Risk, Diagnosis and Treatment for Pancreatic Cancer

Pancreatic cancer is the fourth leading cause of cancer-related deaths in the United States. Your pancreas is essential to digestion and insulin production. Pancreatic cancer grows and spreads rapidly. One of its major challenges is early detection.

“It affects both men and women equally and is slightly more common in African Americans,” notes Dr. Amudhan Pugalenthi, surgical oncologist for Dignity Health Medical Group Bakersfield. “The peak incidence is about 60 to 70 years of age. Unfortunately, it is estimated to be the number two cancer killer by 2030.”

Pancreatic Cancer Risk

As with many other diseases, there are behavioral risk factors that can be modified. For example, diet and exercise can support your health and reduce cancer risk. Eliminating smoking and cutting out alcohol use are also advisable.

There is also a genetic component to pancreatic cancer risk. Cystic fibrosis, Lynch syndrome and mutations of the BRCA gene associated with breast and ovarian cancer all increase one’s risk for developing pancreatic cancer.

“There are certain pre-malignant conditions we should be aware of like mucinous cysts, which are filled sacs in the pancreas, that can be removed by surgery before they turn into potential cancers,” explains Dr. Pugalenthi.

Diagnosing Pancreatic Cancer

There are two types of cancerous tumors that can develop in the pancreas. Exocrine tumors, also called adenocarcinomas, arise from the duct of the pancreas and affect digestion. Endocrine tumors affect hormones like insulin and are far less common.

“The signs and symptoms depend on the location,” clarifies Dr. Pugalenthi. “Any mass, tumor or even a cyst at the head of the pancreas can block the bile ducts early and can cause jaundice.” For cysts in the body and tail of the pancreas, abdominal pain or weight loss can be nonspecific clues. New onset of diabetes in older adults can indicate potential pancreatic cancer.

Tumors are typically identified by CT scan or MRI, the standard means of evaluating abdominal pain. Pancreatic cysts are often incidentally found during imaging for a different condition. Dr. Pugalenthi reports, “Endoscopies and radiologists can risk stratify them to tell us which one of these need to be removed surgically and which need to be closely monitored by CDL imaging. The IPMN (intraductal papillary mucinous neoplasm) and mucinous neoplasm are at increased risk of developing pancreatic cancer.” Mucinous cysts can be asymptomatic.

Pancreatic Cancer Treatment

Dr. Pugalenthi points out that the wisest option is to surgically remove the cancer along with the lymph nodes for the best chances of recovery. “Other options include chemotherapy and/or radiotherapy, but these tumors can be chemo and radio resistant.” Immunotherapy is also an option for other types of cancers, but only one percent of patients with pancreatic cancer are candidates for this approach. For advanced pancreatic cancer, the focus becomes alleviating the symptoms and providing palliative care treatment for comfort.

With the challenging forecast for most people diagnosed with pancreatic cancer, controlling risk factors where possible is advised. “The most important person is the patient in front of me. It is a unique opportunity for me to change his or her life by making the right decisions, by maintaining a healthy diet, exercise, no smoking and annual health checks by the primary care physician will go a long way to prevent or detect cancers early.”

 **To listen to an interview on this topic with Dr. Amudhan Pugalenthi, surgical oncologist for Dignity Health, visit dignityhealth.org/bakersfield/podcasts.