With the number of new pancreatic cancer cases on the rise in the United States, increasing awareness of this disease is key, even more so because pancreatic cancer often is diagnosed late. The American Cancer Society estimates that about 60,430 people will be diagnosed with pancreatic cancer this year.
Dr. William Fisher, director of the Elkins Pancreas Center at Baylor College of Medicine and professor and vice chair for clinical affairs in Baylor’s Department of Surgery, is an internationally known leader in pancreatic surgery. In this Q&A, he explains the risks for pancreatic cancer, treatment options and what patients should consider when seeking care.
Q: What is pancreatic cancer?
A: Pancreatic cancer is a complex disease that occurs when abnormal cells begin to grow inside the pancreas. When we discuss pancreatic cancer, we are typically referring to pancreatic ductal adenocarcinoma. This is the most common type of pancreas cancer and usually occurs in older people. There are other types of pancreas tumors that are rarer. These are usually pancreatic neuroendocrine tumors. They can occur in younger people, and they are very frequently cured with surgery. Unfortunately, the prognosis with the more common type of pancreas cancer is much worse.
Q: Why is it often diagnosed late, and typically how is it detected?
A: Pancreas cancer is diagnosed late because the symptoms of the disease are vague at first. Typically, patients have about three months of vague, dull, crampy pain in the upper part of the abdomen above the umbilicus and sometimes penetrating to the back. They also often have unexplained weight loss. When the tumor is in the head of the pancreas, it will eventually block the bile duct. This causes jaundice (yellow skin). New onset diabetes in patients who are over 50 years old is often another clue in the diagnosis.
Q: How is it treated?
A: Pancreas cancer is treated with chemotherapy and surgery. Unfortunately, only a minority of the patients—about 15%—are candidates for surgery because the disease is too advanced at the time of diagnosis. Most experts agree that it is better for the patient to have chemotherapy before surgery, even when it looks like the tumor can be removed by surgery at the time of diagnosis.
Q: What are some of the risk factors for pancreatic cancer?
A: Risk factors for pancreas cancer include smoking, obesity, chronic pancreatitis, exposure to chemicals, and things we cannot control like age (average age is about 70 at diagnosis), gender (slightly higher in men), race (slightly higher in African Americans), family history and inherited genetic syndromes associated with other cancers (BRCA and PALB2-breast cancer genes, p16/CDKN2A-melanoma genes, PRSS1-familial pancreatitis, MLH1/MSH2 and STK11-colon polyposis syndrome genes).
Q: If you have a parent who has a positive diagnosis should you get genetic testing?
A: All patients who have been diagnosed with pancreas cancer, regardless of family history, now undergo genetic testing as part of the standard of care. This information can guide the treatment decisions and improve outcomes.
Family members with just one first-degree relative (parent, sibling, child) typically do not have that much of an increased risk of developing pancreas cancer compared with the general population. However, with two or more first-degree relatives with pancreas cancer or certain other types of cancer, or if you have a relative that tested positive for a genetic mutation linked to pancreas cancer, you may be at more risk and should be tested.
Q: What should you do if you are diagnosed with a pancreatic cyst?
A: There are many different types of pancreas cysts. Some are totally benign and do not turn into cancer; others can frequently turn into cancer and must be removed before this happens. Pancreatic cysts are evaluated with CT scans, MRIs and endoscopic ultrasound with aspiration of the cyst fluid for analysis. This information lets your surgeon know if the cyst needs to be removed or if it can just be watched.
Q: What should patients look for when seeking care for pancreatic cancer?
A: Pancreatic cancer is a complicated disease and results are proven to be better when a multidisciplinary team of experts take care of the patient. The Elkins Pancreas Center is part of the Dan L Duncan Comprehensive Cancer Center at Baylor College of Medicine, a National Cancer Institute-designated comprehensive cancer center, and our team is entirely focused on pancreas cancer. Surgery in particular is much better in the hands of experienced pancreas surgeons. Our surgeons at the EPC are some of the most experienced pancreas surgeons in the U.S. and the world.
Learn more about pancreatic cancer.
The Pancreatic Cancer Action Network (PanCAN) has launched the $25-million Early Detection Initiative to determine what role imaging at the time of new-onset diabetes may play in the early detection of pancreatic cancer, and Baylor will be one of the sites for this research.
-By Bertie Taylor, senior writer in the Michael E. DeBakey Department of Surgery at Baylor College of Medicine