Pancreatitis and Pancreatic Cancer
Pancreatic cancer is a type of cancer that occurs when malignant tumors form in the pancreas. According to the American Cancer Society, pancreatic cancer accounts for 3% of all cases of cancer. Those with chronic pancreatitis have an increased risk of pancreatic cancer, and certain pancreatitis patients may be more at risk than others.
What is pancreatitis?
Pancreatitis is the inflammation of the pancreas, an important organ in the digestive system. The pancreas regulates blood sugar levels and produces important enzymes that allow the body to digest nutrients from food. In pancreatitis, the pancreas becomes inflamed, which can cause extreme pain and abdominal symptoms.
There are 3 types of pancreatitis, which are determined by how long it lasts and if there is any permanent damage to the pancreas. The types of pancreatitis include:
- Acute Pancreatitis. Acute pancreatitis is a single episode of inflammation of the pancreas, which occurs over a short period of time (typically days to a week).
- Recurrent Acute Pancreatitis (RAP). Recurrent acute pancreatitis is repeated episodes of acute inflammation of the pancreas. It includes at least two episodes, in which the patient completely recovers between the episodes.
- Chronic Pancreatitis (CP). Chronic pancreatitis is when there is ongoing, persistent inflammation of the pancreas, which can cause permanent damage and scarring to the pancreas. CP can lead to other conditions, like exocrine pancreatic insufficiency and diabetes.
Most patients with acute pancreatitis will have no further problems. For those with recurrent acute pancreatitis, their pancreatitis may become chronic. In chronic pancreatitis, patients have an increased risk of developing pancreatic cancer compared to the general public.
Learn more about chronic pancreatitis.
What is pancreatic cancer?
Pancreatic cancer (PC) is the formation of malignant cancer cells in the tissues of the pancreas. It is often difficult to diagnose pancreatic cancer, as patients may not have any noticeable symptoms during the early stages or until the cancer is advanced. As a result, pancreatic cancer is often diagnosed at an advanced stage, making effective treatment difficult and the survival rate low.
Types of Pancreatic Cancer
There are two main types of pancreatic cancer depending on which function of the pancreas the tumor affects: pancreatic exocrine cancer and pancreatic endocrine cancer.
Pancreatic Exocrine Tumors
Pancreatic exocrine cancer occurs when exocrine cells begin to replicate rapidly and form malignant tumors. The most common type of pancreatic cancer is pancreatic adenocarcinoma. It starts in the cells lining the pancreatic duct, and about 90% of people with pancreatic cancer have this type of cancer.
Other exocrine tumors include acinar cell carcinoma and mucinous cystic neoplasm with an invasive adenocarcinoma.
Pancreatic Endocrine Tumors
Pancreatic endocrine cancer (islet cell cancer) occurs when tumors form in the cluster of cells that make up islets. These tumors are referred to as Pancreatic Neuroendocrine Tumors (PNETs) and make up less than 10% of all pancreatic cancer.
PNETs affect pancreatic islet cells. Some PNETs make extra amounts of hormones, while others do not. Common PNET types are:
- Gastrinoma (makes gastrin)
- Glucaganoma (makes glucagon)
- Insulinoma (makes insulin)
- Somatostatinoma (makes somatostatin)
- Nonfunctional Islet Cell Tumor
Learn more about pancreatic islet cells.
Pancreatitis vs. Pancreatic Cancer
While they are both diseases that affect the pancreas, pancreatitis is inflammation of the pancreas, while pancreatic cancer is when cancer cells start to grow in the pancreas.
Does pancreatitis lead to pancreatic cancer?
People with chronic pancreatitis have an increased risk of developing pancreatic cancer compared to the general population. Chronic pancreatitis patients have about a 5% chance of developing pancreatic cancer over a 20-year period. However, the risk of developing pancreatic cancer is not evenly distributed among chronic pancreatitis patients, and certain patients are more at risk than others.
