Treatment In Metastatic Patients
The management of metastatic pancreatic cancer involves symptom control, management of jaundice and palliative chemotherapy with the preferred chemotherapy regime FOLFIRONOX . Conroy et al performed a multicentre, randomised trial in 48 French centres with patients receiving either gemcitabine or FOLFIRINOX within a week of enrolment. There were 171 patients within each group and intention to treat analysis was performed. The median overall survival in the FOLFIRONOX group was 11.1 mo compared to 6.8 mo in the gemcitabine group . There was an increased incidence of adverse affects within the group receiving FOLFIRONOX however, this group concluded that FOLFIRONOX should be the treatment of choice in patients with metastatic disease.
Gallbladder Or Liver Enlargement
If the cancer blocks the bile duct, bile can build up in the gallbladder, making it larger. Sometimes a doctor can feel this during a physical exam. It can also be seen on imaging tests.
Pancreatic cancer can also sometimes enlarge the liver, especially if the cancer has spread there. The doctor might be able to feel the edge of the liver below the right ribcage on an exam, or the large liver might be seen on imaging tests.
Obesity And Physical Inactivity
Being overweight and having little physical activity are also risk factors for pancreatic cancer. Several studies suggest a link, with many specifically pointing to an individuals body mass index .
In a 2010 study in Cancer Causes & Control, researchers noted an increase in pancreatic cancer risk related with BMI. Compared with a person of standard weight , an individual with a BMI from 25 to less than 30 had a 13 percent increased risk of pancreatic cancer. A person with a BMI of 30 to less than 35 had a 19 percent increased risk.
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Pancreatic Cancer: The Basics
The pancreas is a gland in the abdomen that makes enzymes for digestion and hormones that control sugar levels in the blood. Benign or malignant tumors may form if the process of cellular division in this gland breaks down. Malignant tumors of the pancreas are called pancreatic cancer.
About 62,000 Americans will be diagnosed with pancreatic cancer this year, according to the American Cancer Society . Pancreatic cancer accounts for 3 percent of all cancers in the United States and for about 7 percent of all cancer deaths.
The two major types of pancreatic cancer are the exocrine tumor and the neuroendocrine tumor, or islet cell tumor. They are determined by the type of cell in which they originate, and specific risk factors may be related to each type.
Initial signs and symptoms of pancreatic cancer are often vague and include:
Pancreatic Cancer Causes And Risk Factors
Pancreatic cancer happens when tumors form in your pancreas, an organ behind your stomach that helps in digestion.
About 62,000 people in the U.S. are expected to be diagnosed with pancreatic cancer in 2022. As with many types of cancer, the causes of pancreatic cancer are mysterious. Some risk factors have been identified, but the story is far from complete.
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Overview Of Pancreatic Cancer
Pancreatic cancer is currently the fourth leading cause of cancer deaths in the United States. The American Cancer Society estimates that in 2020 57,600 Americans will be diagnosed with pancreatic cancer in the U.S., and over 44,050 will die from pancreatic cancer. One of the major challenges associated with pancreatic cancer is that the condition often goes undetected for a long period of time because signs and symptoms seldom occur until advanced stages. By the time symptoms occur, cancer cells are likely to have spread to other parts of the body, often preventing surgical removal of tumors.
Pancreatic cancer is a major focus of cancer research, and much progress is being made in understanding the risks for pancreatic cancer, diagnosing and treating it, and the genetics behind the condition. Pancreatic cancer research funding has increased by almost 400% since 2000, when only $22 million was spent on research, to $99.5 million in 2011. Research findings and advancements are being published on an ongoing basis, helping to advance medical knowledge and improve patient quality of life.
Magnetic Resonance Imaging Scan
A magnetic resonance imaging scan also produces an image of the inside of your body, but it uses strong magnetic and radio waves instead of X-rays.
MRI scans are carried out in a tube-shaped MRI scanner. It’s a noisy procedure that can feel claustrophobic. It also takes longer than other types of scans.
Like a CT scan, an MRI scan allows your doctor to check for signs of cancer in other parts of the body.
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Red And Processed Meat
Eating red meat may increase the risk of pancreatic cancer, particularly meat cooked at high temperatures. Red meat includes beef, lamb and pork.
Eating processed meat may also increase your risk of pancreatic cancer. Processed meat is meat that has been preserved by smoking, curing, salting or adding chemical preservatives. It includes sausages, ham, bacon, salami and burgers.
