Pancreatic Cancer: Detection, Symptoms and Emerging Therapies

March 13, 2019

Clinical Contributors to this Story

Rosario Ligresti, M.D. contributes to topics such as Cancer Care.

Timeless gameshow host of Jeopardy, Alex Trebek, recently passed away after a battle with pancreatic cancer. For the show’s many fans, you probably have a long list of questions about the disease, as you remember Mr. Trebek and send thoughts and prayers to his family.

We reached out to some experts at Hackensack Meridian Health Cancer Care to get a better understanding of pancreatic cancer, risk factors, symptoms and treatment options.

How early can pancreatic cancer be detected?

Unlike other cancers, early pancreatic cancers often do not cause any signs or symptoms, making it hard to diagnose in the early stages. By the time a patient notices symptoms, the cancer has likely grown large and possibly spread. Early tumors can’t be seen or felt by health care providers during routine exams.

About half of the patients are already in the final stage of the disease when they are diagnosed, says Rosario Ligresti, M.D., FASGE, chief of Gastroenterology and director of the Pancreas Center at the John Theurer Cancer Center at Hackensack University Medical Center,

Screening for pancreatic cancer is a challenge due to the lack of symptoms. A patient may go for routine bloodwork and have results that come back abnormally. A good general practitioner can connect the dots with risk factors, and then would refer the patient to an oncologist, Dr. Ligresti says.

From there, he or she would have a cat scan to diagnose the disease.

About 1.6 percent of Americans will be diagnosed with pancreatic cancer in their lifetimes, the National Cancer Institute reports. More than 55,000 new cases were diagnosed last year, they report.

Pancreatic Cancer: Signs and Risks

Some signs of pancreatic cancer can be jaundice, weight loss, vomiting, back pain, abdominal discomfort, gallbladder or liver enlargement and blood clots.

Patients with diabetes and those who smoke are at a higher risk for developing pancreatic cancer. Other pancreatic cancer risk factors include being between the ages of 70 and 80. In fact, more than 80 percent of pancreatic cancers develop between the ages of 60 and 80 years old. Other risk factors include obesity, poor diet, genetic factors and being African-American or of Ashkenazi Jews descent.

Those who are at risk for the disease due to genetic factors may have regular checkups every six months to try and detect the disease if it develops.

Treating Pancreatic Cancer

Dr. Ligresti said that depending where the cancer is in the pancreas, some surgical candidates are advised to have chemotherapy prior to surgery. Sometimes chemotherapy can address areas of the pancreas that may not be detected by a CAT scan.

“Some patients can progress despite having chemotherapy first,” he adds.

Otherwise, patients who are surgical candidates have surgery and chemotherapy—the gold standard treatment—and sometimes radiation as well.

While surgery and chemotherapy are common treatments for pancreatic cancer, they are not used on Stage IV patients because the cancer has spread to distant sites of the body and is likely in the lymph nodes. Often patients with Stage IV pancreatic cancer seek clinical trial treatments.

Advancements in Pancreatic Cancer Detection and Treatment

The biggest development on the horizon as far as detection is a blood test that could offer earlier detection, but even if that becomes readily available, it won’t be for another 10 to 15 years.

“Targeted treatments are also in the pipeline,” Dr. Ligresti said.

Immunotherapies (a form of biological therapy that uses substances made from living organisms to help your immune system fight cancer) are mostly in trial phases, with very little available on the market to treat pancreatic cancer. More immunotherapy options are already on the market to treat other forms of cancer, though, such as breast cancer, Dr. Ligresti says.

Dr. Ligresti said the institution is working on a number of trials for pancreatic cancer. In 2015, the center was the first in the area to be recognized as a National Pancreas Foundation National Center of Excellence.

John Theurer Cancer Center is one institution out of four in the U.S. working on a multi-national trial. The treatment involves stage III patients with non-metastatic pancreatic cancer to undergo chemotherapy and receive injections of an anti-DNA compound into inoperable tumors. The tumors are shrinking and therefore responding to treatment.

“It’s the first time we’ve actually seen some positive results,” Ligresti says.

The patient population would otherwise receive palliative treatment, so the trial is offering hope to a narrow group of pancreatic cancer patients who cannot have surgery.

“We may just be able to turn that around,” Ligresti adds.

Want to try to prevent pancreatic cancer? Your best bet is to avoid smoking—a top risk factor—and stay on top of your health by having regular checkups, he explains.

“Right now it’s just health awareness, staying on top of any early signs,” he says. “If you are diagnosed with pancreatic cancer, choose your doctor wisely. It really matters where you go.”

Next Steps & Resources:

American Cancer Society
Johns Hopkins Medicine
National Cancer Institute

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