November is National Pancreatic Cancer Awareness Month
November is Pancreatic Cancer Awareness Month, a chance for the pancreatic cancer community to come together to raise vital funds and awareness, remember loved ones who have sadly died of pancreatic cancer, and acknowledge those living with or beyond the disease.
Pancreatic Cancer Awareness Month started in the UK in 2011 and evolved from Pancreatic Cancer Awareness Week and other similar projects from the US. PCAM brings together all the pancreatic cancer charities and groups from around the world into one united, dedicated, and hardworking international team- to transform the future for those affected by pancreatic cancer.
What is Pancreatic Cancer?
Pancreatic cancer begins in the cells of the pancreas – an organ in the abdomen that lies behind the lower part of the stomach. The pancreas has two main functions. It makes enzymes that help with digestion, and it makes hormones, such as insulin, that control how our bodies store and use glucose – sugar that is the body’s main source of energy.
There are two forms of pancreatic cancer: exocrine pancreatic cancer, which accounts for approximately 95 percent of all cases, and endocrine or pancreatic neuroendocrine tumors, also called islet cell tumors.
Smoking, being overweight, having diabetes, chronic pancreatitis, and certain hereditary conditions are risk factors for pancreatic cancer.
The National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program estimated that there will be an estimated 60,430 people diagnosed with pancreatic cancer in the U.S. and some 48,220 deaths from these cancers in 2021. It is the third leading cause of cancer death in this country.
Moreover, pancreatic cancer is projected to become the second leading cause of cancer-related death in the U.S. by 2030, behind lung cancer, according to data published in Cancer Research, a journal of the American Association for Cancer Research (AACR).
Symptoms
As well as being quite vague, the symptoms of pancreatic cancer may come and go to begin with, and some people may not have all of them. Early pancreatic cancers often do not cause any signs or symptoms. By the time they do cause symptoms, they have often grown very large or already spread outside the pancreas.
Having one or more of the symptoms below does not mean you have pancreatic cancer. In fact, many of these symptoms are more likely to be caused by other conditions. Still, if you have any of these symptoms, it’s important to have them checked by a doctor so that the cause can be found and treated if needed.
Jaundice and related symptoms
Jaundice is yellowing of the eyes and skin. Most people with pancreatic cancer (and nearly all people with ampullary cancer) will have jaundice as one of their first symptoms.
Jaundice is caused by the buildup of bilirubin, a dark yellow-brown substance made in the liver. Normally, the liver releases a liquid called bile that contains bilirubin. Bile goes through the common bile duct into the intestines, where it helps break down fats. It eventually leaves the body in the stool. When the common bile duct becomes blocked, bile can’t reach the intestines, and the amount of bilirubin in the body builds up.
Cancers that start in the head of the pancreas are near the common bile duct. These cancers can press on the duct and cause jaundice while they are still fairly small, which can sometimes lead to these tumors being found at an early stage. But cancers that start in the body or tail of the pancreas don’t press on the duct until they have spread through the pancreas. By this time, the cancer has often spread beyond the pancreas.
When pancreatic cancer spreads, it often goes to the liver. This can also cause jaundice.
There are other signs of jaundice as well as the yellowing of the eyes and skin:
- Dark urine: Sometimes, the first sign of jaundice is darker urine. As bilirubin levels in the blood increase, the urine becomes brown in color.
- Light-colored or greasy stools: Bilirubin normally helps give stools their brown color. If the bile duct is blocked, stools might be light-colored or gray. Also, if bile and pancreatic enzymes can’t get through to the intestines to help break down fats, the stools can become greasy and might float in the toilet.
- Itchy skin: When bilirubin builds up in the skin, it can start to itch as well as turn yellow.
Pancreatic cancer is not the most common cause of jaundice. Other causes, such as gallstones, hepatitis, and other liver and bile duct diseases, are much more common.
Belly or back pain
Pain in the abdomen (belly) or back is common in pancreatic cancer. Cancers that start in the body or tail of the pancreas can grow fairly large and start to press on other nearby organs, causing pain. The cancer may also spread to the nerves surrounding the pancreas, which often causes back pain. Pain in the abdomen or back is fairly common and is most often caused by something other than pancreatic cancer.
Weight loss and poor appetite
Unintended weight loss is very common in people with pancreatic cancer. These people often have little or no appetite.
Nausea and vomiting
If the cancer presses on the far end of the stomach it can partly block it, making it hard for food to get through. This can cause nausea, vomiting, and pain that tend to be worse after eating.
Gallbladder or liver enlargement
If the cancer blocks the bile duct, bile can build up in the gallbladder, making it larger. Sometimes a doctor can feel this (as a large lump under the right side of the ribcage) during a physical exam. It can also be seen on imaging tests.
Pancreatic cancer can also sometimes enlarge the liver, especially if the cancer has spread there. The doctor might be able to feel the edge of the liver below the right ribcage on an exam, or the large liver might be seen on imaging tests.
Blood clots
Sometimes, the first clue that someone has pancreatic cancer is a blood clot in a large vein, often in the leg. This is called a deep vein thrombosis or DVT. Symptoms can include pain, swelling, redness, and warmth in the affected leg. Sometimes a piece of the clot can break off and travel to the lungs, which might make it hard to breathe or cause chest pain. A blood clot in the lungs is called a pulmonary embolism or PE.
