Pancreatic Cancer: Risk Factors, Symptoms and Early Diagnoses

This is the second blog from Let’s Win Pancreatic Cancer. To learn about the free resources and support they provide to patients and providers within the pancreatic cancer community, read the first one here.

Approximately 64,000 patients will be diagnosed with pancreatic cancer this year. According to the National Cancer Institute, the annual rate of new cases of pancreatic cancer was 13.3 per 100,000 individuals from 2016 to 2020. The rate is higher for Black Americans (16.2%). The survival rate for pancreatic cancer is just above 12%, making it one of the deadliest cancers of our time.

What makes pancreatic cancer so lethal? The answer is complex. For starters, there is currently no standard of care screening for the disease. Additionally, the most common symptoms—back or abdominal pain and digestive issues—are common in many less serious conditions. The location of the pancreas within the body also makes it difficult to detect tumors during a physical examination. As a result, pancreatic cancer is often diagnosed at an advanced stage, when it is much harder to treat. Lastly, the stroma, a dense outer layer which surrounds the tumor, makes it resistant to treatment. All of this begs the question, how can we identify and diagnose this dangerous disease sooner?

The wealth of information available on the Let’s Win platform can help educate patients and their healthcare providers about the risk factors and symptoms of pancreatic cancer, thereby increasing the chances of earlier diagnosis and better treatment options. If more people are aware of these critical facts, the outcome for patients with pancreatic cancer could improve.

Pancreatic Cancer Risk Factors

Understanding the risk factors associated with pancreatic cancer enables patients and their doctors to act quickly when symptoms arise. These risk factors are broken into three groups: lifestyle, family history/genetic mutations, and diseases.

Lifestyle

The lifestyle factors include:

• Smoking: The risk for pancreatic cancer is twice as likely in smokers as it is in nonsmokers.
• Obesity: Individuals with a BMI >30 are 20% more likely to get pancreatic cancer. Reducing the occurrence of obesity and keeping any related diabetes symptoms in check can reduce an individual’s risk for pancreatic cancer.
• Heavy alcohol consumption: Studies indicate that heavy alcohol consumption can lead to various cancers, including pancreatic cancer.
• Aging: Two-thirds of pancreatic cancer patients are over the age of 65. However, aging is a factor beyond our control.
  

Family History/Genetic Mutations

Family history is an important risk factor. Approximately 10% of pancreatic cancer cases are hereditary, where the patient has a direct relation—a parent, sibling, or child—that has had the disease. About 7% of patients with a family history have a known genetic mutation that increases their risk. The best-known mutations are BRCA1, BRCA2, and PALB2, but there are also other mutations that increase an individual’s risk of pancreatic cancer. Even though genetic mutations and family history are risk factors that cannot be prevented, their effects can be reduced through genetic testing, and understanding one’s family history. Identifying genetic mutations can influence treatment choices while genetic testing is now standard of care for all pancreatic cancer diagnoses.

Diseases

Diseases that are common risk factors for pancreatic cancer include:

• Pancreatitis: Inflammation of the pancreas, particularly chronic pancreatitis, is related to pancreatic cancer. In some cases, hereditary factors can contribute to chronic pancreatitis.
• Pancreatic cysts: These are very common and in most cases, are not cancerous. But two types—intraductal papillary mucinous neoplasms (IPMNs) and mucinous cystic pancreatic neoplasms (MCPNs)—tend to develop into cancer over time.
• Diabetes: This is the most notable disease risk factor for pancreatic cancer. Nearly 1 in 4 people diagnosed with pancreatic cancer have diabetes. More importantly, new-onset diabetes may be a symptom of pancreatic cancer; particularly in patients over 50 years of age and when associated with weight loss rather than the typical weight gain, in individuals with diabetes. Researchers believe that as the tumor takes over the pancreas, it leads to an ineffective production of insulin and insulin resistance, which results in diabetes. People who are newly diagnosed with diabetes may want to discuss this relationship with their doctors and arrange for further testing.

Symptoms of Pancreatic Cancer

Much of the difficulty in diagnosing pancreatic cancer comes from the lack of telltale signs for the disease. The most common symptoms of pancreatic cancer are also symptoms of many other less lethal gastrointestinal (GI) or muscular conditions. They include:

• Back and abdominal pain 
• GI problems, including indigestion, reflux, bloating, nausea, and loss of appetite
• Jaundice
• Dark urine and pale stools
• Itchy skin

The location of the tumor impacts the symptoms a patient experiences. A tumor that presses on the stomach can cause nausea and loss of appetite, while a tumor wrapped around the celiac nerves causes abdominal pain or back pain. A tumor blocking the bile duct causes jaundice, itchy skin, and discolored urine and stool. This further complicates the diagnosis process because jaundice can occur as the final symptom in a patient with stage IV pancreatic cancer; or it could be one the first symptoms. Other, less-common symptoms include:

• Fatigue
• Loss of appetite
• Taste aversions (eg: a sudden dislike of coffee, smoking, or wine)
• Blood clots
• Fatty deposits under the skin
• Acute pancreatitis attacks
• Depression

How Oncologists Can Facilitate Earlier Diagnoses

By the time a patient sees an oncologist, he or she has already been diagnosed with pancreatic cancer—and it can be devastating. However, sharing information about risk factors and symptoms of pancreatic cancer is one way we can all play a part in earlier diagnoses, particularly for people with a family history of the disease. Let’s Win consolidates a wide spectrum of information, resources, and support for those at risk of developing the disease, those who have already been diagnosed, and those who are supporting and treating them.

More than anything else, it is important for providers and patients to advocate for each other and themselves when something doesn’t seem right. Early detection can lead to a better outcome, which can make all the difference in the world.