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Warning Signs of Pancreatic Cancer and Advances in Treatment

Survival rates have risen and there are new treatments but early diagnosis is key

magicmine/Getty Images 20 years ago, it was very often devastating to get a pancreatic cancer diagnosis. The cancer usually wasn’t caught until later stages, partly because the pancreas is tucked behind the stomach, making it hard to detect tumors. Plus, some of the warning signs — abdominal discomfort, back pain, unintended weight loss and fatigue — are easy to overlook or attribute to other conditions. And they often arise late in the game.
The five-year survival rate for this kind of cancer was around 4 percent. For treatment, doctors were able to offer patients only standard chemotherapy, radiation and/or a risky surgery. Get instant access to members-only products and hundreds of discounts, a free second membership, and a subscription to AARP the Magazine. Today, however, the five-year survival rate for pancreatic cancer has more than doubled. If the disease is caught early and the tumor is small and confined to the pancreas, the survival rate is around 40 percent. A surge in research funding is partly responsible for this good news. For example, at the National Cancer Institute (NCI), money for pancreatic cancer research rose from $17 million in 1999 to more than $182 million in 2018. Funding by other agencies and organizations has made similar leaps. With stronger support, pancreatic cancer research is making huge advances. Scientists are developing new ways to screen for this cancer so that it can be caught earlier. Medical experts are also engineering new drugs to treat the cancer and finding innovative ways to repurpose existing therapies and deliver more focused radiation to tumors to shrink them, which can make remov ing them easier. AARP Membership — $12 for your first year when you sign up for Automatic Renewal Get instant access to members-only products and hundreds of discounts, a free second membership, and a subscription to AARP the Magazine. published in 2020 in The Lancet Oncology found that pancreatic cancer patients who received tailored drug therapy based on their tumor’s unique characteristics lived an average of one year longer than those who did not receive targeted therapy. Entertainment $3 off popcorn and soft drink combos See more Entertainment offers > In 2018, a year after being diagnosed with pancreatic cancer, Karen Kiernan, 63, a retired nurse from Naperville, Illinois, received such a targeted therapy with Keytruda, a drug approved for treating lung and other cancers. By that point, Kiernan had severe back pain from her cancer and had lost 40 pounds. But once she began taking Keytruda, she was able to regain some weight and return to doing the things she did before she had cancer. Her recovery hasn’t been without the occasional bump, but Kiernan says she is “truly in remission now.” “I think we are starting to see more progress and traction in testing every pancreatic cancer patient’s tumor,” says Michael Pishvaian, M.D., director of the Gastrointestinal, Developmental Therapeutics and Clinical Research Programs at the Johns Hopkins Kimmel Cancer Center. He estimates that more than half of all pancreatic cancer patients are now having their tumors tested. “This is definitely something patients can take some measure of control over. They should generally feel more comfortable and be more aggressive in asking their doctor for this,” Pishvaian says. risanapong detraphiphat/Getty Images

Know — and Lower — Your Risk Factors for Pancreatic Cancer

“Increasing awareness of the risk factors associated with pancreatic cancer development — such as having a family history of pancreatic cancer, having a pancreas cyst on a CT or MRI scan, or developing new onset diabetes — offer s the opportunity for us to diagnose pancreatic cancer early and intervene, with the overall hope of improving patient outcome overall,” says James Farrell of the Yale Center for Pancreatic Diseases at the Yale Cancer Center.
You can lower your risk for pancreatic cancer by changing unhealthy lifestyle behaviors you can control, , drinking and being overweight. About 25 percent of pancreatic cancers are thought to be caused by cigarette smoking. Cigar smoking and using smokeless tobacco raise your risk, too, according to the American Cancer Society (ACS). People who are (BMI of 30 or higher) are about 20 percent more likely to develop pancreatic cancer, according to the ACS. Type 2 diabetes is more common among overweight adults, and this condition raises the risk for pancreatic cancer, too, especially in those over 50 who suddenly develop type 2 without having a family history of it, says Brian Wolpin , M.D., of the Dana-Farber Cancer Institute. can lead to chronic pancreatitis, or inflammation of the pancreas, which has been linked to an increase in pancreatic cancer. Certain risk factors for pancreatic cancer can’t be changed, but they’re important to know, and you should share yours with your doctor. About 10 percent of pancreatic cancers are thought to be the result of genetics. If you have a family history of the disease, talk with your doctor about whether you should be screened for it. A family history of other cancers and syndromes can also raise your risk for pancreatic cancer . These include hereditary breast and ovarian cancer caused by BRCA1 or BRCA2 mutations, and Lynch syndrome, an inherited disorder associated with colon cancer. Data has been mixed about whether long-term use of proton pump inhibitors to reduce stomach acid, or infection with Helicobacter pylori (a bacteria that can cause ulcers), increases the risk of pancreatic cancer, Wolpin says. Other risk factors include age, gender and race. Men develop pancreatic cancer slightly more often than women. The risk of developing it increases with age. And African Americans are more likely to get pancreatic cancer than any other racial group.

