Pancreatic Cancer

Risk Factors

Most people with pancreatic cancer don't have a clear single cause, but certain factors increase risk:

• Tobacco smoking: Current smokers have 2–3 times higher risk.
• Chronic pancreatitis: Long-standing inflammation of the pancreas.
• Diabetes: Especially if it's recent-onset.
• Family history and genetic mutations: BRCA1, BRCA2, CDKN2A, and Lynch syndrome increase risk.
• Obesity: Body mass index ≥30 increases risk.
• Age: Risk rises significantly after age 65.

How It's Diagnosed

Pancreatic cancer can be hard to catch early because the pancreas is deep in the abdomen and early symptoms are vague. Diagnosis typically involves:

• Imaging (CT, MRI, or endoscopic ultrasound): Shows the tumor and whether it has spread.
• Blood tests: Measure CA 19-9 (a tumor marker) and liver function.
• Biopsy: A small sample of tissue is examined under the microscope to confirm cancer.

Screening is not routinely recommended for average-risk people, but people with strong family histories or genetic mutations may benefit from surveillance with imaging.

Staging and Prognosis

Pancreatic cancer is classified as:

• Resectable (can be surgically removed): Tumor hasn't invaded major blood vessels.
• Borderline resectable: Tumor is touching or partially involving blood vessels.
• Unresectable locally advanced: Tumor is attached to major blood vessels and can't be removed.
• Metastatic: Cancer has spread to distant organs.

Prognosis varies widely. Five-year survival rates are ~10% overall, but this has been improving with new treatments. Earlier stage and resectable tumors have better outcomes. Your oncology team can discuss your individual prognosis.

Treatment Options

Treatment depends on the stage, location, overall health, and whether the tumor can be removed. Options include:

Surgery

• Pancreaticoduodenectomy (Whipple procedure): Removes the head of the pancreas, part of the small intestine, the gallbladder, and part of the bile duct. This is the most common surgery for resectable tumors.
• Distal pancreatectomy: Removes the body and tail of the pancreas.
• Total pancreatectomy: Removes the entire pancreas (less common).

Chemotherapy

• FOLFIRINOX (5-FU, leucovorin, irinotecan, oxaliplatin): Given before and after surgery, or used alone for advanced cancer. Effective but more toxic than other regimens.
• Gemcitabine + nab-paclitaxel (Abraxane): Another option for advanced disease, often with fewer side effects than FOLFIRINOX.
• Single-agent gemcitabine: Used if patients can't tolerate stronger combinations.

Radiation Therapy

Used in combination with chemotherapy for locally advanced cancers or after surgery to reduce recurrence risk.

Targeted Therapy and Immunotherapy

• Immunotherapy drugs (pembrolizumab, nivolumab) are being studied and used in certain cases, especially if tumors have specific genetic changes or high microsatellite instability.
• Targeted drugs like erlotinib may be used if specific mutations are present.

Palliative Care

Focuses on managing pain, managing bile duct blockages (via stents), and addressing other symptoms alongside curative treatment. Palliative care starts early and improves quality of life.

Common Side Effects and Management

• Nausea and vomiting: Anti-nausea medications are standard. Small, frequent meals help.
• Diarrhea: Usually managed with dietary changes and medications.
• Fatigue: Very common. Pacing activities, sleep support, and exercise (if tolerated) help.
• Pain: Aggressive pain management is important; talk openly with your team about pain control.
• Blood clots: Pancreatic cancer increases clotting risk; your doctor may prescribe blood thinners.
• Surgical side effects: After Whipple, some people need digestive enzyme supplements and experience changes in eating.

Always report side effects to your care team. Many can be prevented or managed.