The Mystery of Pancreatic Cancer

By: Dr. Cherif Boutros

In the United States, it is estimated that over 50,000 people are diagnosed with pancreatic cancer annually. Pancreatic cancer is the fourth leading cause of death in men and women. The one year survival rate of people with pancreatic cancer is about 30 percent while the five-year survival rate is under 10 percent. 

The pancreas is an oblong organ that lies deep in the abdomen, and is an integral part of both the digestive and endocrine system. It secretes hormones to regulate the body and also digestive enzymes to break down food.

Pancreatic cancer remains one of the most difficult cancers to diagnose. This is because there are no specific, cost-effective screening tests that can easily detect early stage pancreatic cancer in people who do not have symptoms. Because of this, the cancer is often not found until the later stages when the cancer can no longer be removed with surgery and has spread from the pancreas to other parts of the body.

As people age, the risk of developing pancreatic cancer goes up. Most patients are older than 45, and nearly 90 percent are older than 55. The average age at diagnosis is 71.

Men have a slightly higher likelihood of developing pancreatic cancer than women, which may partly result from increased tobacco use in men. In the past, when men more commonly smoked than women, the gender gap was wider.

There is also a noted association with race: African-Americans are more likely to develop pancreatic cancer than other races. Doctors don't know why, but speculate that higher rates of men smoking and having diabetes, and women being overweight, may contribute to that association.

There are two types of pancreatic cancer: exocrine tumors and endocrine tumors. Exocrine tumors are the majority of pancreatic cancers, and the most common form is called adenocarcinoma, which begin in gland cells, usually in the ducts of the pancreas. These tumors tend to be more aggressive than neuroendocrine tumors, the kind that Apple co-founder Steve Jobs had, but if caught early enough they can be treated effectively with surgery.

Pancreatic neuroendocrine tumors constitute only one percent of all pancreatic cancers. They can be benign or malignant, but the distinction is often unclear and sometimes apparent only when the cancer has spread beyond the pancreas.

Treatment for pancreatic cancer depends on the stage and location of the cancer as well as on your overall health and personal preferences. For most people, the first goal of pancreatic cancer treatment is to eliminate the cancer by removing it through surgery, when possible. Surgery for pancreatic cancer is becoming safer and can be performed for certain patients laparoscopically or through robotic surgery. When that isn't an option, the focus may be on improving your quality of life and preventing the cancer from growing or causing more harm.

Treatment may include surgery, radiation, chemotherapy or a combination of both. When pancreatic cancer is advanced and these treatments aren't likely to offer a benefit, your doctor will offer symptom relief (palliative care) that makes you as comfortable as possible.

Dr. Cherif Boutros is the Chief of Surgical Oncology at UM Baltimore Washington Medical Center and Medical Director of the Tate Cancer Center. He can be reached at 410-553-8146.