Genetics
Pancreatitis patients with PRSS1 variants (sometimes called hereditary pancreatitis) have a significantly increased risk of pancreatic cancer. Depending on the PRSS1 variant, the risk of developing pancreatic cancer is estimated to be 7.2% to 40%.
Studies suggest that people with chronic pancreatitis and some CFTR mutations have a slightly greater risk of pancreatic cancer than the general population.
Research has not found a direct association or increased risk for pancreatic cancer for people with chronic pancreatitis-linked genetic variants such as SPINK1, CTRC, and CEL. More research is needed to understand the link between these genetic causes and pancreatic cancer.
Smoking
Other patients may be more at risk of developing pancreatic cancer if they are or were previously a smoker, which increases the risk of PC regardless of a pancreatitis diagnosis. One study found that current smokers had a 74% increased risk of developing PC. Former smokers had a 20% increased risk. Smoking is considered to be the most important modifiable risk factor for preventing pancreatic cancer. If you are considering quitting smoking, talk to your doctor about counseling or other resources that can help you quit.
Diabetes
People with pancreatitis have an increased risk of developing diabetes. New-onset diabetes can be a risk factor for pancreatic cancer. Studies have shown that those with type 1 or type 2 diabetes are two times as likely to develop PC. Additionally, diabetes may occur after the development of pancreatic cancer.
Should pancreatitis patients be screened for pancreatic cancer?
Regular pancreatic cancer screenings are recommended for high-risk pancreatitis patients who meet specific criteria. These criteria include:
- PRSS1. People with PRSS1 “hereditary” pancreatitis should be screened for pancreatic cancer every year starting at age 40.
- Two or more blood relatives with pancreatic cancer. People with two or more blood relatives with pancreatic cancer should be screened yearly beginning at age 50, even if they do not carry a genetic variant associated with PC.
- Pancreatic cancer-related genetic variants. Patients with pancreatic cancer-related variants, such as BRCA1, BRCA2, PALB2, CDKN2A, STK11, and PRSS1 genes, should be screened yearly beginning at age 50.
- IPMN. Those with intraductal papillary mucinous neoplasm (IPMN) should receive regular screening as recommended by their doctor.
According to the American Gastroenterological Association, people with pancreatitis and SPINK1 p. N34S, CFTR, CTRC, CPA1, or CEL, do not have a high enough risk of pancreatic cancer to justify screening or surveillance (unless they meet any other criteria). If you do not know what genetic mutations you have, you can find out through specialized genetic testing. Talk to your doctor to determine if pancreatic cancer screening is right for you.
Learn more about screening for pancreatic cancer.
Symptoms of Pancreatic Cancer
Pancreatic cancer often doesn’t show any symptoms in its early stages. This makes it difficult for doctors to diagnose the disease when it’s less advanced and more treatable. Unfortunately, symptoms tend to appear only in the later stages of pancreatic cancer when treatment options are less effective, and sometimes even limited. This late detection contributes to lower survival rates for people with pancreatic cancer.
Symptoms of pancreatic cancer can include:
- Abdominal and back pain
- Jaundice (yellow skin and/or eyes) with or without itching
- Weight Loss
- Loss of appetite
- Nausea
- Changes in stool
- Weakness
- Fatigue
- Pancreatitis
- New-Onset Diabetes
- Blood Clots
- Depression
If you have any of these symptoms, seek medical advice.
Diagnosing Pancreatic Cancer
Typically, diagnosing pancreatic cancer involves imaging the pancreas through scans like an MRI (Magnetic Resonance Imaging) or EUS (endoscopic ultrasound). However, it can be difficult to identify tumors in the pancreas due to its location, and advanced imaging scans may not always be 100% accurate. This can be especially true if your pancreas is inflamed or damaged. As a result, experts recommend that patients with a high risk of pancreatic cancer be routinely screened.
Diagnosing pancreatic cancer may require one or more of the following:
- Imaging tests. Imaging tests, such as an MRI (Magnetic Resonance Imaging), EUS (endoscopic ultrasound), or CT (computerized tomography) scan, are used by physicians to see the inside of the body. These may help identify tumors in the pancreas.
