Pancreatic Cancer

The precise causes of pancreatic cancer have not yet been determined. Some risk factors associated with this include:

Smoking: The risk of pancreatic cancer is higher among smokers. Smokers are two to three times more likely to develop pancreatic cancer. This appears to be the most significant risk factor for pancreatic cancer.

Age: The risk of pancreatic cancer increases sharply after 50 years of age. More than 90% of pancreatic cancers occur in patients aged over 55 years of age.

Race: African-Americans are more likely to have pancreatic cancer than other ethnic groups. There is also an increased risk in people of Ashkenazi Jewish descent.

Family history: Pancreatic cancer seems to run in some families. Approximately 5 to 10% of patients with pancreatic cancer have a family history of the disease. The exact genes responsible have not been fully identified. People with two or more relatives who have had pancreatic cancer have increased risk. Some implicated gene mutations include the BRCA2, p16, STK11 genes. Hereditary conditions associated with increased risk of pancreatic cancer include:

• BRAC2 gene mutations. This is noted in some families with a high rate of breast, ovarian and prostate cancer. It also seems to be more common in people with Ashkenazi Jewish or Eastern European heritage
• Peutz-Jeghers syndrome
• Hereditary pancreatitis
• Multiple endocrine neoplasia type 1 syndrome
• Hereditary nonpolyposis colon cancer (HNPCC, called Lynch syndrome)
• Familial atypical multiple mole melanoma syndrome (FAMMM)
• Von Hippel-Lindau syndrome
• Ataxia-telangiectasia

Chronic pancreatitis: This long-term inflammation of the pancreas is linked with a slightly higher risk of pancreas cancer. Chronic pancreatitis may be difficult to diagnose with pain being the most common symptom.

Obesity: Increase cancer risk has been associated with obesity, in particular a body mass index (BMI) of over 30. Obesity is found more often in people who do not exercise regularly, and this may also be associated with increased risk.

Environmental exposure: certain pesticides, dyes, and chemicals has been linked to higher risk of pancreatic cancer.

Sudden onset diabetes: Diabetes has been implicated as a risk factor in some studies and an early symptom of pancreatic cancer. The exact relationship between diabetes and pancreatic cancer is still, however, unknown.

Pancreatic cancer can be devastating disease. Early treatment offers the best chance of cure. For many conditions screening exams are important in identifying problems at the earliest stage. Unfortunately, for pancreatic cancer there are no standardised screening tests that have been shown to alter outcomes and no clear recommendations can be provided as how to screen for such cancers. If you are at high risk for pancreatic cancer (see risk factors above) assessment by several modalities may be considered, but no single tests is proven at this stage to significantly alter outcomes. Dr Nikfarjam may discuss with you the following screening modalities:

• CT (computed axial tomography) or MRI (magnetic resonance imaging) scans to look for abnormalities
• Endoscopic ultrasound: An endoscope with an ultrasound probe on the end is inserted through the mouth into the pancreas

In many cases pancreatic cancer is identified in patients without any known risk factors. Lifestyle choices that may lower your chances of getting pancreatic cancer include:

• Cessation of smoking
• Eating a healthy diet
• Maintaining a healthy weight
• Regular exercise
• Screening in high risk patients – Potential benefit but not yet proven