Pancreatic Cancer (cont.)
Francis W. Nugent, MD
Dr. F.W. Nugent is a medical oncologist specializing in gastrointestinal cancers with a special interest in pancreatic cancer. Dr. Nugent graduated from Middlebury College with a bachelors degree in religion before graduating from Albany Medical College. He presently serves as vice-chairman of medical oncology at the Lahey Clinic in Burlington, Massachusetts.
Keith E. Stuart, MD
Dr. Keith E. Stuart is a medical oncologist specializing in the study and treatment of cancers involving the gastrointestinal tract, with a special interest in tumors involving the liver. He was educated at Harvard University (graduating magna cum laude) and Albert Einstein College of Medicine and did his medical training at the New England Deaconess Hospital.
Charles Patrick Davis, MD, PhD
Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
In this Article
- Pancreatic cancer facts
- What does a pancreas do?
- What is cancer?
- What is pancreatic cancer and its types?
- What are pancreatic cancer causes and risk factors?
- What are pancreatic cancer symptoms and signs?
- How is the diagnosis of pancreatic cancer made?
- How is pancreatic cancer staged?
- What is the treatment for resectable pancreatic cancer?
- What is the treatment for locally advanced unresectable pancreatic cancer?
- What is the treatment for metastatic pancreatic cancer?
- What are the side effects of pancreatic cancer treatment?
- What is the survival rate with pancreatic cancer?
- What research is being done on pancreatic cancer?
- Is complimentary or alternative medicine effective in pancreatic cancer treatment?
- Is it possible to prevent pancreatic cancer?
- Where can people get support when coping with pancreatic cancer?
- Where can people find additional information about pancreatic cancer?
- Pancreatic Cancer Overview
- Pancreatic Cancer Tumors
- Cancer-Fighting Foods
- Find a local Oncologist in your town
What is pancreatic cancer and its types?
Cancers that develop within the pancreas fall into two major categories: (1) cancers of the endocrine pancreas (the part that makes insulin and other hormones) are called "islet cell" or "pancreatic neuroendocrine" cancers and (2) cancers of the exocrine pancreas (the part that makes enzymes). Islet cell cancers are rare and typically grow slowly compared to exocrine pancreatic cancers. Islet cell tumors often release hormones into the bloodstream and are further characterized by the hormones they produce (insulin, glucagon, gastrin, and other hormones). Cancers of the exocrine pancreas develop from the cells that line the system of ducts that deliver enzymes to the small intestine and are commonly referred to as pancreatic adenocarcinomas. Adenocarcinoma of the pancreas comprises most of all pancreatic ductal cancers and is the main subject of this review.
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Cells that line the ducts in the exocrine pancreas divide more rapidly than the tissues that surround them. For reasons that we do not understand, these cells can make a mistake when they copy their DNA as they are reproducing to replace other cells. In this manner, an abnormal cell can be made. When an abnormal ductal cell begins to divide in an unregulated way, a growth can form that is made up of abnormal looking and functioning cells. The abnormal changes that can be recognized under the microscope are called "dysplasia." Often, dysplastic cells can undergo additional genetic mistakes over time and become even more abnormal. If these dysplastic cells invade through the walls of the duct from which they arise into the surrounding tissue, the dysplasia has become a malignant tumor (cancer).
In a study published in 2016, researchers reported genomic analysis of 456 pancreatic ductal adenocarcinomas. Subsequent expression analysis of these adenocarcinomas allowed them to be defined into four subtypes. These subtypes have not been previously discerned. The subtypes include:
- Squamous: These tumors have enriched TP53 and KDMA mutations.
- Pancreatic progenitor: These tumors express genes involved in pancreatic development such as FOXA2/3, PDX1, and MNX1.
- Aberrantly differentiated endocrine exocrine (ADEX): These tumors display upregulated genes (KRAS) and exocrine (NR5A2 and RBPJL) plus endocrine (NEUROD1 and NKX2-2) differentiation.
- Immunogenic: These tumors contain pathways that are involved in acquired immune supression.
These new findings may allow future patients to be treated more specifically and, hopefully, more effectively. For example, the immunogenic subtype could possibly respond to therapy where the immune system is re-engineered to attack these types of cancer cells.
Pancreatic cancer should not be confused with the term pancreatitis. Pancreatitis is simply defined as inflammation of the pancreas and is mainly caused by alcohol abuse and /or gallstone formation (about 80% to 90%).
What are pancreatic cancer causes and risk factors?
About 48,900 cases of pancreatic cancer occur yearly in the United States. Most people who develop pancreatic cancer do so without any predisposing risk factors. However, perhaps the biggest risk factor is increasing age; being over the age of 60 puts an individual at greater risk. Rarely, there can be familial or hereditary genetic syndromes arising from genetic mutations that run in families and put individuals at higher risk, such as BRCA-2 and, to a lesser extent, BRCA-1 gene mutations. Familial syndromes are unusual, but it is important to let a doctor know if anyone else in the family has been diagnosed with cancer. Additionally, certain behaviors or conditions are thought to slightly increase an individual's risk for developing pancreatic cancer. For example, African-Americans may be at greater risk as may individuals with close family members who have been previously diagnosed with the disease. Other behaviors or conditions that may put people at risk include tobacco use, obesity, a sedentary lifestyle, a history of diabetes, chronic pancreatic inflammation (pancreatitis), and a fatty (or Western) diet. Prior stomach surgery may moderately increase one's risk as can certain chronic infections such as hepatitis B and H. pylori (a bacterial infection of the stomach lining). Certain drugs (sitagliptin [Januvia] and metformin and sitagliptin [Janumet]) have been linked to the development of pancreatic cancer. Some types of pancreatic cysts may put individuals at risk of developing pancreatic cancer. When pancreatic cancer begins, it usually starts in the cells that line the ducts of the pancreas and is termed pancreatic carcinoma or pancreatic exocrine cancer. Despite the associated risks cited above, no identifiable cause is found in most people who develop pancreatic cancer.
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