The pancreas is an organ of the digestive system located deep in the upper part of the abdomen, behind the stomach and in front of the spine.
The pancreas is only about 2 inches wide and 6 to 8 inches long, and sits horizontally across the abdomen. It is composed of 3 contiguous parts:
- The large, rounded portion of the gland is called the head. It is located on the right side of the abdomen and abutting the beginning of the small intestine, which is called the duodenum.
- The middle section, called the body, is tucked behind the stomach.
- The thin end of the pancreas, called the tail, is located on the left side of the abdomen, next to the spleen.
The pancreas is a glandular tissue comprised of two cell types: 1. exocrine (produces and secretes substances into a duct, which drains into the duodenum) and 2. endocrine (produces and secretes substances into the blood) tissue. The exocrine tissue comprises 95 percent of the pancreas, and the endocrine tissue makes up the remaining 5 percent of the pancreas.
Exocrine glandular tissue produces pancreatic enzymes. These enzymes travel down the pancreatic duct and into the duodenum where they aid in the digestion of food. The endocrine glandular tissue of the pancreas produces hormones and releases them into the bloodstream. Two of these hormones, insulin and glucagon, help control blood sugar levels.
Cancer of the Pancreas
The word cancer is used to describe any one of a group of diseases in which abnormal cells grow out of control, and can spread. These abnormal cells are different from normal cells in both appearance and function. Pancreatic cancer occurs when abnormal cells grow out of control in the tissue of the pancreas and form a tumor.
Because the pancreas lies deep in the abdomen, a doctor performing an examination on a patient would not be able to feel a pancreatic tumor. Pancreatic cancer has no early warning signs, and there are currently no effective screening tests. As a result, pancreatic cancer is usually discovered late. Often, the diagnosis is not made until the cancer has spread to other areas of the body (stage IV). However, research focused on better diagnostic tests and newer treatments provides a more optimistic future for patients diagnosed with pancreatic cancer. In fact, a blood test and better scans are in development.
Before 2030, pancreatic cancer is expected to be the second-leading cause of cancer-related deaths in the United States, second only to lung cancer. In 2018, the American Cancer Society estimates there will be 55,440 new cases of pancreatic cancer, 44,330 of which will die.
Types of Pancreatic Cancer
The most common type of pancreatic cancer arises from the exocrine cells and is called a pancreatic ductal adenocarcinoma (PDAC). These tumors are designated “ductal” because they microscopically form structures that resemble the pancreatic ducts. About two-thirds of all pancreatic cancers arise in the head of the pancreas. The remainder arise in the body and tail. These tumors are malignant, meaning they can invade nearby tissues and organs. Cancerous cells can also spread through the blood and lymphatic systems to other parts of the body. When this occurs, they are called metastatic cancer.
Tumors can also resemble the endocrine cells of the pancreas. These types of rare tumors are called islet cell tumors, pancreatic endocrine neoplasms, or pancreatic neuroendocrine tumors, are generally less aggressive, and may be curable if detected early. It is important to distinguish between exocrine and endocrine tumors because each has different signs and symptoms, is diagnosed using different tests, has different treatments, and has different prognoses (likely course of the disease). Our research efforts are focused on PDAC.
Precursors to Pancreatic Cancer
An understanding of the lesions that give rise to pancreatic cancer is important because many of these precursor lesions can be identified and removed before they cause pancreatic cancer. Some of these precursors form cysts, which are collections of fluid within the substance of the pancreas.
Almost 3 percent of American adults have a pancreatic cyst. Improvements in imaging tests over the past decade have led to a significant increase in the number of patients found to have a cyst in their pancreas. Most of these cysts are harmless and can be safely watched and followed.
Intraductal papillary mucinous neoplasms (IPMNs) and mucinous cystic neoplasms (MCNs)
have been recognized as special types of cysts in the pancreas because they are precursor lesions that can later progress to invasive cancers if left untreated. Both IPMNs and MCNs are called “mucinous” because they produce large amounts of mucus, which, in the case of IPMNs, can clog and enlarge the pancreatic duct. IPMNs and MCNs are very different from most pancreatic tumors because they may be present for a long time without spreading. Surgical removal is the treatment of choice for IPMN cysts that are at high risk for progressing to invasive pancreatic cancer. However, doctors have to balance the risk of over-treating patients with harmless cysts with the benefit of removing a precancerous lesion. Many small IPMN and MCN cysts can safely be followed with annual surveillance imaging, most commonly using magnetic resonance imaging (MRI) scans.
