Understanding pancreatic cancer

November 15, 2024

Providence Cancer Team

[5 MIN READ]

November is Pancreatic Cancer Awareness Month, a good time to learn about the signs and symptoms of this disease.
There are two main types of pancreatic tumors — exocrine and neuroendocrine.
The most common treatments for pancreatic cancer are surgery, chemotherapy and radiation therapy. However, surgery is not an option for stage 4 pancreatic cancer.

Understanding pancreatic cancer: Symptoms and treatment

For some types of cancer, such as breast and colon, we are fortunate to have proven screening methods that can detect them in early stages. Pancreatic cancer is different — there are no screening tests, and it often doesn’t produce signs or symptoms early on, which makes early detection difficult.

Still, it’s important to understand the disease and know whether you might be at risk. November is Pancreatic Cancer Awareness Month — let’s take a look at this specific type of cancer and what you can do to avoid it.

What is pancreatic cancer?

Your pancreas is a six-inch long gland that is shaped like a pear on its side. It makes juices that break down food into substances the body can use and hormones, such as insulin and glucagon.

There are two main types of pancreatic cancer — exocrine and neuroendocrine. Exocrine tumors start in the cells that make digestive juices, and neuroendocrine tumors start in the cells that make hormones.

About 93% of pancreatic cancers are exocrine tumors, including the most common type — adenocarcinomas. “An adenocarcinoma is a particularly aggressive form of cancer,” says Juan Mejia, M.D., a Providence pancreatic surgeon who practices in Spokane, Washington. “Some patients read about pancreatic cancer online and assume that they have this type. But some people instead have a neuroendocrine tumor, which can be a better-behaved form of pancreatic cancer.”

Neuroendocrine tumors are also called islet cell tumors and the majority of them grow much more slowly than exocrine tumors. Pancreatic neuroendocrine tumors are classified by the types of hormones they make.

Risk factors and causes

The main pancreatic cancer risk factors are smoking, drinking, obesity, diabetes and a family history of this type of cancer.

However, says Dr. Mejia, “It’s not a cancer where the connection with the risk factors is strong enough that there are population-based screening guidelines,” he says. “For example, if you smoke, you meet criteria for lung cancer screening because you are at an increased risk for lung cancer. But the only patients we screen for pancreatic cancer are those with a genetic predisposition.”

While smoking is considered to be a major risk factor for pancreatic cancer, that’s not unusual, says Dr. Mejia. “If you look up the risk factors for a wide range of cancers, smoking probably comes up often on that list,” he says.

“I also see a lot of patients who don’t have any of those risk factors,” Dr. Mejia adds.

Symptoms of pancreatic cancer

In its early stages, pancreatic cancer often does not cause any signs or symptoms. “At times, we can find this type of cancer incidentally,” says Dr. Mejia. “For example, if a patient is undergoing an imaging test for a symptom that is unrelated to pancreatic cancer, it’s possible that their doctor would be able to spot a tumor.”

As a pancreatic cancer grows, some of its main symptoms can include:

Jaundice (a condition in which your skin and the white of your eyes turn yellow)
Dark urine
Unexplained weight loss
Fatigue
Pain in the upper abdomen or the middle of the back

One of the reasons why pancreatic cancer is so hard to detect is because most of these symptoms could point to many other conditions. “If the symptoms are not severe and you’re going to your primary care doctor, 95% of the time when they hear those symptoms, it’s not cancer,” says Dr. Mejia. “It’s something else, like heartburn. Many times, by the time patients see me, it’s been three or four months since their symptoms first started.”

Treatment options

The main three pancreatic cancer treatments are surgery, chemotherapy and radiation therapy. “Based on the stage of cancer you have, we determine which one of those treatments are options, and what order we should perform them,” says Dr. Mejia.

For patients who have stage 1 pancreatic cancer, the usual treatment is to administer chemotherapy first, and then to perform surgery to remove the tumor. “We can perform surgery for stages 1 through 3, as long as the tumor is determined to be easily removed by the surgeon,” says Dr. Mejia. “We cannot do surgery for stage 4, because by that time, the cancer has spread to other organs and parts of the body. Although chemotherapy and radiation can help, they are not curative. Surgery is the one treatment that would give the patient an opportunity for complete recovery.”

If your doctor isn’t able to remove your cancer via surgery, they may instead opt for palliative therapy — treatments that can improve your quality of life by reducing your symptoms. Examples of palliative therapy include:

Radiation therapy to relieve pain by shrinking the tumor
An injection of medicine to relieve pain
Endoscopic stent placement to help drain bile

Although it can be difficult to treat pancreatic cancer, it’s still important to understand the signs and symptoms so you can seek treatment as early as possible.

Contributing caregivers

Juan Mejia, M.D., is a Providence pancreatic surgeon who practices in Spokane, Washington.

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