By: Lauren McRae

In the United States, approximately 56,000 patients will be diagnosed with pancreatic cancer over the next year. It is the fourth leading cause of cancer-related death in the United States for both men and women.

Everyone knows someone or has been affected by cancer in some way. When Jeopardy! fans found out their favorite game show host, Alex Trebek, was diagnosed with stage 4 pancreatic cancer in March, awareness for this disease went sky high. 

Unfortunately, there is no early screening tests for the disease, so it’s imperative that anyone who experiences persistent symptoms like pain in the upper abdomen, unexplained weight loss, fatigue, jaundice or a new onset of diabetes take notice. 

Learn about the signs and symptoms, risk factors, detection and more offered by Matthew Adess, MD, Gastrointestinal Cancer, Hematology.

What are the initial signs and symptoms?
The most common symptoms associated with pancreatic are pain typically in the abdomen and back, yellowing of the eyes and skin, and unexplained weight loss. Some symptoms seen less frequently are dark urine, light stools, nausea, and vomiting. Many times, people have nonspecific symptoms felt to be related to other health issues. This can make it difficult to diagnose and may lead to a delay in the diagnosis.

What are some of the causes or who is at greater risk?
There are several environmental risk factors that have been associated with an increased risk of pancreatic cancer. Cigarette smoking has been demonstrated to increase the risk. Smoking accounts for approximately 25% of all cases. There is data to suggest that heavy alcohol use increases the risk. It has also been suggested that increased weight and a lack of exercise increases one's risk for pancreatic cancer.

There is a proven hereditary component to pancreatic cancer in some families. An estimated 10-15% of pancreatic cancers are connected to genetic causes. Approximately 5-10% of individuals with pancreatic cancer have a family history of the disease. The major genetic changes causing most hereditary pancreatic cancers are not known yet. There are several genetic changes we can test for at this time. We do know that individuals with relatives with pancreatic cancer have a higher risk for diagnosis. If there is any family history, we refer our patients to our Medical Genetics group for further evaluation. This helps the patient and their family better understand their risk.

How is it detected?
The diagnosis of pancreatic cancer cannot be made based on symptoms alone. A CT scan is the preferred initial test if pancreatic cancer is suspected.  This allows the doctor to confirm the presence of a mass and to see if it is localized to the pancreas. Further testing may be necessary once a mass is seen specifically to evaluate if pancreatic cancer can be removed surgically. This can either be done by a more specific CT scan or MRI.

Why is it so difficult to diagnose in the early stages?
At this time, surgery is the only potentially curative treatment for pancreatic cancer. Unfortunately, only 15-10% of patients are candidates for surgery at the time of diagnosis. Most people do not have symptoms until pancreatic cancer has progressed to a point where they will not benefit from surgery. At this time, there is no screening test available to identify those at risk or those with early cancer. This is a current major focus of research as early detection would lead to many more successful outcomes for patients. 

How aggressive is it in terms of spreading to other sites in the body?
Pancreatic cancer frequently does spread to other areas of the body. Pancreatic cancer is felt to be aggressive, and most patients present with relatively advanced disease. We frequently see pancreatic cancer spreading to the liver, tissue in the abdomen, and lungs.

What is the typical progression?
The progression depends on when the pancreatic cancer is discovered. If someone has a tumor that can be removed surgically, they will have several months of chemotherapy in addition to the surgery. With surgery, the hope is that treatment is curative. Currently, this occurs in approximately 25-30% of people undergoing surgery. If the tumor cannot be removed surgically or it has spread to other areas of the body, we treat people with chemotherapy.

The goal of chemotherapy is for people to live with the best quality of their life, and to live as long as they can with the disease. Unfortunately, chemotherapy will not get rid of cancer.  As pancreatic cancer progresses, we do expect to see symptoms such as fatigue, weight loss, and potentially pain. We involve our Palliative Care team at NorthShore to help manage these symptoms effectively.

What does typical testing look like?
Once someone is diagnosed, the single most important issue is if the tumor can be removed surgically. This can be answered with either a CT scan or an MRI. If there is any question if pancreatic cancer has spread outside of the pancreas, then a PET scan may be helpful. It is important to confirm the diagnosis with a biopsy.

If the disease is limited to the pancreas this can be done with a gastroenterologist. They perform an upper endoscopy with endoscopic ultrasound. They are able to take a biopsy during the procedure. If there is disease outside of the pancreas, then our Interventional radiology team can biopsy different areas including the liver and tissue in the abdomen.

At the time of diagnosis, we also like to monitor blood work. There is a protein marker CA 19-9 that we can check through blood work. If it is elevated, it can help potentially follow how people respond to our treatment.

What is the typical treatment?
When pancreatic cancer can be removed surgically, we treat with six months of chemotherapy. This can be given either before or after the surgery depending on the situation. If the cancer is advanced, then we treat with chemotherapy.

Patients with advanced pancreatic cancer should have their tumor genetically sequenced. This helps us understand all treatment options and possible clinical trials that they may benefit from. Genetic sequencing of tumors is done at NorthShore.

Is there anything else people should know about this cancer and how to be diligent about their own health?

I think the most important thing to remember is that we are definitely making progress. People are living longer as a result of advances in our treatment. There are people who we can now take to surgery, who we previously thought were not surgical candidates. Despite these advances, pancreatic cancer remains a very difficult cancer to treat. We have a long way to go, but we remain cautiously optimistic given the advances we have seen over the last decade.