Pancreatic Cancer

Pancreatic Cancer: Here’s Why It’s So Deadly

Pancreatic cancer was the third-leading cause of death from cancer in the United States in 2018, after lung and colorectal cancers, according to the National Cancer Institute.

This year, an estimated 56,770 new cases of pancreatic cancer will be diagnosed and an estimated 45,750 deaths from pancreatic cancer will occur across the nation, according to the American Cancer Society.

As people age, the risk of developing pancreatic cancer goes up. Most patients are older than 45, and nearly 90% are older than 55. The average age at diagnosis is 71.

There is also a noted association with race: African-Americans are more likely to develop pancreatic cancer than whites. Doctors don’t know why but speculate that higher rates of men smoking and having diabetes, and women being overweight, may contribute to that association.

What are the types of pancreatic cancer?

The pancreas is an oblong organ that lies deep in the abdomen and is an integral part of both the digestive and endocrine system. It secretes hormones to regulate the body and digestive enzymes to break down food.

Pancreatic neuroendocrine tumors constitute only 1% of all pancreatic cancers. They can be benign or malignant, but the distinction is often unclear and sometimes apparent only when the cancer has spread beyond the pancreas.

The five-year survival rate for neuroendocrine tumors can range from 50% to 80%, compared with less than 5% for adenocarcinoma.

More advanced tumors have a higher risk of recurrence and can spread to the liver, said Dr. Steven Libutti, pancreatic cancer expert and director of the Montefiore-Einstein Center for Cancer Care in the Bronx.

Treatment options

Pancreatic cancer is usually controllable only through removal by surgery and only if found before it has spread, according to the National Cancer Institute. Palliative care can help a patient’s quality of life if the disease has spread.

Everolimus, marketed by Novartis as Afinitor, received US Food and Drug Administration approval to treat pancreatic neuroendocrine tumors and prevents transplant rejection. Potential side effects are serious, however: lung or breathing problems, infections and renal failure, which may lead to death.

Jobs also underwent a liver transplant in Tennessee in 2009, which is “cutting-edge stuff” for when neuroendocrine tumors spread, said Dr. Maged Rizk, director of the Chronic Abdominal Pain Center at the Cleveland Clinic who specializes in gastroenterology and hepatology.

Do transplants help?

There are two rare genetic syndromes — multiple endocrine neoplasia type 1 (MEN1) and Von Hippel-Lindau syndrome (VHL) — that increase the risk of pancreatic neuroendocrine tumors. Other than that, though, it’s unclear whether having a family member with pancreatic cancer increases an individual’s risk.

Pancreatic cancer struck former President Jimmy Carter’s family hard. He lost his father and all of his siblings, brother Billy and sisters Ruth Carter Stapleton and Gloria Carter Spann.

The future of treatment

“There are a number of agents that are being looked at in clinical trials that focus on pathways that may allow pancreatic cancer to evade normal processes,” Libutti said.

“What’s going to make real difference in the future is the revolution of the genomic era,” she said.