What is Pancreatic Cancer?

Everything You Need to Know About Pancreatic Cancer

Pancreatic Cancer remains one of the most lethal cancers with the least favourable survival rate. It's highly skilled at flying under the radar and keeping things asymptomatic until they are in their later stages when doctors have a more challenging time treating them. The prognosis is not great at later stages, and treatment options are much more limited.

However, progress is being made, and researchers are working hard to advance the survival rate each year. In the last two years, the United States has seen an annual increase of 1%. Clinical trials targeting specific biomarkers uncovered through genetic and somatic testing are becoming more common.

So, let’s explore the role of your pancreas, how Pancreatic Cancer develops, and some of the risk factors and symptoms. Finally, we’ll talk about some of the support available to people with pancreatic cancer in Canada that may help you in your journey.

But before that, let’s take a look at some key statistics about Pancreatic Cancer in Canada. They’re concerning. Especially since Pancreatic Cancer is set to move into third place in Canada by 2030.

Key Statistics about Pancreatic Cancer in Canada

• Incidence: By 2024, it’s estimated that around 7,100 Canadians will be diagnosed with Pancreatic Cancer.
• Mortality: In the same year, 6,100 Canadians are expected to die from Pancreatic Cancer.
• The Overall Survival Rate in Canada stands at 10%.
• Age of Diagnosis: From 2011-2013, 79.5% of cases were diagnosed in those over 60, and 52% were 70 or older.
• Age-specific incidences were 20-30% higher in males than in females.
• Men: 3,800 (Diagnosed) 3,200 (Deaths)
• Women: 3,300 (Diagnosed) 2,900 (Deaths).

Research and Funding

Research Investments: Pancreatic Cancer research in Canada remains embarrassingly underfunded. The Terry Fox Research Institute allocated just five percent of its budget to Pancreatic Cancer. Pancreatic Cancer Canada invested $4,000,000 since 2006. While these look like sizeable amounts to the average joe, this level of funding is absolutely insufficient given the scale of the problem.

Dependancy on private foundations: The majority of funding for Pancreatic Cancer research comes from private entities or non-profits as seen above. Government of Canada, where are you?

About the Pancreas

The pancreas is a vital organ that’s sandwiched just behind the stomach. It plays a crucial role in our digestion and keeping our blood sugar in check. It is composed of two main types of tissue - exocrine and endocrine..

The exocrine tissue of the pancreas is made up of cells that produce digestive enzymes, such as amylase, lipase, and protease— the same enzymes that are in Pancreatic Enzymes that people living with Pancreatic Cancer take orally to make up for some of the pancreas reduced ability to create them. 

These enzymes make their way into the pancreatic ducts and then are released into the small intestine to aid in the breakdown and absorption of nutrients from our food. (How does the pancreas work?, 2018)

What Is Pancreatic Cancer?

Pancreatic cancer, of course, originates in the pancreas. When cells in the pancreas start growing uncontrollably, they form a tumour, which then eventually spreads to other parts of the body like the lymph nodes, liver, bones, duodenum or other parts of the body if not caught early.

Pancreatic Cancer is rarely diagnosed early because it often doesn’t show symptoms until it has progressed, mainly because of the lack of symptoms. But also because there are no approved early detection methods. In fact, almost (over 50%} of patients are diagnosed at later stages. (PANCAN, 2023)

In October of 2022, the Canadian Cancer Society awarded $7.5 million to fund a Pancreatic Cancer Research Program led by Dr. Steven Gallinger with one of the goals being the use of liquid biopsies to establish early screening methods for those deemed high-risk. Earlier screening could mean doctors are able to catch, and treat pre-cancerous cells before they become tumours.

Different Forms of Pancreatic Cancer

There is more than just one type of Pancreatic Cancer. It’s divided into two types based on where the cancer starts to develop, either in the exocrine or the endocrine cells. We’ll take a look at both types and explore some sub-categories.

Exocrine Tumours

These are the most common types of pancreatic cancer, originating from the exocrine cells of the pancreas that produce digestive enzymes. Exocrine tumours account for approximately 95% of all pancreatic cancer cases, with the vast majority being a specific type called Adenocarcinomas. (American Cancer Society, 2023)

Adenocarcinoma: The most common form of pancreatic cancer, starting in the cells that line the pancreatic ducts. It’s often referred to as pancreatic ductal adenocarcinoma (PDAC).

Acinar Cell Carcinoma: A rare type of pancreatic cancer originating from the acinar cells, which produce digestive enzymes.

Mucinous Cystadenocarcinoma: A rare, slow-growing cancer that forms cysts filled with mucus.

Intraductal Papillary-Mucinous Neoplasm (IPMN): A type of tumour that grows in the ducts of the pancreas and produces a thick, sticky fluid called mucus.

Endocrine Tumors

These tumours are much rarer, making up only about 5% of pancreatic cancers. They originate from the pancreas' endocrine cells, which produce hormones like insulin, glucagon, and somatostatin.

They are sometimes called pancreatic neuroendocrine tumors (PNETs) or islet cell tumours. While generally less aggressive than exocrine tumours, endocrine tumours can still pose significant health risks depending on the specific hormones they overproduce.

Insulinoma: A rare tumour that secretes excess insulin, which can lead to low blood sugar levels.

Gastrinoma: This tumour produces high levels of gastrin, a hormone that stimulates acid production in the stomach, causing peptic ulcers.

Glucagonoma is a rare tumour that secretes glucagon, increasing blood sugar levels.VIPoma: A cancer that releases vasoactive intestinal peptide (VIP), which can cause severe diarrhea and dehydration.

