With a five-year survival rate of just seven percent, pancreatic cancer is one of the deadliest forms of cancer. According to the American Cancer Society, approximately 55,440 people will be diagnosed with pancreatic cancer in the U.S. in 2018; that same year, it is estimated that approximately 44,330 people will perish from the disease. Although pancreatic cancer only accounts for around three percent of cancers in the U.S., it is responsible for around seven percent of cancer-related deaths.

One reason that pancreatic cancer tends to be so deadly is because it often isn’t detected until it has already spread to other parts of the body. Unfortunately, symptoms don’t tend to appear until the cancer has gotten to this point and treating advanced cases of the disease can be very complicated.

What is Pancreatic Cancer?

Cancer is a disease that is characterized by out-of-control cell growth. With pancreatic cancer, cells within that organ start to grow out of control, typically forming a tumor. Located just behind the lower part of the stomach, the pancreas secretes enzymes that aid in digestion and hormones that help to keep blood sugar levels in check.

With pancreatic cancer, cancer may form in the exocrine cells, which form glands that secrete enzymes for digestion, or in the endocrine cells, which form glands that secrete hormones like insulin that help to regulate blood sugar levels. Most forms of pancreatic cancer — approximately 95 percent of cases — are exocrine cancers. This form of pancreatic cancer starts in the ducts of the pancreas. The type that develops in endocrine cells forms what are known as pancreatic neuroendocrine tumors, or NETs.

Because these two forms of pancreatic cancer involve different types of cells, different treatments are typically required.

Signs and Symptoms

Signs and symptoms of pancreatic cancer don’t usually appear until the disease has already spread beyond the pancreas, so it is crucial to seek medical attention at the first sign of a problem:

1. jaundice
2. itchy skin
3. dark urine
4. greasy and/or light-colored stools
5. enlarged gallbladder and/or liver
6. poor appetite and weight loss
7. back and belly pain
8. nausea and vomiting
9. blood clots, including deep vein thrombosis, or DVT

Although endocrine pancreatic cancer is rare, one possible sign of it is developing Type II diabetes because the endocrine cells are directly responsible for the regulation of blood-sugar levels in the body. Pancreatic cancer can impede its ability to do so, which may lead to Type II diabetes.

Causes and Risk Factors

Medical researchers are not certain about what causes pancreatic cancer. However, it does appear that certain factors may increase your risk of developing the disease. Some of these factors may be beyond your control, including:

1. Gender: Men are more likely than women to develop pancreatic cancer.
2. Age: The average age at which someone is diagnosed with pancreatic cancer is 71.
3. Race: African-Americans appear to be more likely to develop pancreatic cancer.
4. Family History: If people in your family have had pancreatic cancer, you are more likely to as well.
5. Inherited Genetic Syndromes: It is estimated that around 10 percent of all cases of pancreatic cancer stem from inherited genetic syndromes.
6. Cirrhosis of the Liver: People who have cirrhosis of the liver are likelier to develop pancreatic cancer.
7. Diabetes: People who suffer from diabetes — especially Type II — may be at increased risk of developing pancreatic cancer.

Factors that you can control and that may increase your risk of pancreatic cancer include:

1. Being overweight or obese
2. Using tobacco
3. Working in an environment where you are exposed to chemicals, such as metal working or dry cleaning

Treatment Options

There are several treatment options for pancreatic cancer, and most patients undergo a combination of them.

Surgery

Surgery for pancreatic cancer may be informational, such as a laparoscopic surgery to determine the extent of the cancer. In cases where the cancer is beyond treatment, it may be done palliatively, which means that it is done to provide relief from the worst symptoms. Potentially curative surgery may be performed but only if doctors believe that all the cancer can be removed. In that case, the Whipple procedure, which involves removing the head and sometimes the body of the pancreas, is most commonly performed.

Radiation

High-energy x-rays may be used to shrink and kill cancerous cells. Radiation is sometimes used for some types of endocrine pancreatic cancer. It is typically performed in conjunction with chemotherapy, and it may be performed prior to surgery to shrink growths for easier removal. It may also be used in cases where the cancer has been deemed to be locally advanced and unresectable. External beam radiation is the most common type that is used.

Chemotherapy

Different types of chemotherapy may be prescribed depending on whether you have exocrine pancreatic cancer or NETs. Chemotherapy is often used in conjunction with radiation prior to surgery, which is known as neoadjuvant chemotherapy, to shrink cancerous growths. Adjuvant chemotherapy may be performed with radiation after surgery. A variety of chemotherapy drugs may be used to treat exocrine pancreatic cancers. Some of the most common ones that are used today include gemcitabine, xeloda, eloxatin, and taxol.

Ablation and Embolization

For pancreatic cancer tumors that have spread to other organs — especially to the liver — ablation and embolization treatments may be performed to destroy the tumor. These treatments aren’t necessarily performed to remove or cure the cancer so much as to help to prevent advanced symptoms and to relieve existing ones. The nature of the growth and other factors may determine the precise method that is used.

With ablation, extreme heat or cold is used to destroy cancerous tumors. Embolization, which involves injecting chemicals into arteries to block blood flow to cancerous cells and tumors, may also be used for similar reasons.

Targeted Therapies

As with many other types of cancer, targeted therapies are occasionally used to treat pancreatic cancer. This refers to targeting specific signifiers with drugs that help to impede or slow down growth. Many types of targeted therapies have been explored for pancreatic cancer.

These days, the most common example is a drug called erlotinib. This drug targets the EGFR protein, which is found on pancreatic cancer cells. This protein normally promotes cellular growth. When targeted by this drug, however, growth may be impeded or stopped, and this can help to provide relief.

Prognosis

Ongoing research and clinical trials are continually bringing potential new treatments for pancreatic cancer to the table. For patients who suffer from NETs, there is promise in research that is being performed concerning targeted therapies that use somatostatin analogs. When injected under the skin about once per month, a somatostatin analog called lanreotide may help to slow the growth of NETs.

Patients who undergo the Whipple procedure, which is the most common type of surgery for treating pancreatic cancer, may face shorter recovery times in the future. Researchers have been experimenting with laparoscopic versions of the procedure that require a lot less downtime for patients.

Finally, clinical trials in France have shown strong results for a new four-drug chemotherapy cocktail that is tailored for pancreatic cancer. The treatment appears to add up to two years to the survival rate for the disease, which is very promising indeed.