- Blood tests. A blood test can check for certain proteins, such as CA19-9, in the blood that are produced by pancreatic cancer cells. However, blood tests are not as accurate as other types of testing because not all people produce these types of proteins.
- Biopsies. A biopsy is when a small sample of tissue from the pancreas is removed and tested for cancer in a lab. The lab can check if there have been cancer-causing changes to the DNA in pancreatic cells.
Treating Pancreatic Cancer
Treating pancreatic cancer depends on your general health and the stage of the disease. Treatment options for pancreatic cancer include surgery, chemotherapy, and radiation therapy. Unfortunately, if pancreatic cancer is diagnosed at the advanced stage, surgery may not be an option. That’s why it’s important for those at risk of pancreatic cancer to be regularly screened for any changes in their pancreas.
Surgery
Surgery for pancreatic cancer involves removing the tumor and healthy tissue surrounding the tumor. Surgery is the best option for long-term survival. According to the Pancreatic Cancer Action Network (PANCAN), 20% of pancreatic cancer patients may be eligible for surgery. However, up to half of patients who are eligible for surgery are told they are ineligible. PANCAN strongly recommends you see a surgeon who performs a high volume of pancreatic surgeries (more than 15 per year) to determine eligibility.
Chemotherapy
Chemotherapy involves the use of drugs that kill cancer cells, preventing tumors from growing and potentially shrinking their size. These drugs travel through the bloodstream and can work against cancer cells throughout your whole body.
Radiation Therapy
Like chemotherapy, radiation therapy damages cancer cells and prevents them from growing or dividing. Radiation therapy, however, uses energy in the form of particle or electromagnetic waves to do so.
Frequently Asked Questions
While pancreatitis and pancreatic cancer both affect your pancreas, pancreatitis is not cancer. Pancreatitis occurs when the pancreas becomes inflamed. Pancreatic cancer occurs when tumors form in the pancreas. While inflammation may be a symptom of pancreatic cancer, pancreatitis and pancreatic cancer are different diseases of the pancreas and have different treatments.
The five-year overall survival rate for all stages of pancreatic cancer is estimated to be about 13%. However, when caught in an earlier stage, the survival rates are close to 44%. As new screening technologies become available, it is becoming possible to detect pancreatic cancer in earlier stages and begin treatment sooner.
Learn more about a new clinical study working to detect pancreatic cancer earlier.
Pancreatic cancer can be hereditary, which accounts for about 10% of all PC cases. Pancreatic cancer-related genes include BRCA1, BRCA2, PALB2, CDKN2A, STK11, and PRSS1. Patients with mutations in these genes are at higher risk of developing pancreatic cancer and should be screened regularly.
People with PRSS1 “hereditary” pancreatitis should be screened for pancreatic cancer every year starting from age 40. Other pancreatitis patients who should be screened regularly include those with pancreatic cancer-related genetic mutations, 2 or more blood relatives diagnosed with pancreatic cancer, and those with a benign pancreatic tumor.
Key Takeaways
- Pancreatitis is the inflammation of the pancreas. Those with hereditary or chronic pancreatitis may be at an increased risk for developing pancreatic cancer.
- Pancreatic cancer occurs when malignant tumors form in the pancreas. There are two main types of pancreatic cancer: pancreatic exocrine cancer and pancreatic endocrine cancer.
- Risk factors for pancreatic cancer can include smoking, having chronic pancreatitis, and new-onset diabetes.
- Diagnosing pancreatic cancer is challenging due to the location of the pancreas. A combination of imaging scans, biopsies, and blood tests can be used to diagnose pancreatic cancer. Regular screening is recommended for high-risk individuals.
- Those with pancreatitis and PRSS1, pancreatic-cancer related mutations, or two or more blood relatives with pancreatic cancer should receive regular screening for pancreatic cancer.
- Treatment options for pancreatic cancer include surgery, chemotherapy, and radiation therapy.