Somatostatinoma: This tumour produces excessive amounts of somatostatin, a hormone that inhibits various other hormones, affecting digestion and metabolism.

Nonfunctional Islet Cell Tumour: These tumours do not produce hormones but can still cause symptoms due to their size or effects on surrounding tissues.

Risk Factors and Prevention Strategies

Certain factors increase the likelihood of developing pancreatic cancer. Unfortunately, some of these factors are not something that we can change. Some we can. However, recognizing that they can elevate your risk can help with early detection. 

• Age: The risk increases as you get older, with most cases occurring in people over 65.
• Lifestyle Choices: Smoking is a significant risk factor. Quitting smoking can lower your risk.
• Genetics: A family history of pancreatic cancer or certain genetic conditions can elevate your risk. Genetic counselling might be an option if you have a strong family history.
• Chronic Pancreatitis: Long-term inflammation of the pancreas has been linked to an increased risk of cancer.
• Body Weight: Maintaining a healthy weight can be a preventative measure. Obesity has been associated with a higher risk of developing pancreatic cancer.

Recognizing the Signs of Pancreatic Cancer

Pancreatic cancer is often referred to as a "silent" disease because it frequently does not cause any noticeable symptoms until the cancer has progressed to a more advanced stage where it’s more challenging to treat and options become more limited.

However, there are some signs and symptoms that individuals should be aware of and watch out for, even in the early stages of the disease: Jaundice, abdominal or back pain, unintentional weight loss, and digestive problems. (World Health Organization, 2022)

While pancreatic cancer symptoms early in the game may be subtle or easy to overlook, being mindful of changes in your health and reporting anything that feels out of sorts to your healthcare provider can be crucial for early detection and improved outcomes.

Some key signs and symptoms of pancreatic cancer may include:

• Jaundice: This condition causes a yellowing of the skin and eyes. It can be a sign that cancer is affecting the bile ducts. (Mayo Clinic, n.d.)
• Pain in the Abdomen or Back: Persistent pain or discomfort in the stomach or back might indicate pancreatic issues.
• Unintentional Weight Loss: Losing weight without a diet or exercise change might indicate an underlying problem.
• Digestive Problems: Issues like nausea, vomiting, or loss of appetite could be related to pancreatic cancer.
• Active Diabetes, especially long-term diabetes is associated with an increased risk.

How Pancreatic Cancer Is Diagnosed

When a doctor suspects pancreatic cancer, they can use a combination of advanced diagnostic tests to confirm the diagnosis and gather valuable information about the tumour.

Imaging Techniques: Sophisticated imaging tests like CT scans, MRIs, and endoscopic ultrasounds play a crucial role in visualizing the pancreas and detecting any abnormalities, such as tumours or signs of metastasis. These scans can help determine the size, location, and stage of cancer, which is critical for developing an appropriate treatment plan. (American Society of Clinical Oncology, 2023)

Biopsy Procedures: If imaging tests indicate the presence of a suspicious mass or lesion, a biopsy may be performed. This involves the removal of a small tissue sample from the pancreas, which is then analyzed under a microscope to confirm the presence of cancer cells. Biopsies can provide valuable insights into the specific types and characteristics of pancreatic cancer, guiding the selection of the most effective treatment strategy.

Serum Markers: Blood tests to measure certain substances, or "serum markers," can also assist in diagnosing and managing pancreatic cancer. The most commonly used marker is CA19-9, which can be elevated in the presence of pancreatic cancer. However, it's important to note that CA19-9 by itself is not specific to pancreatic cancer and can be elevated in other conditions as well. Another marker, CEA, can also be used in conjunction with CA19-9 to improve the accuracy of the diagnosis. (The Lancet Oncology, 2021)

More recently, somatic and genetic testing analyzing the genetic material, or "tumour DNA markers," from cancer cells in the blood have emerged as a promising tool. These tests can provide valuable insights into the specific genetic characteristics of the cancer, which can help guide the selection of targeted therapies and personalize the treatment approach.

Treatment Options for Pancreatic Cancer

Once diagnosed, treatment options vary based on the cancer’s stage, location, and overall health. Common cancer treatments include:

• Surgical Procedures: Surgery might involve removing the tumour or part of the pancreas. Options include the Pancreaticoduodenectomy— more commonly known as the “Whipple procedure“ and distal pancreatectomy. These surgical options are often the only approach with “curative” intent. (Journal of Clinical Oncology, 2023)
• Chemotherapy: This treatment uses drugs to kill or stop cancer cells from growing.
• Radiation Therapy: Targeted radiation can help destroy cancer cells and shrink tumours.
• Targeted Therapy: These therapies focus on specific molecules involved in cancer growth uncovered through genetic or somatic testing.
• Palliative Care: This care focuses on relieving symptoms and improving the quality of life for patients with advanced cancer.
• Clinical Trials: Patients may also choose at any time during their diagnosis to take part in one of many clinical trials which study possible up-and-coming medical treatments that may one day become a new standard of care.

Support Systems and Resources

Dealing with pancreatic cancer is not just a medical challenge; it’s also an emotional and psychological journey. We’ve written a lot of praise for peer support programs provided by cancer advocacy groups like Peers with Pancreatic Cancer there is no shortage of support.

• Peer Support Groups: These groups offer a space for sharing experiences and advice with others facing similar challenges. In Canada, both Craig’s Cause and Pancreatic Cancer Canada have great peer support programs.
• Professional Counseling: Speaking with a counsellor can help manage the emotional impact of the disease. (Psychosocial Oncology, 2023)
• Educational Resources: Books, websites, and articles can provide more information about pancreatic cancer and treatments. We hope you’ll also check out the resources and tools Team Heather has to offer.

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