Because it can be hard to tell which IPMNs and MCNs are precancerous and which are harmless, researchers have been studying them and their genetic makeup for new ways to determine which are more likely to progress to pancreatic cancer. Our researchers are actively developing new molecular tests to better classify pancreatic cysts. Recently, researchers at Johns Hopkins identified a panel of molecular markers and clinical features that show promise for classifying pancreatic cysts and determining which cysts require surgery. This panel has the potential to lower the number of unnecessary surgeries by an overwhelming 91 percent. This more specific panel of markers is likely to provide physicians with additional information to help them determine whether surgery or surveillance of the cyst(s) is the most appropriate course of action for their patients, based on the type of mutation they see in a particular cyst. Avoiding unnecessary pancreatic surgery is important, and this research on cysts is one step forward.
Genes and Pancreatic Cancer
All the cells in the body contain DNA. DNA is the molecule in the cell nucleus that carries the instructions (genes) for making living organisms. When cells grow and divide, they also copy their DNA.
Research conducted by Dr. Vogelstein at Johns Hopkins found that random, unpredictable ‘mistakes’ that occur when DNA is copied account for nearly two-thirds of cancer mutations, and that environmental factors account for another 29 percent. Mutations in DNA occur frequently, especially when cells divide. Cells have an exceptional ability to repair these changes in DNA. However, the DNA repair mechanisms can also fail. When they do, these mistakes in DNA can be passed along to future copies of the altered cell. More abnormal cells can then be produced and when these abnormal cells continue to grow unchecked, cancer may develop.
The DNA mutations that cause pancreatic cancer may be either inherited from a parent or acquired as we age. Inherited mutations are carried in the DNA of a person’s reproductive cells and can be passed on to that person’s children.
Not everyone who has an inherited mutation will develop pancreatic cancer.
Acquired mutations are ones that develop during a person’s lifetime, either as random mutations in DNA or in response to injuries from harmful environmental factors such as exposure to the carcinogens in tobacco smoke or cosmic rays. Scientists believe that most cancers result from complex DNA changes that involve many different genes. Some of these outside factors are called risk factors. Certain risk factors increase the chances of a person developing cancer. Not everyone who has an acquired mutation will develop pancreatic cancer. It is important to note that pancreatic cancer is relatively rare, striking only 12 to 13 people per 100,000 each year, so even doubling a rare risk still means that the risk is very low.
Family History and Pancreatic Cancer
Pancreatic cancer may be inherited because it can run in families. This means that blood relatives of patients with pancreatic cancer may have an increased risk of developing the disease. The risk depends on the gene inherited. If the gene inherited isn’t known, inherited risk can still be estimated based on the number of first-degree relatives (i.e., a sibling, parent, or child) that an individual has who have been diagnosed with pancreatic cancer. One first-degree relative with pancreatic cancer means a two to four-fold risk, two relatives increases the risk by six or seven-fold, and three first-degree relatives, which is highly unusual, results in a 32-fold risk. Having a family member who had pancreatic cancer younger than 50 years of age is an added risk of pancreatic cancer. However, not everyone with a family history of pancreatic cancer will develop the disease.
- Random genetic mistakes
- Smoking or environmental causes
Data for hereditary and smoking causes are from the American Cancer Society.
Inherited mutations in known cancer-causing genes such as BRCA2, BRCA1, PALB2, p16/CDKN2A, ATM, STK11, PRSS1, SPINK1, and in one of the DNA mismatch repair (DNA is not properly repaired) genes have been shown to increase the risk of developing pancreatic cancer. These genes are therefore called familial pancreatic cancer genes. However, not everyone who has one of these mutations will develop pancreatic cancer.
It is estimated that 10 percent of pancreatic cancer is familial. Researchers around the world have set up pancreatic cancer registries to study the hereditary factors that influence pancreatic cancer. The qualifications for joining a registry may vary from one registry to another and may include providing answers to a questionnaire and a blood or saliva sample. Some registries enroll patients and family members who have at least one relative who has pancreatic cancer. Other registries require that enrollees have at least two relatives who have pancreatic cancer. Registry participants must be 18 years of age or older.
Screening programs are currently being explored for patients with a known genetic abnormality that predisposes them to pancreatic cancer or who have a strong family history of pancreatic cancer. These screening programs often include screening with endoscopic ultrasound (EUS) and MRI. This is because these imaging technologies may be useful for detecting small lesions and may identify early pancreatic tumors.
