What to Know about Pancreatic Cancer

When you are diagnosed with pancreatic cancer, you will have many questions. What does the diagnosis mean? What are my treatment options? At Catholic Health, our compassionate cancer experts are here to help you navigate the journey. Our Catholic Health Cancer Institutes across Long Island offer personalized care close to home.

What is pancreatic cancer?

Pancreatic cancer accounts for about 3% of all cancers and 7% of cancer deaths in the United States.

The most common type of pancreatic cancer is pancreatic ductal adenocarcinoma (PDA), which accounts for 90% of pancreatic cancer cases.

“PDA is historically associated with a very poor prognosis,” said Gary Gecelter, MD, Catholic Health Chair of Surgery Services. “However, the science of the disease and its treatment is in an exciting (although slowly) evolving transformation.”

He also noted that more patients are being diagnosed with less aggressive tumors that do not have the same poor prognosis as PDA but still fall into the category of pancreatic cancer.

What are the types of pancreatic cancer?

There are two types of pancreatic cancer:

Exocrine pancreatic cancer, which is the most common type, begins in the ducts carrying pancreatic juices.

Endocrine pancreatic (or Islet Cell) cancer starts in the pancreas cells that make hormones. The tumors are often small and have a low risk of leading to death, but they need to be monitored.

“I am seeing many less aggressive cancerous and precancerous conditions in the pancreas that form from cystic lesions that develop in the pancreatic ducts,” said Dr. Gecelter. “These cysts are found incidentally when imaging tests are done for other reasons, such as kidney stones, gallstones, and back pain.”

He explained that precancerous cysts will be monitored, and surgery will be recommended before they develop into full-blown cancers. Unlike kidney and liver cysts, pancreatic cysts tend to evolve into cancers. Monitoring these cysts leads to early detection and treatment and increases the likelihood of survivability.

What are the signs and symptoms of pancreatic cancer?

Pancreatic cancer is difficult to detect at early stages. Symptoms typically emerge when a tumor starts impacting other organs in the digestive system. Pancreatic cancer symptoms may include:

Blood clots
Dark urine
Fatigue
Gas or bloating
Itchy skin
Jaundice (yellowing of skin)
Lack of appetite
Light-colored stool
Middle back pain
Nausea and vomiting
New-onset diabetes
Upper abdominal pain
Weight loss

“Detecting potentially curable pancreatic cancer is related to the location of the tumor in the pancreas,” said Dr. Gecelter. “If a tumor in the pancreas develops close to the bile duct, the first signs are dark urine, pale stools and skin itching caused by bile obstruction. If left undiagnosed, a patient will become jaundiced (yellowing of the skin). Light stools and dark urine precede yellow skin.”

He further noted that as a tumor progresses, especially in the left side of the pancreas, the first symptom is back pain followed by weight loss and weakness.

“An often-overlooked feature of pancreatic cancer is new-onset diabetes or pancreatitis,” said Dr. Gecelter. “These symptoms will prompt your doctor to order a pancreatic CAT scan.”

What are the risk factors for pancreatic cancer?

The majority of pancreatic cancers occur sporadically, with no family history.

“However, as we learn more about the human genome, we see patterns develop in families that identify a predisposition to cancer,” said Dr. Gecelter. “These are detected by genetic counselors who review all new cancer patients' pathology and family history.”

All children of pancreatic cancer patients should be screened for heritable traits. Although the BRCA gene is commonly associated with breast cancer, the genetic mutation is also linked to pancreatic cancer.

In addition, the following conditions have been associated with an increased (although minimal) risk of developing pancreatic cancers:

Smoking
Obesity
Diabetes
Exposure to certain chemicals (pesticides and petrochemicals)
Chronic pancreatitis (inflammation of the pancreas)

How is pancreatic cancer diagnosed?

Your doctor will begin with a thorough examination and review of your medical history.

“One of the most common problems I see is when patients have nonspecific symptoms of fatigue, loss of appetite and then abdominal or back pain that does not go away,” said Dr. Gecelter.

He noted that patients who are diagnosed with advanced pancreatic cancer will often report at the time of diagnosis that the last time they felt well was at least six months prior.

An abdominal CAT scan is the most commonly used imaging test for pancreatic cancer. Following a CAT scan, more specific tests, such as an endoscopic ultrasound performed by a specialized gastroenterologist, can show small tumors that may be biopsied with an endoscope.

Dr. Gecelter noted the following:

A standard ultrasound is not a sensitive enough test to identify a solid pancreatic tumor.
No screening test is accurate enough to identify an early, curable pancreatic cancer. However, specific blood tests are currently being researched to identify early cancers in high-risk family members.
Cancer markers, such as blood tests for CEA and CA 19-9, are only used to monitor treatment response once the diagnosis has been made. They are not to be used for screening as they are non-specific, and many patients with confirmed pancreatic cancer do not have elevated levels.

How is pancreatic cancer treated?

“Today’s approach to treating pancreatic cancer is multidisciplinary,” said Dr. Gecelter.

A multidisciplinary care team will include a gastroenterologist, radiologist, pathologist, surgeon, oncologist and genetic counselor.

Each evaluates the patient individually and creates a tailored treatment plan based on the combination of:

Tumor characteristics
Tumor location
Tumor size
Genetics

“It used to be that the first line of treatment for pancreatic cancer was surgical,” said Dr. Gecelter. “Now, we have learned that this may only sometimes be the best option. In the right circumstances, pre-surgical chemotherapy may improve the patient’s overall survival.”

A patient's preference is an essential part of the treatment plan. It ensures that the patient participates in and makes meaningful decisions about treatments.

“I tell them that the most important decision they can make is to select a team that offers the most cohesive, skilled, up-to-date and compassionate approach to their cancer,” said Dr. Gecelter. “You can find that care at Catholic Health Cancer Institutes."