The Problem with Pancreatic Cancer

Compared to other cancers, the survival rate is quite poor for those suffering from pancreatic cancer

By Deborah Jeanne Sergeant

Despite the steady progress in reducing cancer deaths in recent decades, a few types seem stagnant in their rates.

One of these is pancreatic cancer, the nation’s third deadliest cancer, according to the Pancreatic Cancer Association of Western New York.

Only 8 percent of patients survive for five years after diagnosis. In the past decades, all other cancers’ survival rates have risen at a rate ranging from 49 to 67 percent and, for a few, even 90-plus percent. More than 40,560 died of pancreatic cancer in 2015.

As with most types of cancer, earlier detection can improve outcome; however, “in contrast to colon cancer, screening for pancreatic cancer has no established benefits for the average-risk person,” said Christos Fountzilas, gastrointestinal medical oncologist with Roswell Park Comprehensive Cancer Center.

Instead, providers try to identify high-risk patients. This can include people with two or more first-degree relatives with pancreatic cancer or families with history of breast, ovarian, prostate cancer and melanoma.

“Another high-risk group are people with cysts and other non-cancerous lesions in their pancreas,” Fountzilas said. “Though the majority of the cysts are not cancer and they don’t transform into cancer, there is a type of pancreas precancerous conditions known as intraductal papillary mucinous neoplasms, or IPMNs for short.”

He said that Roswell has established a high-risk pancreas cancer-screening program that includes periodic screening with MRI and endoscopic ultrasound as well as screening for other cancers.

For those with cyst and non-cancerous lesions in the pancreas, providers may remain watchful and use endoscopic ultrasound and MRI as needed.

“Certain conditions such as the development of diabetes can be an early sign of pancreatic cancer, especially if accompanied by weight loss rather than gain,” Fountzilas said. “These patients should be screened by their primary care provider for pancreatic cancer.”

Health care providers offer the only screenings for pancreatic cancer. It’s much different from when breast cancer patients sometimes detect a lump during a home breast exam or during a routine mammogram. Without this kind of early detection, cancer has an opportunity to metastasize to other areas, which is why pancreatic cancer is so often deadly.

“Most who have prostate cancer and breast cancer survive,” said physician Leslie Kohman, board chairwoman of the American Cancer Society for Upstate New York and professor of surgery and director of outreach at Upstate Cancer Center in Syracuse. “Pancreas cancer patients die from it. The differences are great. Early detection improves your chances of surviving cancer.”

That’s why people such as physician Aimee Lucas, an American Cancer Society-funded researcher, studies the effectiveness of pancreatic cancer screening for people who rated as high risk. This includes people with a first-degree relative with pancreatic cancer and cancers associated with germline mutations, such as BRCA1 and BRCA2 genes which predispose to breast and ovarian cancer.

“Compared to other cancers, the survival rate is quite poor,” said Lucas, who is an associate professor of gastroenterology at Icahn School of Medicine at Mount Sinai in New York City. “There’s a lot of work being done on all fronts.”

This includes focusing on high-risk individuals so care providers can know who needs screening, when and how and if earlier screening can improve survival and even, eventually, prevent pancreatic cancer.

Cancer in the pancreas, an organ in the mid-upper posterior, doesn’t offer obvious symptoms.

Weight loss, abdominal pain and changes in urine and feces color could be attributed to any number of causes. Some patients experience jaundice.

“It’s often very difficult to pinpoint,” Lucas said. “There are a lot of groups working on discovering blood markers. CA19-9 is one, but it can be a positive in pancreatic cancer and also positive in several other conditions, including gallstone disease that are not cancer. The other problem is that not all pancreatic cancer express CA19-9. Sometimes the blood level is normal.”

Clinical screening is important since most patients remain asymptomatic until the cancer has become advanced. Lucas said that 80 percent of patients are diagnosed when the tumor cannot be surgically removed. Pancreatic cancer doesn’t respond to chemotherapy and radiation like other cancerous tumors.

“My goal and the focus of my group is to improve earlier detection so we can detect more patients earlier so treatments are more effective,” Lucas said. “Or we could pick up a lesion in the pancreas before the development of pancreatic cancer.”

To lower the risk of pancreatic cancer — and especially for those with family history — Lucas advises avoiding tobacco use, obesity, and heavy alcohol use. Diabetics need to manage their condition according to their care provider’s orders.

People with family history and who smoke may hasten development of pancreatic cancer by 10 years.

“Nutrition can certainly impact the disease,” Lucas said. “A few studies have shown that certain dietary factors such as diets high in red meat and low in fruits and vegetables can be associated with an increased risk of developing pancreatic cancer.”

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