Hereditary syndromes are inherited genetic mutations in one or more genes that may predispose the affected individuals to the development of certain cancers and may also cause the early age of onset of these cancers. The hereditary syndromes listed below have been associated with the development of pancreatic cancer.
Familial Breast Cancer Syndrome. People who have the breast cancer 2 gene (BRCA2) mutation have an increased risk of several cancers, among them pancreatic. Inherited mutations in the BRCA2 gene are particularly common in the Ashkenazi Jewish population. It has recently been suggested that cancers that arise in patients with a BRCA2 mutation may be particularly sensitive to treatment with drugs called PARP inhibitors. Although the association is not as strong as it is with BRCA2, inherited mutations in the first breast cancer gene, BRCA1, may also increase the risk of pancreatic cancer.
Familial Atypical Multiple Mole Melanoma (FAMMM) Syndrome. People with FAMMM syndrome, also called p16-Leiden, have many different-sized skin moles that are asymmetrical and raised. Most cases of FAMMM syndrome are caused by inherited mutations in the p16/CDKN2A gene.
Peutz-Jeghers Syndrome (PJS). People with this rare syndrome have mutations in the STK11/LKB1 gene. Polyps in the small intestine and dark spots on the mouth and fingers characterize the syndrome. In people with PJS, the risks of gastrointestinal tumors such as esophageal, small bowel, colorectal, and pancreatic cancer are increased.
Hereditary Pancreatitis. Hereditary pancreatitis is a rare disease in which patients develop recurrent episodes of severe recurrent pancreatitis at an early age. The main genes related to this disorder are PRSS1, SPINK1, and the cystic fibrosis gene, CFTR. About 30 to 40 percent of people with hereditary pancreatitis will develop pancreatic cancer by age 70, and the risk is especially high among patients with hereditary pancreatitis who also smoke cigarettes.
Hereditary Nonpolyposis Colon Cancer (HNPCC; Lynch Syndrome). People with HNPCC have a higher-than-normal chance of developing colon, pancreatic, uterine, stomach, or ovarian cancer. People with this disorder have inherited mutations in DNA mismatch repair genes. Recently it has been shown that the drug Keytruda (pembrolizumab) may be very effective in the treatment of cancers that arise in patients with HNPCC who develop pancreatic cancer.
Partner and Localizer of BRCA2 (PALB2). Mutations in this gene, which is related to BRCA2, also increases the risk of breast and pancreatic cancer.
ATM. Mutations in this gene may increase the risk of pancreatic cancer.
Risk factors are characteristics, habits, or environmental exposures that have been shown to increase the odds of developing a disease. Some can be controlled, while others cannot.
Risk Factors You Can Influence
Smoking. Smoking or being exposed to secondhand smoke is the leading preventable cause of pancreatic cancer. People who smoke have twice the chance of getting pancreatic cancer compared with people who do not smoke. Importantly, the risk of cancer falls after smoking cessation. Over time, smokers who quit will decrease their risk of developing pancreatic cancer, and after 10 years the risk in ex-smokers is the same as that of nonsmokers.
Obesity. People who are significantly overweight are more likely to develop pancreatic cancer compared with those who are not overweight, with those patients who are obese during their teens and twenties having the highest risk.
Other Risk Factors
Age. As people get older, their risk of pancreatic cancer increases. Pancreatic cancer mostly affects people 55 years of age or older.
Race. In the United States, pancreatic cancer is more common in African Americans than in Caucasians, although the reasons are not clear. Differences in dietary habits, the rates of obesity and diabetes, and the frequency of cigarette smoking exist between these groups. Genetic or other unknown factors may also explain the higher incidence in African Americans.
Medical Factors. The incidence of pancreatic cancer is higher in people who have any of the following medical conditions.
• Chronic pancreatitis (inflammation that causes irreversible damage to the pancreas)
• Long-term diabetes mellitus (high blood sugar)
• Helicobacter pylori infection or ulcers
Adult Onset Diabetes. Long-term diabetes is a risk factor for pancreatic cancer. New onset diabetes in an older person can be the first sign of pancreatic cancer. In fact, up to 80 percent of patients with pancreatic cancer are either prediabetic or are in a presymptomatic phase of diabetes.
Presence of Risk Factors
When a person has one, or even more than one, of these risk factors, it does not mean that he/she will develop pancreatic cancer. Conversely, some people who do not have any risk factors will still get pancreatic cancer. Researchers are working to understand how lifestyle and environmental risk factors interact with an individual’s genetic makeup to influence pancreatic cancer development. Most importantly, the best way to reduce your risk of developing pancreatic cancer is to not smoke, and to maintain a healthy body weight.