Still, having a blood clot does not usually mean that you have cancer. Most blood clots are caused by other things.
Diabetes
Rarely, pancreatic cancers cause diabetes (high blood sugar) because they destroy the insulin-making cells. Symptoms can include feeling thirsty and hungry, and having to urinate often. More often, cancer can lead to small changes in blood sugar levels that don’t cause symptoms of diabetes but can still be detected with blood tests.
Pancreatic Cancer Risk Factors
Certain risk factors may increase the likelihood of getting pancreatic cancer.
Family History
Know your family history of pancreatic and other cancer types. If possible, encourage them to undergo genetic testing for inherited mutations - to inform their treatment decisions and family members’ risk. If you are a first-degree relative of someone diagnosed with pancreatic cancer, you may have an increased risk of developing pancreatic cancer. Your family member with pancreatic cancer is strongly recommended to undergo genetic testing for inherited mutations.
- Negative results often mean you do not need to get genetic testing.
- If the results are positive, unknown, or if you have several close family members with cancer, the Pancreatic Cancer Action Network recommends you consult with a genetic counselor to determine if you should get genetic testing for inherited cancer risk and if you should discuss options for monitoring.
The risk increases if more family members are affected with pancreatic cancer or other specific
cancers or conditions, including:
- Familial breast, ovarian or colon cancer
- Familial melanoma
- Hereditary pancreatitis: repeating pancreatic inflammation, generally starting by age 20
- Inherited genetic syndromes associated with pancreatic cancer
Inherited Genetic Mutations
Inherited genetic mutations and syndromes associated with a higher risk of getting pancreatic cancer include:
- BRCA 1 or 2 mutation
- Cystic Fibrosis
- Familial Adenomatous Polyposis (FAP)
- Familial Atypical Multiple Mole Melanoma (FAMMM)
- Hereditary Nonpolyposis Colorectal Cancer (HNPCC) or Lynch Syndrome
- Hereditary pancreatitis
- PALB2 mutation
- Peutz-Jeghers Syndrome
Diabetes (Long-standing and New-onset)
Pancreatic cancer is more likely to occur in people who have had diabetes for more than five years.
Research also suggests that a sudden onset of type 2 diabetes may be an early symptom of pancreatic cancer, especially in those who are over the age of 50, have a low body mass index (BMI), are losing weight, or do not have a family history of diabetes.
Smoking
Smoking is a significant risk factor. It may cause about 20 – 30% of all exocrine pancreatic cancer cases. People who smoke cigarettes are two times more likely to develop pancreatic cancer than people who have never smoked.
Race / Ethnicity
Black Americans have a higher incidence of pancreatic cancer than people of Asian, Hispanic or Caucasian descent. Ashkenazi Jews also have a higher incidence of pancreatic cancer, possibly because the BRCA2 gene mutation is higher in people in this group.
Obesity
People who are obese have a 20% increased risk of developing the disease compared to people who are of normal weight. The risk is even higher in people who are obese during early adulthood. People with excessive abdominal fat may have an increased risk even if they are not obese.
Pancreatitis
People with chronic pancreatitis have an increased risk of developing pancreatic cancer. Chronic pancreatitis is common in people who consume large amounts of alcohol for many years.
Hereditary pancreatitis causes recurrent inflammation of the pancreas that generally starts by the time a person is 20 years old. The risk of developing pancreatic cancer is even higher in people who have hereditary pancreatitis than it is in those with chronic pancreatitis.
Older Age
The chance of getting pancreatic cancer increases with age. Most people diagnosed with pancreatic cancer are over the age of 60.
Diet
A diet high in red and processed meats is thought to increase the risk of getting pancreatic cancer. A diet high in fruits and vegetables may decrease the risk.
Alcohol
Some research suggests a link between heavy alcohol use and pancreatic cancer. The risk of developing pancreatic cancer is higher in people who drink more than three alcoholic drinks daily compared to those who do not.
Chemical and Heavy Metal Exposure
Research suggests that exposure to certain environmental chemicals and heavy metals may increase the risk of developing pancreatic cancer. These include:
- Beta-naphthylamine
- Benzidine
- Pesticides
- Asbestos
- Benzene
- Chlorinated hydrocarbons
Gum Disease
Periodontal (gum) disease and tooth loss appear to be linked to pancreatic cancer, even when controlling for other risk factors.
Taking Action on World Pancreatic Cancer Day
Wearing purple and spreading the word about pancreatic cancer symptoms and risk factors are just two of the ways you can take action to show your support of the cause.
Knowing the symptoms of pancreatic cancer could help get an earlier diagnosis for you or someone close to you. The symptoms of pancreatic cancer are vague and hard to spot. They might come and go, to begin with, and some people might not have all of them. The symptoms can also be caused by more common things.
It’s more important than ever we get the message out there to anyone with symptoms to not delay.
Sources:
https://www.cancer.org/cancer/pancreatic-cancer/detection-diagnosis-staging/signs-and-symptoms.html
https://www.cancer.gov/types/pancreatic/hp/pancreatic-treatment-pdq
https://www.pancan.org/news/5-ways-to-take-action-on-world-pancreatic-cancer-day/