An expert breakdown of pancreatic cancer
This article was updated on November 24, 2020 to reflect recent research.
November is National Pancreatic Cancer Awareness Month.
- Pancreatic adenocarcinoma and islet cell cancer are the most common types of pancreatic cancer.
- The future outlook for pancreatic cancer treatment is positive.
- Researchers at Providence are actively seeking better ways to offer immunotherapy.
[3 MIN READ]
November is National Pancreatic Cancer Awareness Month, and we sat down with Paul Hanson, M.D to get some expert insights on the pancreas, cancers that develop in this vital organ, and his perspective of the future of treatment for people with pancreatic cancer.
What is the pancreas, and what is the most common type of pancreatic cancer?
The pancreas is a 6-inch-long gland that sits between the stomach and the spine. About 98 percent of the pancreas is made up of glands and ducts that make enzymes to help digest food. Most of the time, when people talk about pancreatic cancer, they are referring to cancers that develop in this glandular tissue. This type of cancer is called pancreatic adenocarcinoma (“adeno” refers to glands, and “carcinoma” is another word for cancer). It’s by far the most common type of pancreatic cancer.
The first symptoms of adenocarcinoma often are abdominal pain and weight loss. Other early symptoms can include jaundice (yellowing of the skin and eyes) with itchiness and clay-colored stool.
The first symptoms of adenocarcinoma often are abdominal pain and weight loss. Other early symptoms can include jaundice (yellowing of the skin and eyes) with itchiness and clay-colored stool.
Because these cancers grow quickly and usually are not found until a very late stage, the average survival after diagnosis is only about a year.
What about other types of pancreatic cancers?
The other 2% of the pancreas is made up of neuroendocrine cells, which are cells that release insulin and other hormones (“endocrine” relates to hormones). Another name for neuroendocrine cells is islet cells, because they cluster together like small islands throughout the pancreas.
About 7% to 8% of all pancreatic cancers form in the neuroendocrine or islet cells. These cancers go by two different names—islet cell cancer and pancreatic neuroendocrine tumors (NETs). Neuroendocrine cells make a variety of hormones that are vital to the body’s function including insulin and glucagon that control blood sugar and gastrin that helps manage the digestive system.
Compared to the more common type of pancreatic cancer that develops in the glandular tissue of the pancreas, these cancers:
- Grow slowly
- Have a better prognosis (most people survive for three to eight years after their diagnosis)
- Can be cured more often
Patrick Swayze and Michael Landon had adenocarcinomas – the glandular type of pancreatic cancer. Steve Jobs also had pancreatic cancer, but his was an islet cell cancer, or NET.
The most common symptoms of islet cell cancers or NETs are abdominal pain and weight loss. As with many cancers, however, symptoms of these cancers usually aren’t noticeable until the cancer is quite advanced. When these cancers are found in earlier stages, it’s often because they are discovered accidentally when a person is having an imaging scan for a different issue.
Other types of cancers develop in the pancreas, but they are much rarer.
What’s the future of pancreatic cancer treatment?
For a long time, the news for people with pancreatic cancers hasn’t been great. But we’re starting to get the sense that things are finally changing. With new advances on the horizon, we have reason to be positive about the future outlook for pancreatic cancer treatment.
With new advances on the horizon, we have reason to be positive about the future outlook for pancreatic cancer treatment.
I often compare where we are with pancreatic cancer treatment today to testicular cancer in the 1970s. If you were diagnosed with testicular cancer 50 years ago, the chance that you would die from that cancer in the next five years was about 97%. There just weren’t many curative treatments. But today, if you’re diagnosed with testicular cancer, the chance that you’ll die from it is only about 3%. The numbers have completely reversed – we’re starting to win that war to a large degree.
With testicular cancer, it wasn’t any single breakthrough that changed things overnight, but a series of incremental steps and refinements that pushed us up that ladder to be able to diagnose and cure it much more successfully. Pancreatic cancer is more challenging in many ways, but we’re starting to climb that ladder. We’re finally starting to make small changes that are showing glimmers of progress. We haven’t seen any big breakthroughs yet, but my guess is that they’ll be coming in the next five, 10 or 15 years – and Providence will be involved.
What is Providence doing to advance pancreatic cancer care?
Providence Cancer Institute has an aggressive medical and surgical program for pancreatic cancer. A third of all pancreatic cancer patients in Oregon come to Providence for their treatment, because we offer the expertise that can’t be found anywhere else in the state. For example, we’re the only center in Oregon that performs minimally invasive Whipple procedures. These are very complex operations with a high risk of complications, so to be able to offer them in a way that uses smaller incisions and is less traumatic for the patient is a major benefit. We’re able to perform the procedure using minimally invasive techniques in about 25% of our patients.
In addition, Providence is very active locally and nationally in immunotherapy research, which aims at working with a person’s own immune system to fight cancer. So, when patients come to us, they have access not only to the latest standard treatments but also to clinical trials of the newest investigational treatments.
Immunotherapy is based on the understanding that we all develop cancer cells throughout our lives, and our immune system usually identifies those cells and gets rid of them. But occasionally, one gets through the system, and that’s what grows into a cancerous tumor. Our research is aimed at increasing the immune system’s ability to recognize and go after cancer cells.
When we work with patients, a part of our treatment course is to try to find out why their specific cancer cells escaped detection by the immune system, and whether there is a way that we can turn their immune system back on to kill their cancer. We’re already seeing successes with other types of cancers, and phase one clinical trials for pancreatic cancers are underway.
The big breakthroughs may not come tomorrow, but they’re definitely coming.
About the author
Paul Hansen, M.D., is a surgeon and the medical director of surgical oncology for Providence Cancer Institute. In 2009, Dr. Hansen was given the award for “Clinical Excellence” by the Society of the Americas Gastrointestinal and Endoscopic Surgeons (SAGES).
You can find out more about our pancreatic clinical trials here.
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This information is not intended as a substitute for professional medical care. Always follow your healthcare professional’s instructions.