How Is Pancreatic Cancer Treated
Pancreatic cancer treatment depends on certain things, including where the tumor is located, what stage it is in, how healthy you are and whether or not the cancer has spread beyond the pancreas. Treatment options include:
- Surgical removal: The cancerous part of the pancreas is removed. Lymph nodes near to the pancreas may also be removed. The surgery to remove the pancreas or part of the pancreas is called a pancreatectomy. If your tumor is located in the head of the pancreas, your provider may recommend the Whipple procedure. This surgical method removes the head of the pancreas, the duodenum , the gallbladder, a portion of the bile duct and nearby lymph nodes.
- Radiation therapy: High-speed energy used to kill the cancer cells.
- Chemotherapy: This method uses drugs that kill cancer cells.
- Immunotherapy: Treatment to help your body fight the cancer. Immunotherapy has largely been ineffective against pancreatic cancer, but about 1% of people with pancreatic cancer and a specific genetic change may benefit from it.
- Targeted therapy: Directed at certain genes or proteins that help cancer grow. Genetic testing is generally how we determine if a targeted therapy is right for you.
- Clinical trials: Talk to your healthcare provider about whether participating in a clinical trial might be an option.
Other things to know about treatment:
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Causes And Risk Factors Of Pancreatic Cancer
The exact cause of pancreatic cancer in an individual is still being researched. However, the most important risk factor for pancreatic cancer is increasing age, with the risk rising to 1 in 61 by the age of 85 years. Other factors that increase the risks may include:
Family Cancer Syndromes And Genetic Factors
Sometimes pancreatic cancer is found to run in families. But only between 5 and 10 in 100 people diagnosed with pancreatic cancer have a family history of it.
You have an increased risk if you have a first degree relative with pancreatic cancer. This risk is higher if you have more than one first degree relative with the disease, or a first degree relative is diagnosed at a young age.
Pancreatic cancer can be part of a family cancer syndrome, where an inherited family gene causes a number of different cancers to develop within the members of one family.
Your risk of pancreatic cancer is higher if you carry the faulty breast cancer gene BRCA2. There is also some evidence that having a BRCA1 gene fault could increase your risk of pancreatic cancer. But the evidence is less strong.
The pancreatic cancer risk is higher in people who have:
- Peutz-Jeghers syndrome
- Familial atypical multiple mole melanoma syndrome
- Lynch syndrome/hereditary non-polyposis colorectal cancer
You often know about these conditions already if one runs in your family.
The risk of pancreatic cancer is increased if you have a history of the following:
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What Questions Should I Ask My Healthcare Provider
Develop an open and cooperative relationship with your healthcare provider. Take a list of questions with you so you remember to get the answers you need to live your best life. These questions might include:
- What stage is the cancer? What does this mean for me?
- What are my treatment options? Which do you recommend and why?
- What side effects might I develop as a result of treatment?
- Is genetic testing right for me?
- Am I able to be a part of a clinical trial?
- Will I be able to keep working and doing the things that I need or want to do every day?
- Are there situations in which I need to call you immediately or get emergency care?
- Can you tell me where to find financial support?
- Can you tell me where to find emotional support?
- What should I do to stay as healthy as I can?
Make sure to follow the plan that you and your provider agree on. Keep to the schedule of follow-up appointments and testing.
Enhancing Healthcare Team Outcomes
The diagnosis and management of pancreatic cancer is with an interprofessional team that consists of an oncologist, general surgeon, radiologist, pain specialist, gastroenterologist, palliative care nurse, and an internist. By far the majority of cases of pancreatic cancer are advanced at the time of presentation and these patients have a very short life expectancy. Palliative care and a pain specialist should be involved in the care of these patients. Coordination of education of the family by the palliative nurse or provider is key because survival is severely reduced in most patients. The surgery for pancreatic cancer is complex and technically demanding. Even those who undergo successful resection may develop serious life-threatening complications which may alter the quality of life.
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Can You Prevent Pancreatic Cancer
Researchers are working to develop reliable detection tests that can catch pancreatic cancer at its earliest stages, when it is most treatable. The hope is to identify indicators of the disease also known as biomarkers that would be detectable through a blood test or analysis of another substance in the body.
Until these tests become available, people who are at high risk because of mutations passed down through families, say, or rare genetic illnesses may be able to take part in investigative screening programs that use a variety of imaging methods, such as endoscopic ultrasound and CT scans.
But while risk factors like family history cant be changed, there are a number of things that anyone can do to minimize their chances of developing pancreatic cancer:
What Are The Known Risk Factors For Pancreatic Cancer
There is good evidence that age, smoking, being overweight or obese, a family history of pancreatic cancer, pancreatitis, and diabetes may increase your risk of pancreatic cancer.
Some evidence has suggested that the following may also increase your risk:
We need more research to show whether these definitely do increase your risk.
