Pancreatic Cancer

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Overview

The pancreas is an organ of the digestive system. It is located near the stomach and small intestine and has two major jobs or functions. The exocrine pancreas makes enzymes that help in the digestion of food products, and the endocrine pancreas produces several hormones that have diverse functions. Cancers of the pancreas can occur in the exocrine pancreas (classic pancreatic adenocarcinomas) or in the endocrine pancreas. This section will discuss exocrine pancreatic carcinoma.

Cancers of the exocrine pancreas are a very serious health issue in the United States. According to the American Cancer Society, approximately 38,000 people are diagnosed with pancreatic cancer and about 34,000 people die from the disease each year.

Due to difficulties in diagnosis, the aggressive nature of pancreatic cancer, and the limited systemic treatments available, the five-year survival rate (number of patients who are alive 5 years after diagnosis) for patients who have pancreatic adenocarcinoma is only about 5%.

Pancreatic cancer is the fourth leading cause of cancer-related deaths in the United States. Because many patients diagnosed with pancreatic cancer have a poor prognosis, it is very important that patients are offered the opportunity to participate in clinical trials. Patients who have pancreatic cancer should speak with a physician regarding clinical trials that are available.

Risk Factors

The risk for pancreatic cancer increases with age. The disease is relatively rare in people who are younger than age 40, and most patients are diagnosed after the age of 45. About 90% of patients with the disease are older than 55 years and about 70% are older than age 65. Environmental factors, medical/surgical factors, genetic factors, and occupational exposures also can increase the risk for pancreatic cancer.

Risk factors include the following:

• Age
• Race–Pancreatic cancer is more common in African Americans than in Caucasians.
• Smoking–Smokers develop pancreatic cancer more than twice as often as nonsmokers.
• Diet–Frequency of pancreatic cancer may be associated with high intakes of meat and fat.
• Medical factors–Pancreatic cancer is more common in patients who have a history of cirrhosis (a chronic liver disease), chronic pancreatitis, diabetes, and surgery to the upper digestive tract.
• Environmental factors–Long-term exposure to certain chemicals, such as gasoline and related compounds, as well as certain insecticides, may increase the risk of developing cancer of the pancreas.
• Genetic predisposition–As many as 10% of all cases of pancreatic cancer are related to genetic disorders (e.g., BRCA2 gene mutation, PRSS1 gene mutation, hereditary non-polyposis colorectal cancer [HNPCC; Lynch syndrome], Peutz-Jeghers syndrome).

Signs and Symptoms

The diagnosis of pancreatic cancer is usually delayed because symptoms are nonspecific and are often attributed to another condition. In some cases, patients do not even notice the gradual onset of symptoms.

Jaundice, which causes yellowing of the skin, is present in approximately 50% of patients at the time of diagnosis and may be associated with less-advanced disease. Other symptoms include weight loss, fatigue, discomfort in the abdomen, loss of appetite, and glucose intolerance.

In addition, the patient may experience pain in the abdomen and back. The pancreas may produce too much insulin, causing such symptoms as dizziness, weakness, diarrhea, chills, or muscle spasms.

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