Dr. James Wallis Marsh Jr.

Pancreatic cancer cases are increasing, and the disease recently surpassed breast cancer in the number of cancer-related deaths nationwide. More than 53,000 cases of pancreatic cancer are expected to be diagnosed in the United States this year. In recognition of Pancreatic Cancer Awareness Month, WVU Medicine surgical oncologist James Wallis Marsh Jr., MD, provides you with information about this form of cancer to increase understanding and help you protect yourself and your family.

Pancreatic tumors
The pancreas assists with digestion and produces hormones, such as insulin. The organ is located behind the stomach and near the spine, and because of its location, pancreatic cancer can be difficult to diagnose in the early stages.

The pancreas contains two types of cells – exocrine and endocrine  – where tumors can originate. It’s crucial to know whether the cancer is an exocrine or endocrine pancreatic tumor because the treatment and prognosis differ. A biopsy performed with a scope (endoscopic ultrasound) may be needed to determine the type of tumor.

Types of pancreatic cancer
The most common types of pancreatic cancer are:

  • Adenocarcinoma – This cancer occurs in the exocrine cells of the pancreas and is the most common and aggressive type of pancreatic cancer.
  • Pancreatic neuroendocrine tumors – These tumors start in endocrine cells of the pancreas and generally grow much slower than exocrine tumors. There is usually a much better prognosis than with exocrine adenocarcinomas.

Symptoms
Symptoms of pancreatic cancer depend on the location of the tumor in the pancreas. The various parts of the pancreas are referred to as the head, neck, body, and tail.

  • Head and neck of the pancreas – Signs and symptoms may include jaundice without pain, newly developed diabetes, an unexplained episode of pancreatitis (inflammation in the pancreas), newly diagnosed depression, nausea/vomiting or not being able to eat normal portions of food before feeling a sense of fullness, dark urine, clay-colored stool, or greasy/oily bowel movements.
  • Body and tail of the pancreas – Jaundice is usually not a symptom of a tumor in this location of the pancreas. Symptoms may include upper abdominal and/or back pain, nausea/vomiting, unexplained pancreatitis, greasy/oily bowel movements, or new or worsening diabetes.

Risk factors
Anyone can get pancreatic cancer, but there are some factors that may increase your risk. The following increases your chances of developing tumors of the pancreas:

  • Older age
  • Being male, African American, or Ashkenazi Jewish
  • Tobacco use, including chewing tobacco
  • Heavy alcohol use
  • Poor diet and lack of physical activity
  • Being overweight or obese
  • Type 2 diabetes
  • Chronic pancreatitis or long-term inflammation of the pancreas
  • Family history of the disease

Prevention
Talk with your healthcare provider about your risk factors for pancreatic cancer. Ask what you can do about them. Do not use any form of tobacco. If you do, try to quit. WVU Medicine has smoking cessation resources and support groups to help you quit tobacco. Limit how much alcohol you drink. Reach and keep a healthy weight. Eating a nutritious diet and staying active can help.

Screening for pancreatic cancer in the general population is not recommended by any major medical organization in the United States at this time. If you have a strong family history of pancreatic cancer, talk with your doctor about screening, or ask about genetic counseling and testing to help determine your risk.

Treatment
Pancreatic neuroendocrine tumors are very treatable and associated with a good prognosis in most cases, even when this form of cancer has been caught at late stages. Treatment options where chemotherapy or radiation is delivered directly to the tumor are effective for improving patient outcomes.

Unlike pancreatic neuroendocrine tumors, exocrine adenocarcinoma of the pancreas is more difficult to treat because it’s usually diagnosed at late stages when the cancer is inoperable. In cases where surgery remains an option, complete surgical removal combined with other treatments, such as chemotherapy and possibly radiation, can offer patients a chance for improvement.

New advances in pancreatic cancer treatment include using chemotherapy before surgery (neoadjuvant chemotherapy), which is different than previous approaches where surgery was performed first. Personalized medicine is increasingly being applied to the treatment of pancreatic cancer patients; the biology of a person’s specific tumor is analyzed to identify what treatments may be the most beneficial. Clinical trials continue to play a significant role in advancing treatment options so that patients with pancreas cancer can be treated more effectively than ever before.

Are you concerned about your risk of pancreatic cancer? Make an appointment: 855-WVU-CARE