options, I’m hopeful that day will come sooner rather than later.
Have you or a loved one been affected by pancreatic cancer? Use the hashtag #CallOutCancer to share encouraging words and advice with others on social media.