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Pancreatic cancer is the third deadliest cancer in the United States, but it doesn’t have to be that way. Although late-stage diagnoses are difficult to treat, the five-year survival rate is higher when the disease is detected at its earliest stages.
Thousands of lives could be saved if people at risk were identified and early detection was prioritized, said Dr. Diane Simeone, pancreatic surgeon and director of the UC San Diego Moores Cancer Center. HealthyWomen spoke to Simeone to learn more about this silent disorder.
Are the symptoms of pancreatic cancer different in men and women?
There is no information to suggest that there is a difference in symptoms depending on gender. The symptoms of pancreatic cancer are usually non-specific and unclear to everyone, for example pain in the upper abdomen or bloating.
The symptoms usually only appear in advanced stages of the disease: that is why it is so fatal. One of the warning signs of pancreatic cancer is a new diagnosis of diabetes and weight loss. Another warning sign is jaundice, which is a yellowing of the eyes or skin.
Does a history of diabetes or pancreatitis affect my risk of developing pancreatic cancer?
Diabetes is associated with pancreatic cancer for two reasons. First, your risk doubles if you have type 2 diabetes, and second, weight loss along with a new diabetes diagnosis is a warning sign of pancreatic cancer. With pancreatitis, i.e. chronic inflammation, the risk of cancer doubles, and this also applies to pancreatitis, i.e. inflammation of the pancreas.
What role does family history play in my risk of developing pancreatic cancer?
It has been found that there is a genetic link, meaning that pancreatic cancer is the result of changes in your DNA in 10% of cases. But if family history is also taken into account, we think the number could rise to 20%.
In the pancreatic cancer community, we encourage people to undergo germline testing, a blood test that can detect inherited genetic defects known to cause cancer.
What mutations are associated with pancreatic cancer and why should I care which mutations I have?
The BRCA genes, which are often linked to breast cancer, also have an important connection to pancreatic cancer. Late detection is associated with worse clinical outcomes. Therefore, we believe that germline testing in cancer is critical. This is currently not being done consistently. Another new strategy should be used that includes routine germline testing, particularly in people at risk of pancreatic cancer.
What should high-risk people do to protect themselves from pancreatic cancer?
I recommend that people with risk factors go to a specialized center and work with a multidisciplinary team to assess their risk and create a personalized plan to control it. The plan will likely include the germline testing and regular checkups I mentioned. The pancreas is not easy to reach with an endoscope and there is no specific blood test that can definitively detect pancreatic cancer. But there are markers that show up in the blood, and detection methods are getting better as we study pancreatic tumors and their genetic makeup.
Are clinical trials a good option for people with pancreatic cancer?
Yes, clinical trials are always an important option to consider. There are studies evaluating the success of early detection tests and there are an increasing number of clinical trials on new therapies. The Precede study aims to improve pancreatic cancer survival rates to 50% over the next 10 years through collaboration, funding and research to provide early detection, screening, risk modeling and prevention services. These studies are not just aimed at patients: family members can also take part.
How does a healthcare provider decide which treatment options are appropriate for a particular patient?
While some cancers can be treated at a local cancer center, pancreatic cancer is a disease for which we recommend treatment at a National Cancer Institute-designated comprehensive cancer center. A multidisciplinary team is important so that patients can participate in studies, undergo germline testing and tumor sequencing, and gather as much information as possible to determine the best treatment plan.
Treatment will likely include a combination of surgery, radiation therapy and chemotherapy. There are promising advances in immunotherapy and vaccines that need to be validated in clinical trials. And new therapies could have a significant impact, such as those that specifically target a gene called RAS that causes cancer when mutated. But any treatment will work optimally if the cancer is detected in its early stages.
Why is nutrition important for someone with pancreatic cancer?
The best nutritional information shows that a healthy, balanced diet low in processed foods reduces the risk of cancer. Exercise is also important. A study showed that people who walk 7,500 steps daily can extend their life expectancy by 10 years. There is a growing body of information indicating that exercise not only reduces the risk of cancer, but also helps the body respond better to cancer treatments.
Are there relevant racial or socioeconomic disparities when it comes to pancreatic cancer?
Much information suggests that underrepresented populations are less likely to be offered the opportunity for germline testing and are not fully informed about their eligibility for cancer screening.
With 67,530 new cases of pancreatic cancer in the U.S. this year, most patients will die from the disease. The main problem was and is the late diagnoses. When I became a pancreatic surgeon and scientist 30 years ago, the five-year survival rate was 5%. Currently it is 13%. It is poised to become the second leading cause of cancer death in our country.
I recommend my patients to take care of themselves. It is very important to listen to your body, get a second opinion, and push to be heard and seen. Your life is at stake. In order for these statistics and the devastating impact of this disease on patients and their families to change, it is important that we all do what is necessary to focus on early detection.
This educational resource was created with support from Merck.
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