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Ask an Expert Series on Facebook

September 2012

From: Karen: How many years does it take for pancreatic cancer to metastasize to other organs ie your liver? Or is this a very rapid growing disease? 

From The Lustgarten Foundation:
Dear Karen,

There are conflicting studies on when exactly pancreatic cancer cells leave the pancreas and move to other organs.  In one recent Johns Hopkins study, using gene analysis of material taken at autopsy from pancreas cancer patients, it was found that it takes at least a decade from the first cancer-causing mutation in a normal pancreas cell, until the development of a full-blown cancer cell.  It was further speculated that it takes another five to seven years before this initial cancer cell turns into a tumor and metastasizes. 

In another study, from U. Penn. however, it was recently reported that in animal models of pancreas cancer we can already see cells at very early stages of PanINs (premalignant growths that can develop into pancreas cancer) that are starting to move out of the pancreas.  So the answer to your question is really, we are working hard to figure that out but don’t know yet.

What we do know for certain is that from the time pancreas cancers are detected by standard means (CT, MRI, PET) they have often already metastasized to other organs and that once they do it is a fast growing cancer.

From Christy: I have two genes that cause hereditary pancreatitis. Both my boys have as well along with 30 or more family members with HP. What is my risk for Pancreatic Cancer? I do not drink or smoke. What is the time frame you have with and without treatment once dx with PC???  

From The Lustgarten Foundation:
Dear Christy,

The estimated life-time risk of pancreatic cancer in patients with hereditary pancreatitis approaches 40%. This can be higher in patients where the hereditary pancreatitis is inherited via the paternal line (from Hereditary pancreatitis and the risk of pancreatic cancer. International Hereditary Pancreatitis Study Group (1997).

As for time frames, this is a difficult number given that early intervention can dramatically affect pancreas cancer outcomes.  In the case of high-risk families (which you are describing) they should be enrolled in a monitoring program closely screened by their doctor.  In these families, surgical removal of very early pancreas tumors can significantly extend life span and even be curative.  Statistically speaking, if no treatment is given for pancreas cancer the average life span after diagnosis is about 4 months.

From Neca: What is the latest treatment for pancreatic cancer?

From The Lustgarten Foundation:
Dear Neca,

Below are two promising treatments for pancreatic cancer.

Promising new results of a Phase II trial for pancreatic cancer
Medical News Today – Release 7 Oct 2011

Promising results of a Phase II clinical trial in advanced pancreatic cancer were recently reported using a new drug combination consisting of a standard drug called gemcitabine and a drug called nab-paclitaxel.  Of the 67 patients treated, about half the patients showed reductions in tumor size measured by CT scans, and about 50 percent lived at least a year.

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 Patti: Does pancreatic cancer have a link to breast cancer? My grandmother had breast cancer, my dad had pancreatic cancer.

 

From The Lustgarten Foundation:
Dear Patti,

There are some genetic mutations that can be passed in families that make them more susceptible to getting both breast and pancreatic cancers.  A defect in the BRCA1 or BRCA 2 genes, can increase the risk of developing pancreatic cancer by 2 to 10-fold (respectively). Defects in these genes also increase a woman’s chance to develop breast cancer by 5-fold.  There are Genetic tests available to check for BRCA1 and BRCA2 mutations which require a blood sample. And, if a harmful BRCA1 or BRCA2 mutation is found, several options are available to help a person manage their cancer risk.

From Pamela: My mom passed of PC in July, what are the chances of me or my brother also getting it. What test should one ask for to be tested and how often?  

From Stacey: My dad was just diagnosed w stage 4, 2 months ago. I, too, am wondering what the chances are of it being hereditary, does it depend on the type? @Christy, how did u find out about the gene status? My prayers are with all of you: for your losses, fears, etc. ♥  

From Lynn: My dear husband died of liver failure on July 29 after being diagnosed with pancreatic cancer during laparoscopic gall bladder surgery on June 29. He had always been a very healthy man and took care of his health. Is there any test that can screen for it for my daughter and grandchildren?  

From The Lustgarten Foundation:
Dear Pamela, Stacey and Lynn,

Clearly early detection and hereditary pancreatic cancer is a major topic for family members touched by pancreatic cancer.  Pancreatic cancer, as all cancers, is a disease caused by DNA errors, mutations, in a person’s cells.  Most of the time (in 90-95% of cases) people are not born with these mutations but rather they develop spontaneously in their cells during their lifetime.  These mutations happen just by chance.  There are things that increase the chance of DNA mutation in the pancreas that can be controlled (like smoking, diet or obesity) as well as some that cannot (like age or diabetes). 

Hereditary pancreatic cancer, which increases risk of developing the disease in family members, plays a role in 5-10% of patients. Some studies indicate that people having a one first-degree relative (parent, sibling, or child) with pancreatic cancer have two to three times the risk of developing pancreatic cancer compared with people with no family history. 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).  Unfortunately there is no routine test that can detect Pancreatic Cancer early but there are screening programs for people in high-risk groups.  These screening programs monitor the pancreas routinely using state of the art imaging techniques.  This type of intense screening is currently limited to those with known syndromes predisposing to pancreatic cancer or be from a family which includes at least three affected members (one of which must be a first degree relative).  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 Cynthia: Does this type of cancer usually spread to the liver & lungs? Is it more common n diabetic's? 

From The Lustgarten Foundation:
Dear Cynthia,

Pancreatic cancer does indeed often spread to the liver and can spread to the lungs.  And diabetes has been linked to pancreatic cancer. Diabetes appears to be both a symptom of pancreatic cancer, and long-standing adult-onset diabetes may also increase the risk of developing pancreatic cancer. Recent preliminary studies have shown that 1% of patients diagnosed with diabetes after the age of 50 years will be diagnosed with pancreatic cancer within 3 years of their diagnosis of diabetes. These studies suggest that new onset diabetes in a person over the age of 50 may be an early warning sign of pancreatic cancer.

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