Several steps are involved in making a diagnosis of pancreatic cancer. The first thing your doctor will do is ask questions about your medical history, family history, possible risk factors, and symptoms. Answering these questions honestly and completely will help both you and your doctor during the diagnostic process.
MEDICAL HISTORY QUESTIONS
- Do you have pain?
- Where is the pain located?
- How long have you had the pain?
- How intense is the pain (i.e., on a scale from 0 to 10)?
- Is there something you can do that causes the pain to come back?
- Is there something you can do that makes the pain go away?
- Have you lost weight without trying?
- What other symptoms do you have?
- If you have jaundice: When did you notice the jaundice?
- If you have dark urine or light stools: How long have you had this?
- Has anyone in your family ever had cancer?
- Has anyone in your family ever had pancreatic cancer?
Answering these questions honestly and completely will help both you and your doctor during the diagnostic process.
A doctor will perform a physical examination and check your abdomen for tenderness, fluid buildup, enlargement of your gallbladder or liver (that may result from blockage of the bile duct), and masses. Your lymph nodes will be checked for tenderness and swelling, and any sign of jaundice will be noted. Your doctor also may order blood or urine tests, testing of stool samples, or imaging tests.
Blood tests are frequently performed for diagnostic purposes. No single blood test can be used to make a diagnosis of pancreatic cancer. When a person has pancreatic cancer, however, elevated levels of bilirubin or liver enzymes may be present.
Different tumor markers in the blood are used to detect and monitor many types of cancer. Tumor markers are substances, usually complex proteins, produced by tumor cells. Proteins form the basis of body structures such as cells, tissues, and organs. Enzymes and some hormones are composed of protein. Some tumor markers can indicate specific types of cancer; others are found in several types of cancer.
Two commercially available tumor marker tests are of use in patients with pancreatic cancer: cancer antigen 19-9 (CA 19-9) and carcinoembryonic antigen (CEA). These markers are not accurate enough to be used to screen healthy people or to make a diagnosis of pancreatic cancer. However, CA 19-9 and CEA are frequently used to track the progress of treatment in patients with pancreatic cancer. CA 19-9 is a substance found on the surface of certain types of cells and is shed by tumor cells, making it useful in following the course of cancer. The presence of the protein CEA may indicate cancer because elevations in CEA levels are not usually found in people who are healthy. CEA is not as useful as is CA 19-9 in pancreatic cancer testing.
We have funded researchers at Johns Hopkins who have designed a blood test called CancerSEEK that can detect the presence of pancreatic cancer as part of a panel of eight common cancers –pancreas, ovary, liver, stomach, esophagus, colorectum, lung and breast. It can identify the presence of relatively early cancer, and can detect the organ of origin of the cancers. This test is an important breakthrough because these eight cancers account for more than 60 percent of cancer deaths. While further testing is needed, the goal is for CancerSEEK to be offered as part of routine medical checks.
If you have blood and urine testing, your doctor will receive written reports from the laboratory. If the results show high levels of bilirubin, it may be an indication of pancreatic cancer. However, many other medical situations can cause an elevation in bilirubin. Additional testing will almost always be needed to confirm a diagnosis of pancreatic cancer. Liver function tests will also be performed on blood samples to determine if a tumor is affecting the liver.
Imaging tests are important tests used to detect pancreatic cancer. These tests use a variety of methods to see inside the body. CT scans – or some variation of a CT scan — of the chest, abdomen, and pelvis are most commonly used in the diagnosis of pancreatic cancer.
A CT scan, formerly called computed axial tomography (CAT) scan, uses a large machine shaped like a donut to take detailed, cross-sectional, X-ray images from many different angles while you lie on a table that moves into the machine. The computer combines these images into a series of views of the area in question for diagnostic purposes. A CT scan may be done at a special center or in a hospital, but it does not require an overnight stay. This test is not painful, and no sedation is needed.
A dye, called a contrast agent, can be injected into a vein to produce better CT images of body structures. Typically, a contrast agent is also given by mouth to provide better images of the stomach and small intestines.
In many centers, modifications of basic CT scanners are used to image the pancreas more accurately. A multiphase CT scan is a sensitive imaging test used to evaluate patients suspected of having pancreatic cancer. Multiphase CT scanning may produce detailed, 3-dimensional images of the pancreas.
