When “Jeopardy!” host Alex Trebek revealed his pancreatic cancer diagnosis in 2019, it caused distress among his fans. That’s because pancreatic cancer is one of the most lethal types of cancer. The disease usually doesn’t cause symptoms early on, so it’s typically discovered only after it has spread. Although pancreatic cancer is the 11th most common type of cancer diagnosed in the United States—occurringfar less often than breast, lung, colon, and prostate cancers, for example—it’s the fourth-leading cause of cancer deaths, according to the National Cancer Institute.
The pancreas is a thin, six-inch-long gland that lies horizontally behind the abdomen. It makes digestive enzymes that help break down food for use as energy by the body. The pancreas also makes the hormones insulin and glucagon, which help regulate blood glucose (sugar) levels. Cancer develops when pancreatic cells mutate, multiply, and spread. About 95 percent of pancreatic cancer occurs in the ducts of the pancreas or the cells that make digestive enzymes.
Although pancreatic cancer runs in some families, most pancreatic cancers occur in people with no family history of the disease. The median age at diagnosis is 70, with most cases occurring between 65 and 74. Pancreatic cancer is associated with certain diseases and conditions such as obesity, chronic pancreatitis (inflammation of the pancreas), cirrhosis (scarring of the liver), and diabetes. The only known strategies for preventing pancreatic cancer are maintaining a healthy weight, not smoking, and avoiding workplace exposure to certain environmental chemicals.
Diagnosing and staging
If you have symptoms that might suggest cancer (see inset below), your doctor will likely ask you about your family history and conduct a physical exam focused primarily on your abdomen. The tests used to diagnose and stage pancreatic cancer are usually done at the same time. Tests can include blood and imaging tests. In some cases, your doctor may recommend a pancreatic biopsy.
Pancreatic Cancer Symptoms
By the time symptoms or signs of pancreatic cancer appear, the disease is likely to have already spread. Here are eight possible symptoms to be aware of, though none are specific to pancreatic cancer.
Staging determines the pancreatic tumor’s size and whether it has spread to nearby lymph nodes or blood vessels or to distant sites, such as other organs like the liver or the lungs. Pancreatic cancer stages range from 0 (the cancer hasn’t spread) to 4 (advanced cancer).
Your treatment plan will depend on the cancer’s stage, as well as other factors such as your age, expected lifespan, and overall health. You should also consider the treatment’s side effects, which can sometimes be harsh, and the likelihood that the treatment will help. Whatever the treatment, cures are rare.
If cancer is limited to the pancreas, surgery might offer a cure if the entire tumor or pancreas can be removed. The most common type of surgery used is called a Whipple procedure, a complex operation that might also include removing parts of structures surrounding the pancreas, such as part of the small intestine, bile ducts, lymph nodes, and gallbladder. Unfortunately, more than four in five pancreatic cancers have spread beyond the pancreas when they’re discovered, and a potentially curative surgery may not be possible. Even with surgery, the cancer recurs in up to 70 percent of patients.
Whether or not potentially curative surgery is attempted, chemotherapy, targeted therapy (drugs that specifically target cancer-cell genes, proteins, or other factors), radiation, immunotherapy (drugs that stimulate your immune system to fight cancer cells), or a combination of these can help improve your chances of a cure or at least prolong your survival time.
Your doctor might also suggest palliative surgery, not as a cure but to relieve symptoms. For example, surgery might repair a blocked bile duct causing severe pain. Sometimes, radiofrequency ablation, which uses electrical energy to destroy cancer cells, or embolization injections, which block blood flow to pancreatic cancer cells, can prevent or relieve pain or treat pancreatic cancer that has spread to other organs.
Choosing the treatment that’s best for you is often not a simple decision. If you’re not sure which treatments to opt for, seeking a second opinion can be helpful. You might also consider participating in a clinical trial that can provide access to experimental treatments unavailable to patients who aren’t part of the trial.
Some types of cancer, such as breast cancer and prostate cancer, have high five-year overall survival rates (90 percent for breast cancer and 98 percent for prostate cancer) in large part because screening can catch them early. But no screening exists for pancreatic cancer, which has an overall five-year survival rate of only 10 percent, according to the American Cancer Society.
Although pancreatic cancer’s prognosis remains discouraging, some modest but positive treatment advances have been made in recent years, including new therapies approved by the FDA.
This article first appeared in the April 2020 issue of UC Berkeley Health After 50.
Also see Acute Pancreatitis: What You Should Know.
Published April 20, 2020