Pancreatic Cancer Awareness


Pancreatic cancer is not a common cancer with an average lifetime risk of just 1 in 64, however, it is a cancer with a relatively low survival rate compared to other cancers. Part of the reason why that is, there are no routine screenings available, and, once diagnosed, the cancer has progressed significantly. In this week’s article, we will discuss risk factors, prevention, signs and symptoms, and testing options.

The pancreas is an organ that sits behind the stomach and is shaped a bit like a fish, with a wide head and tapering body with a pointed tail. It is around six inches long but less than two inches wide. The body of the pancreas lies behind the stomach, while the tail lies on the left side next to the spleen. Most of us are familiar with the pancreas as it related to diabetes because pancreatic cells make insulin and glucagon which controls blood sugar levels. The pancreas also releases several enzymes responsible for helping us digest and break down foods. When the pancreas becomes compromised by disease such as diabetes or cancer, enzyme and insulin replacement is necessary.  Unfortunately, pharmaceutical versions of these enzymes and insulin are not as effective as the natural ones and are very expensive as they are needed daily in order to survive. Some risk factors that you can change that place you at higher risk of pancreatic cancer are tobacco use, being overweight, and diabetes. Chronic pancreatitis, which is long term inflammation of the pancreas, is linked to higher risks of pancreatic cancer and is typically associated with chronic alcohol use as well as certain medications such as Tylenol.  Certain inherited genetic syndromes have been found in 10 percent of pancreatic cancers and can be detected in DNA/blood samples. Prevention of pancreatic cancer involves focusing on factors that lead to increased risk such as smoking, drinking, overeating, and long term use of certain prescription medications. 

Signs and symptoms of pancreatic cancer are unfortunately not obvious until later stages of cancer progression. While many of the symptoms listed below are common, that is not indicative of pancreatic cancer. The symptoms should be discussed with a doctor, and blood tests can be performed to rule out other diseases or conditions. Signs of pancreatic cancer can include the following:

  • Jaundice and related symptoms - this can include yellowing of the skin and eyes as well as dark urine, light colored or greasy stools, and itchy skin.
  • Belly or back pain
  • Weight loss and poor appetite
  • Nausea and vomiting - This is particularly common if the pancreatic tumor is pressing on the stomach and blocks the passage of food. Pain will typically get worse after eating.
  • Gallbladder or liver enlargement - A doctor can feel this during a physical exam below the right ribcage, or it can be found during imaging.
  • Blood clots - Because of the close proximity of the pancreas to the liver and the liver’s ability to make clotting factors, sometimes the first indication of pancreatic cancer may be a deep vein thrombosis.
  • Diabetes - Sometimes pancreatic cancers can cause diabetes because they destroy the insulin making cells. Of course, not all diabetics have pancreatic cancer and not all pancreatic cancer patients have or develop diabetes - it should be ruled out.

Tests for pancreatic cancer involve a medical history and physical exam. Imaging tests such as x-rays, MRIs or CT scans are often used to look for suspicious areas that might be cancer as well as looking to see how far the cancer may have spread. Another imaging test that is used specifically for the pancreas and gall bladder is cholangiocreatography. This test looks at the pancreatic ducts and bile ducts to look for blockages and is often a helpful tool for surgeons to determine the location(s) of tumor(s). An angiography is an x-ray test that looks at blood vessels. Contrast dye is injected into an artery to outline the blood vessels then x rays are taken. It looks for tumors in vessels. Several types of blood tests can be used to help diagnose pancreatic cancer or help determine treatment options. Liver function tests can help determine if the liver is affected. Tumor markers are substances that can sometimes be found in blood when a person has cancer. There are currently two tumor markers that may be helpful in pancreatic cancer, CA 19-9 and Carcinoembryonic antigen (CEA). Levels of these markers are not high in all people with pancreatic cancer, but these tests can be useful along with the other tests in determining if someone has cancer.

If a tumor is found upon imaging usually a biopsy is performed to determine if the tumor is carcinogenic. In these cases, a thin hollow needle is placed through the skin over the abdomen and into the pancreas to remove a small piece of tumor. The tumor is closely examined under a microscope to determine the diagnosis. This particular type of biopsy is the most common, known as a fine needle aspiration, however, other types of biopsies exist, such as a surgical biopsy and endoscopic biopsy.  Since some types of pancreatic cancer are linked with certain genetic mutations, a genetic counselor might be consulted for further gene mutation testing.

Genetic testing for people who might be at increased risk such as a family history of pancreatic cancer or gastrointestinal cancers could be a way to detect early stages of pancreatic cancer. Although no major professional groups currently recommend routine screenings for pancreatic cancer, a high risk individual might wish to be pro-active in their health and ask for yearly imaging or blood marker levels. I know that if I was at high risk for this type of cancer, I would certainly want yearly imaging because when symptoms arise because the survival rate is less than 40 percent.

Talk to your health care professional if you have questions about pancreatic cancer, and, as always, my door is open for questions. You can always call Payless Family Pharmacy or Beth at Sparta Drug Center for more information.


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