A helical CT scanner with multiple detector rows, called a multidetector row helical CT (MDCT) scan, is one of the latest technological advances in CT scanners. MDCT has advantages over other CT methods, including improved image resolution and the ability to rapidly scan large volumes, thus allowing for imaging of the entire pancreas in a single breath-hold by the patient.
Ultrasound is another imaging test that is commonly used. During this test, sound waves are bounced off internal organs to produce echoes. The computer creates patterns from these echoes, as normal and abnormal tissues produce different patterns.
EUS and LUS
EUS (endoscopic ultrasound) and LUS (laproscopic ultrasound) are minimally invasive procedures. EUS is performed using an endoscope, which is a long, thin instrument with a light at the end used to look deep inside the body. During EUS, an endoscope is passed down the esophagus, through the stomach, and into the duodenum. The machine that makes the sound waves is then turned on, and images are created by visualizing the pancreas through the stomach or the duodenum.
Advantages of EUS are that the ultrasound probe can be placed immediately adjacent to the pancreas, producing detailed images. It also allows for biopsies of the pancreas to be obtained to confirm the presence of cancer.
Magnetic Resonance Imaging
MRI is a noninvasive, painless imaging method that is commonly used today. MRI uses powerful magnets, instead of X-rays as in a CT scan, to view internal structures and organs. Since it does not involve radiation, MRI may be safer in patients who require repeated imaging over many years, such as patients with pancreatic cysts. The energy from the radio waves is absorbed by the body then released. A computer translates the patterns formed by this energy release into detailed images of areas inside the body. MRI produces cross-sectional slices like a CT scanner, but also produces slices that are parallel to the length of the body.
MRIs are performed at a special imaging center or at a hospital. If you have any metal in your body, you should check with your doctor prior to undergoing an MRI scan. Some types of metal implants (such as prosthetic hips, prosthetic knees, pacemakers, and heart valves) may cause problems when exposed to high magnetic forces such as those used in MRI.
Positron Emission Tomography (PET) Scan
PET scan is an imaging test that shows not only anatomy, but also biological function. During a PET scan, a small amount of radioactive glucose (sugar) is injected into a vein. Cancer cells take up sugar at higher rates than normal cells. A special camera detects the radioactivity that is taken up by malignant tissue, and a computer creates detailed images. The images created by a PET scan can be used to find cancer cells in the pancreas and in other areas of the body. Recently developed machines combine CT imaging with PET scanning to more accurately identify where cancer is located within the body.
Endoscopic Retrograde Cholangiopancreatography (ERCP)
ERCP is an invasive procedure that is used in conjunction with a dye to view the bile and pancreatic ducts for obstructions. During an ERCP, you will receive an anesthetic to numb the throat and medication for sedation. A thin tube is passed down the throat, through the stomach, and into the small intestine. From there, the gastroenterologist who is performing the procedure will identify the bile duct and pancreatic duct so that the dye can be injected into them. Then, X-rays are taken. This is an outpatient procedure but also may be performed in the hospital.
ERCP is especially helpful in patients with jaundice because a stent can be inserted into the bile duct and left in place to keep the bile duct open, often relieving the jaundice and its associated symptoms. Tissue samples also can be taken during the procedure. ERCP can cause complications, and is usually used to help manage symptoms and not for diagnostic purposes.
Because the only definitive way to diagnose cancer is to directly visualize cancer cells under a microscope, after having the necessary blood tests and scans, a biopsy may be performed when pancreatic cancer is suspected. A biopsy is the process of removing tissue samples, which are then examined under a microscope to check for cancer cells.
A biopsy can be performed in an outpatient setting or in the hospital. Biopsy specimens can be obtained in different ways as listed below.
Fine-Needle Aspiration (FNA) Biopsy
In a FNA biopsy, imaging by CT scan or EUS is used together with a long, thin needle to obtain tissue specimens. The CT scan or EUS imaging method allows the doctor to view the position of the needle to ensure that the needle is in the tumor. EUS also can be used to place the needle directly through the wall of the duodenum or stomach and into the tumor for collection of tissue specimens.
A brush biopsy procedure is used with ERCP. A small brush is inserted through an endoscope into the bile and pancreatic ducts. Cells are scraped off the insides of the ducts with the brush.
Laparoscopy is a minimally invasive surgical procedure. You will receive general anesthesia during the procedure. A laparoscope is inserted through a small incision in the abdomen. The doctor can then view the tumor and remove tissue samples for examination.
