A history of smoking, diabetes and chronic pancreatitis are risk factors, as is obesity. Further, the risk of pancreatic cancer is higher if there is either a family history of pancreatic cancer or a history of certain genetic syndromes. Screening is not standard, but is considered when a person has a strong family history and/or in certain genetic syndromes.
The symptoms of pancreatic cancer are often vague. They can include abdominal pain, weight loss, appetite loss, fatigue, yellowing of the eyes and skin and new onset diabetes. Since there is no routine screening mechanism to detect pancreatic cancer, it is best to consult with your health care provider if you are exhibiting such symptoms. If the disease is diagnosed at an earlier stage, the better the outcomes for the patient.
Determining the stage and the positioning of pancreatic tumors is critical in constructing the optimal plan. Pancreatic cancers grow in an area of the body where they often sit very closely to critical blood vessels and nerves. Pancreatic cancers also have a tendency to spread (metastasize) at an earlier point in their development. For these reasons, we frequently assess whether patients would be better off receiving chemotherapy early in the treatment course, in effort to both shrink the tumors and prevent spread.
There are three major initial approaches depending upon those factors:
- surgery first
- chemotherapy and/or radiation prior to surgery
- chemotherapy as the main treatment, without surgery
When pancreatic cancers can be entirely removed surgically, this becomes one of the most important parts of treatment. Part or all of the pancreas may need to be removed for the best possible outcome. The Whipple procedure is a complex surgery which is the major approach when the tumor starts in the pancreatic head. This surgery involves removing the head of the pancreas, part of the small intestine, the gallbladder, part of the bile duct, and surrounding lymph nodes. Some tumors that involve the body or tail of the pancreas can be successfully removed via a distal pancreatectomy.
Patrick Boland, MD, is a medical oncologist in the Gastrointestinal Oncology Program at Rutgers Cancer Institute of New Jersey and an assistant professor of medicine at Rutgers Robert Wood Johnson Medical School, whose clinical expertise includes pancreatic cancer. For additional information on pancreatic cancer, visit: https://cinj.org/patient-care/adult/gastrointestinal.