How to detect pancreatic cancer
Q: My mother recently was diagnosed with diabetes, but due to abdominal pain and other issues, her doctor suspects she might have pancreatic cancer. How is pancreatic cancer diagnosed and what are the symptoms? A:
I am so sorry to hear about your mother’s recent issues. It can be a scary time for everyone when there is uncertainty related to a cancer diagnosis, let alone general health issues.
Although it is not a common form of cancer, pancreatic cancer is considered one of the least survivable cancers. This is because it spreads, or metastasizes, quickly before symptoms appear, often resulting in late detection. About 60,000 people are diagnosed with pancreatic cancer annually in the U.S., with the average age of diagnosis at 70. However, the incidence of diagnosis in younger people is increasing.
As with many other cancers, only a small fraction of pancreatic cancer cases have specific, known heritable genetic causes, but there is an increased risk if other immediate family members have been affected. For most people with pancreatic cancer, there is no obvious predilection, but there are some known risk factors. Smoking is strongly associated with pancreatic cancer risk.
There also is an association between pancreatic cancer and diabetes. Diabetes is more prevalent than pancreatic cancer, and a diabetes diagnosis by itself does not mean someone may have pancreatic cancer. Research indicates that some patients are presenting with a new diagnosis of diabetes one or two years prior to their pancreatic cancer being detected. This also has been noted in patients with preexisting, wellcontrolled diabetes that becomes more difficult to manage without any obvious cause.
Common symptoms of pancreatic cancer include loss of appetite or unintended weight loss; fatigue; abdominal pain that can radiate to the back; and diarrhea, with stools that can be greasy, oily and float in the toilet. As people age, constipation tends to be common, so new diarrhea is usually abnormal in older patients. If a tumor is in the head of the pancreas, patients may have jaundice, marked by yellowing of the skin and eyes, due to blockage of bile from the liver, which may initially show up as darker, cola-colored urine and pale-colored stools. If any of these symptoms are present, patients should see a medical provider.
If there is high suspicion of a pancreatic cancer diagnosis, several investigations need to take place. This starts with basic laboratory tests looking at blood counts and electrolytes, kidney and liver function, nutritional labs, and tumor markers. Concurrently, imaging and diagnostic procedures are performed. The most common include cross-sectional imaging typically performed via a CT scan of the chest and abdomen. If there is a mass in the pancreas identified on the scans, then additional procedures to obtain a biopsy or ease any associated bile duct obstruction are performed with an endoscopic ultrasound.
If a diagnosis of pancreatic cancer is confirmed, then more studies, such as positron emission tomography, or PET, scan, may be useful. Patients are then clinically “staged” according to all results. The simplest staging consists of categorizing the cancer as either metastatic, meaning the tumor has spread, or nonmetastatic, meaning the tumor has not spread. Patients whose cancer is categorized as metastatic are further grouped according to whether the tumor has extended outside of the pancreas to involve critical blood vessels. Staging helps to determine the best course of treatment.
All patients with pancreatic cancer will require chemotherapy. Patients who have a nonmetastatic form of cancer also are candidates for other local treatment options, such as surgery or radiation therapy.