QUESTIONS TO ASK AFTER DIAGNOSIS
Asking good questions will help you get the best care possible for pancreatic cancer. You have a right to have all questions answered to your satisfaction.
- What type of pancreatic cancer do I have, and what is the stage (resectable, borderline resectable, locally advanced or metastatic)?
- Should I have any additional tests to more accurately stage my cancer?
- What is the treatment plan that you recommend?
- What are the potential benefits, risks, and side effects of that treatment?
- Where will the treatment be given, and how often?
- How will I know if the treatment is working?
- Who will be part of my care team?
- Are clinical trials available for my type and stage of pancreatic cancer?
- If surgery is recommended, is the center that will perform my surgery a high-volume one?
- If I have border-line resectable or locally advanced pancreatic cancer, what will your institution do to try to make my cancer resectable?
- Should I have my tumor or my blood (germline) genetically sequenced?
- Can you estimate the amount of time I may need to recover from surgery?
Signs and Symptoms
A Silent Disease
Pancreatic cancer is often called a silent disease because many times there are no signs or symptoms until the cancer is in an advanced stage. Even when there are early signs and symptoms, they may be vague and easily attributed to another disease. The signs and symptoms also may be confusing to patients and healthcare providers because they vary depending on where the tumor is located in the pancreas (the head, body, or tail). It is important to see your doctor if you have any of the signs or symptoms of pancreatic cancer.
Jaundice is a yellowing of the skin and the whites of the eyes. Symptoms that may occur with jaundice are itching (which may be severe), dark urine, and light or clay-colored stool. Jaundice occurs when bilirubin stains the skin. Bilirubin is a dark-yellow brown substance made in the liver that travels down the bile duct and into the small intestine. When the bile duct is blocked by a tumor or when a tumor is located in the head of the pancreas near the bile duct, the bile is prevented from reaching the intestines. The bile then accumulates in tissues, blood, and the skin, leading to jaundice.
There are other, more common causes of jaundice, such as hepatitis (inflammation of the liver) or obstruction of the bile duct by a gallstone.
Skin can start to itch or turn yellow when bilirubin builds up in the skin.
This common sign of advanced pancreatic cancer occurs when the tumor presses on organs and nerves around the pancreas. The pain may be constant or intermittent and can be worse after eating or when lying down. Many conditions other than pancreatic cancer can also cause back pain, which makes this a challenging symptom.
Digestive Problems or Pain
People with pancreatic cancer may lose weight, may have little or no appetite, or may suffer from malnutrition. When pancreatic enzymes cannot be released into the intestine, digesting food, especially high-fat foods, may be difficult. Over time, significant weight loss and malnutrition may result, at which time a doctor should be consulted.
Nausea or Vomiting
If the tumor blocks the upper part of the small intestine (the duodenum), nausea and vomiting may result.
Similar to back pain, abdominal pain is a common sign of advanced pancreatic cancer which occurs when the tumor presses on organs and nerves around the pancreas. Many conditions other than pancreatic cancer can also cause abdominal pain, which makes this a challenging symptom.
Pancreatic cancer can cause blood to clot more easily, and can be the first sign of the tumor. These clots occur in the veins and can block blood flow. They can occur in the legs (deep vein thrombosis), lung (pulmonary embolism), or organs such as the pancreas itself or liver (portal vein thrombosis).
An inflammation of the pancreas called pancreatitis can be a sign of pancreatic cancer when pancreatitis is chronic or when it appears for the first time and is not related to either drinking alcohol or gallstones.
Developing diabetes mellitus (sugar diabetes), especially after the age of 50, can be a sign of pancreatic cancer. The majority of patients with diabetes, however, will not develop pancreatic cancer. As noted earlier, long-term diabetes is also a risk factor for pancreatic cancer.
When to See a Doctor
Many other illnesses can cause these signs and symptoms, but it is important to take them seriously and see your doctor as soon as possible. If you have a first-degree relative (parent, sibling or child) with pancreatic cancer, tell your doctor and consider joining a pancreatic cancer registry.
Cancer registries are used to collect accurate and complete data about people with cancer that can be used for cancer control and epidemiological research, public health program planning, and to improve patient care. Collecting this information also increases the chances of finding a cure, because the data helps physicians and researchers learn more about the causes of cancer and how to detect cancer earlier.
Data from registries may point out environmental risk factors or high risk behaviors, so that measures to prevent people from getting cancer can be identified. Additionally, local, state, and national cancer agencies and cancer control programs may use registry data from defined areas to make important decisions about public health.