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Ask an Expert Series on Facebook

March 2013

From Marie: It seems there is conflicting information whether or not pancreatic cancer is hereditary. Can you shed some light on that?

From The Lustgarten Foundation: Dear Marie,
Pancreatic cancer is a genetic disease that means that it is caused by a series of changes or mutations in the DNA.  Most of the time, these mutations happen by chance in a cell of the pancreas and in fact 90-95% of people are not born with genes that predispose them to pancreas cancer. 

However, there are a small number of families with hereditary pancreatic cancer, which can increase the risk of developing the disease in family members.  People at “high risk” of hereditary pancreas cancer have two or more first-degree relatives (parents, sibling, child) with pancreatic cancer, one first-degree relative diagnosed with pancreatic cancer at an early age (under the age of 50).  Active screening in these families has saved lives.


From Nadine: Both my parents died from PC. This makes me believe that PC might be environmental. Neither were drinkers but did smoke in their youth. My brothers and I lived with them for about 20 years and visited frequently. So I guess if PC is hereditary or environmental we are at a higher risk anyway. What are your thoughts on this?

From The Lustgarten Foundation: Dear Nadine,
This is a tough one, pancreatic cancer is a genetic disease that means that it is caused by a series of changes or mutations in the DNA.  Most of the time, these mutations happen by chance in a cell of the pancreas and in fact 90-95% of people are not born with genes that predispose them to pancreas cancer.  Clearly there are known “mutagens” that increase the possibility of these mutations (like smoking) and while there is no evidence of other mutagens that increase the incidence of this cancer, it is not impossible that they exist. 

With regards to heredity, there are a small number of families with hereditary pancreatic cancer, which can increase the risk of developing the disease in family members.  People at “high risk” of hereditary pancreas cancer have two or more first-degree relatives (parents, sibling, child) with pancreatic cancer, one first-degree relative diagnosed with pancreatic cancer at an early age (under the age of 50). 

Some DNA mutations are known to be important in hereditary pancreatic cancer and there are tests for some of these (BRCA2, BRCA1, PALB2, p16/CDKN2A, STK11, PRSS1, ATM, and DNA mis-match repair genes).  There are also screening programs for people in high-risk groups.  These screening programs monitor the pancreas routinely using state of the art imaging techniques and have been A list of sites contacts for these types of screening programs can be found in our “Interview with an Expert” series on Screening and Early Detection.

From Marie: Also, is there a preferred chemotherapy regiment for pancreatic andinocarcinoma among the experts, or one that seems to show the greatest success?

From The Lustgarten Foundation:

Dear Marie,
Gemcitabine is the typical standard therapy for pancreas cancer however there are some new promising chemotherapeutic treatments for pancreatic cancer.

Drug Is Shown to Help Pancreatic Cancer Cases
NY Times – Published: January 22, 2013

A new drug called Abraxane given along with Gemcitabine prolonged the lives of patients with advanced pancreatic cancer by almost two months in a clinical trial, researchers reported Tuesday, signifying an advance in treating a notoriously difficult disease

Pancreatic cancer Survival Reaches New Milestone With Folfirinox chemotherapy
Elsevier Global Medical News - June 18, 2010

First-line treatment with Folfirinox chemotherapy produced the longest survival time reported in a phase III trial of metastatic pancreatic adenocarcinoma, but at a cost in terms of serious toxicities.
Compared with gemcitabine, Folfirinox improved overall survival from 6.8 months to 11.1 months. The Folfirinox regimen is more toxic, and patients given Folfirinox should be carefully selected and monitored closely.

From Joedi: I know there usually aren't symptoms, but do we know of anything that could be some red flags and what to look for? Especially since my father passed away from this disease?

From The Lustgarten Foundation: Dear Joedi
The symptoms of pancreas cancer can be quite vague and they vary depending on where the cancer is in the pancreas.  Early symptoms can include:

  • Weight loss for no apparent reason.
  • Pain in the stomach often described as a dull pain beginning in the stomach area and spreading around to the back.
  • Jaundice or yellowing of the skin and whites of the eyes.
  • Loss of appetite
  • Symptoms of diabetes or diagnosis with diabetes within the past year Diabetes causes increased thirst, passing of a lot of urine, general weakness, weight loss and hunger.

From Angela: Why can't a Ca19-9 be part of a yearly physical or atleast an option? Men get the Psa test every year. This has such a terrible prognosis I am dumbfounded it isn't screened for more.

From The Lustgarten Foundation:

Dear Angela,

Researchers are working hard to try to develop a “simple” test for pancreas cancer that insurance companies will not have issues with but, as you know, it is not available yet.   The screening we currently use in high-risk families that are imaging technologies like PET and CT scans.  Like most new technologies, these scans are very expensive and so insurance companies do put significant limits on their use. To prescribe one, a doctor needs to prove there is clear research data supporting their use.  There is no research, as of yet that shows that there is a significant overall benefit for the majority of the population to have routine imaging tests for pancreas cancer.  There is in fact concern that routine imaging screening would hurt more people than it would help.  Imaging scans would find “questionable spots” in many people that are not cancer.  These people would have unnecessary tests and biopsies, each of which have their own negative complications.  Even in the case of mammograms and prostate screens that have been widely accepted by insurance companies, there is an ongoing debate in the field as to their relative benefit (in finding cancers early) versus cost (financial, emotional and medical complications).

From Amy: I have lost both my father and paternal grandmother to pancreatic cancer. Both diagnosed stage IV, 36 years apart. What screening options are available to my brother and I and how often should they be run. Thank you.

From Marina: What are the best screening options for early detection of pancreas cancer? Also, at what age should one consider getting screened if three family members died of PC?

From The Lustgarten Foundation:

Dear Amy and Marina,

There are families with hereditary pancreatic cancer, which can increase the risk of developing the disease in family members.  People at “high risk” of hereditary pancreas cancer have two or more first-degree relatives (parents, sibling, child) with pancreatic cancer, one first-degree relative diagnosed with pancreatic cancer at an early age (under the age of 50).  Active screening in these families has saved lives.

Some DNA mutations are known to be important in hereditary pancreatic cancer and there are tests for some of these (BRCA2, BRCA1, PALB2, p16/CDKN2A, STK11, PRSS1, ATM, and DNA mis-match repair genes).  There are also screening programs for people in high-risk groups.  These screening programs monitor the pancreas routinely (typically every 6 months) using state of the art imaging techniques and have been A list of sites contacts for these types of screening programs can be found in our “Interview with an Expert” series on Screening and Early Detection.

From Millie: Looking for a grief/support group near Tomball, TX (north of Houston). We lost our sister in February of 2013. She fought bravely. 

From The Lustgarten Foundation:

Dear Millie,
Houston area grief/support groups
http://www.vitas.com/texas/Services/LearnAboutHospice/BereavementSupport/SupportGrpMemorialSvc/BereavementSupportHouston.aspx

Lyoa Cancer Support Group
Houston, TX
713-631-2041
 
You might also try contacting:
First Baptist Church
Magnolia, TX
281-356-8543
 
CancerCare also has various support groups.  I'm not certain if there are any in your immediate area, but you could certainly do online or telephone support with them.
http://www.cancercare.org/support_groups

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