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Family History And Genetic Predisposition Syndromes
For some people, pancreatic cancer is hereditary. In fact, up to 10 percent of all pancreatic cancers may result from genetic mutations passed from parent to child, according to . Patients with a family history fall into two big categories: defined syndromes that lead to an increased risk of pancreatic cancer, or familial pancreatic cancer for which no specific molecular cause has yet been identified. But the vast majority of pancreatic cancers are not a result of family genetics but other causes.
A few genetic syndromes that may cause pancreatic cancer include:
- Familial atypical multiple mole melanoma syndrome
- Familial pancreatitis
- Peutz-Jeghers syndrome
What Treatments Exist For Pancreatic Cancer
Pancreatic cancer treatment depends on the stage of the disease and the patients general health. Patients may get standard treatments or take part in clinical trials.
Standard treatments are surgery, chemotherapy and radiation. Clinical trials study new treatments. The Pancreatic Cancer Action Network strongly recommends clinical trials at diagnosis and during every treatment decision.
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Five Major Causes Of Pancreatic Cancer You Must Know
Among all the cancers known to medical science, pancreatic cancer is quite hard to detect during its early stages. It remains the fourth major cause of cancer-related deaths in the United States. Just under 50,000 people die every year because of this deadly disease.
Some common symptoms include chronic stomach pain, jaundice, and unexplained weight loss. While these could be normal symptoms that indicate other simpler conditions, itâs better to be proactive, which could help you with the early detection of deadly cancers.
Cancer Induced By Drugs
Since 2019, medical experts and law officers have been linking ranitidine users and cancer of the pancreas. In fact, pancreatic cancer is just one of few other cancers that have been linked to ranitidine sold under the brand name Zantac by pharmaceutical giant GlaxoSmithKline. Today, the British drug manufacturer faces numerous class-action lawsuits that have now been consolidated into one representative case scheduled to be heard later this year in Miami, Florida.
A random test found Zantac contained large traces of a known carcinogen called NDMA thatâs been linked to several cancers. So if you are a regular Zantac user and are experiencing some of the previously mentioned symptoms, we recommend you get a thorough medical checkup.
Other Common Causes Of Pancreatic Cancer
Pancreatic Cysts
Genetics
Diabetic Patient Risks
To Summarize
What Resources Are Available For People With Pancreatic Cancer
You might find the following organizations to be helpful:
- Visit our Butts & Guts Podcasts page to learn more about digestive conditions and treatment options from Cleveland Clinic experts.
A note from Cleveland Clinic
A pancreatic cancer diagnosis can be shocking and life-changing. You might consider joining a support group for people with pancreatic cancer. Spending time with others who are going through the same things can be empowering and beneficial for your mental and emotional health. You can also talk with a counselor, therapist or social worker about how youre feeling. Knowledge is power, and there are several helpful resources available for you and your family.
Last reviewed by a Cleveland Clinic medical professional on 09/07/2021.
References
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What Is The Pancreas
The pancreas is a small, hockey stick-shaped gland located behind the stomach. The main jobs of the pancreas are to aid in food digestion and regulate blood sugar levels in the body. The pancreas is involved in maintaining blood sugar levels because it makes insulin and glucagon, two hormones that control blood sugar levels.
Postoperative And Rehabilitation Care
For patients with metastatic, stage IV, pancreatic cancer, discussions with the patient regarding treatment are essential. One can receive chemotherapy. However, the life prolongation will be at best months, yet affected the toxicity and effects of the chemotherapy. It is important to keep nutrition on the forefront of the patient’s care as nutrition can affect wound healing.
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How Is Pancreatic Cancer Diagnosed
The doctor first asks about the persons medical history and family history. Then, they look for signs and symptoms of the disease. They might order the tests listed below if they suspect cancer. However, the diagnosis will be confirmed with laboratory examination of a sample of tissue from the tumor taken during a biopsy, fine needle aspiration, or surgery.
Blood tests: Levels of bilirubin will be checked. Levels of carbohydrate antigen 19-9 , a tumor marker, may be increased in blood if pancreatic cancer is present.
Imaging tests: Imaging tests help doctors find out the location and size of cancer and whether there is metastasis . These include:
- Computed tomography scan
- Positron emission tomography scan or PET-CT scan
Other tests include:
- Fine needle aspiration cytology
- Core needle biopsy
- Molecular testing of the tumor
- Germline testing
Who Dies From This Cancer
Because survival is poor, the population distribution of people who die of pancreatic cancer is similar to that of people who are diagnosed with the disease. In part because it is difficult to detect early, the average survival time from pancreatic cancer is low. Pancreatic cancer is the third leading cause of cancer death in the United States. The death rate was 11.1 per 100,000 men and women per year based on 20162020 deaths, age-adjusted.
Death Rate per 100,000 Persons by Race/Ethnicity & Sex: Pancreatic Cancer
Males
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