Using the breast cancer drug Lynparza

In March 2016, Mary Phillips, 59, was diagnosed with metastatic pancreatic cancer. At first she took the latest combination chemotherapy for pancreatic cancer. Then she enrolled in a clinical trial of the drug Lynparza. Because the medication was already being used by some patients with breast or ovarian cancer (those with a mutation in their BRCA or DNA repairing genes), researchers thought that it could be useful for pancreatic cancer patients with the same mutations. Early findings in this area have been promising. A 2019 , published in The New England Journal of Medicine, reported that patients with such a BRCA mutation who took Lynparza for metastatic pancreatic cancer had no new tumor growth, and no spread of their cancer, for twice as many months as those not receiving the drug. Still, there was no difference in long-term survival past 18 months. In December 2019 , the Food and Drug Administration approved the medication for maintenance therapy for this group of patients. AARP Membership — $12 for your first year when you sign up for Automatic Renewal Get instant access to members-only products and hundreds of discounts, a free second membership, and a subscription to AARP the Magazine. , who died of the disease in November 2020. “We should be able to do better,” says Elliot Fishman, M.D., professor of radiology and radiological science at the Johns Hopkins School of Medicine in Baltimore. To that end, Fishman is in his fifth year of using artificial intelligence to teach the computer to read CT scans to detect tumors at earlier stages so they can be surgically removed. So far Fishman has screened several thousand pancreatic cancer patients with the technology and has been able to detect tumors with 90 percent accuracy.

Using blood and urine screenings to detect cancer early

As is done for many other cancers, a simple blood or urine test may one day be used to screen for pancreatic cancer in its earliest stages, since body fluids contain bits of DNA from tumor cells. Research teams are developing methods of blood-based DNA analysis to detect pancreatic cancer with high accuracy, says Brian Wolpin, M.D., associate professor of medicine at Harvard Medical School and director of the Gastrointestinal Cancer Center at Dana-Farber. “Scientists have made quite a bit of progress in the last five years in developing these multi-cancer early detection tests, and large studies are now ongoing to define their utility,” says Wolpin, who notes that such procedures may be able to detect cancerous tissue 90 percent of the time. Meanwhile, in clinical trials in the U nited Kingdom and Finland, researchers are studying urine analysis to detect pancreatic cancer this way. Pawita Warasiri / EyeEm / Getty Images

Early Warning Signs of Pancreatic Cancer

If your pancreatic cancer is caught at an early stage, you have a higher chance of a cure and can better tolerate treatment, says Brian Wolpin, M.D., of the Dana-Farber Cancer Institute. That’s why you should watch out for the following symptoms.

Abdominal and back pain

The most common symptom of pancreatic cancer is abdominal discomfort in the middle to upper abdomen (above the belly button) that often radiates to the back. This kind of pain can also be experienced by people with ulcers and gallstones, or even . The typical pain associated with pancreatic cancer, however, can be very dull at first but can become very severe and persistent, explains James Farrell, M.D., director of the Yale Center for Pancreatic Diseases at the Yale Cancer Center.

Diabetes with weight loss

Another sign is new onset or worsening of blood sugar levels, especially paired with unexplained weight loss, says Wolpin, senior author of a study on the topic published in JAMA Oncology in 2020. Wolpin and his research team found that recent onset diabetes was associated with a threefold higher risk of pancreatic cancer. The incidence rates for this type of cancer were six- to tenfold higher among study participants with newly diagnosed diabetes and weight loss than among participants without diabetes or weight loss. Researchers are continuing to study the potential impact diabetes has on pancreatic cancer risk. An ongoing study is currently looking at whether a blood test can identify diabetics and prediabetics who may need further testing for pancreatic cancer.

Darkening of urine and lightening of stool jaundice itching

Sometimes, pancreatic cancer can obstruct the duct that contains bile, a fluid secreted by the liver that aids in the absorption of nutrients. When the duct gets blocked, it can cause a backup of bile that may leak into the bloodstream, causing jaundice (yellowing of the skin and eyes), darkening of the urine, lightening of the stool and, less commonly, itching.

Nausea and vomiting

It can be hard to tell whether these symptoms are indications of pancreatic cancer or the result of something like food poisoning or a new medication. “If the symptoms are new, don’t resolve after 24 hours and result in excess dehydration, or if they progress, medical attention should be sought,” Farrell advises.

Fatigue

People with pancreatic cancer are often lethargic. “It’s not the kind of severe fatigue you get with the flu,” Wolpin observes. Instead, you become less active and feel like you can’t do as much as you used to, and you’re more tired at the end of the day.

Loss of appetite and unintentional weight loss

Patients with pancreatic cancer often start eating less, in part because they don’t feel well. They can also feel bloated or fuller sooner after eating. Take note if these symptoms seem to get worse over time, Wolpin says. More on health AARP Membership — $12 for your first year when you sign up for Automatic Renewal Get instant access to members-only products and hundreds of discounts, a free second membership, and a subscription to AARP the Magazine. AARP VALUE & MEMBER BENEFITS See more Health & Wellness offers > See more Flights & Vacation Packages offers > See more Finances offers > See more Health & Wellness offers > SAVE MONEY WITH THESE LIMITED-TIME OFFERS