The Pulse | Thursday, February 24, 2022
A Closer Look at Pancreatic Cancer: Symptoms, Awareness and Evolving Research
The American Cancer Society (ACS) predicts that in 2022 more than 62,000 people in the United States will be diagnosed with pancreatic cancer — and while this cancer accounts for about 3% of all cancers in the U.S., it is a scary and life-changing diagnosis no less.
We spoke with Dr. Mark Gromski, who specializes in gastroenterology for Indiana University (IU) Health Physicians Gastroenterology, to learn more about the early signs of this cancer, how GI nurses can advise patients when it comes to pancreatic health, research on the horizon and more.
Your SGNA Annual Course session focused on pancreatic cancer. What are some early signs of this cancer? What should GI nurses be on the lookout for?
Pancreatic cancer has a poor prognosis; and by cancer I mean pancreas adenocarcinoma, the most common cause of pancreatic cancer. One of the tough things about this diagnosis is a lack of clear symptoms.
The first symptom we can look for is jaundice. If someone is turning yellow, their urine is dark or their stools are clay colored — those are signs of biliary obstruction. In over half of pancreatic cancers we detect, the initial sign was jaundice, because that pancreas tumor is obstructing the drainage of the liver through the bile ducts.
Another symptom could be a mid-abdominal gnawing pain. Another is unintentional weight loss. Say someone suddenly loses 20 to 30 pounds; that should raise some alarm bells.
A bit less well-known is the association between pancreatic cancer and acute worsening or acute onset diabetes. A significant portion of people with pancreatic cancer had a new onset of diabetes as an adult, a year or two prior to that diagnosis.
If pancreatic cancer is diagnosed, what are some options for treatment that GI professionals should be aware of? Are there any advanced or leading-edge treatments?
There are some new treatments on the horizon. Here at IU and many centers around the country, we are starting to test pancreatic cancer tumors for genetic and molecular abnormalities. By having that information, hopefully, we'll be able to use the correct type of chemo and the correct type of medicine to best treat patients. It’s part of the larger idea of personalized medicine that we've been hearing about for the last decade or so.
The other exciting area in cancer care is immunotherapy, which activates the patient's immune system to attack cancer cells. Cancer tends to put on a cloak and dagger, hiding from the immune system. By activating the immune system to the specific cancer cells, this may help manage pancreatic cancer.
Immunotherapy is in the early phases of development and research right now. Hopefully in the next five to 10 years, we'll have widely available immunotherapy for pancreatic cancer as we do for some other cancers.
The other aspect is earlier detection, because patients will do better if we're able to spot these cancers sooner in their development. Unlike some other cancers — for instance, breast cancer where you may feel a mass, or colon cancer with blood in the stool — there aren’t specific findings that occur in every patient. Perhaps in the future we'll have better screening to detect early markers, within the blood or some other area. While that testing doesn’t exist yet, there is work going on in that arena as well.
What are some ways nurses can advise their patients to “look out for” their pancreas?
Genetics certainly play a role, and some of it is just luck. Certainly if there's a strong family history for pancreatic cancer, that person may have a genetic predisposition to be aware of. Screening with either imaging or endoscopic ultrasound would likely be appropriate. I would recommend that a nurse or a practitioner refer that patient to a center that specializes in pancreas care.
Number two is overall health of the pancreas. There are a few things we know increase the risk of pancreatic cancer, one being smoking or tobacco use over time. We all know the risk smoking has on the lungs, but it also increases the risk of pancreatic cancer. This is just another reason for GI nurses to encourage patients to quit smoking. Chronic pancreatitis can also increase the risk of pancreatic cancer, so drinking alcohol moderation is important.
Those are ways that nurses can advise patients to change their lifestyles to further improve their pancreas health. Aside from that, it comes down to being vigilant about symptoms and knowing your family history.
How else are you seeing the conversation around pancreatic cancer evolving?
Pancreatic cancer is a tough diagnosis, but there are some exciting areas of research. As gastroenterologists, we interface with patients who have pancreatic cancer all the time, sometimes before they are diagnosed.
There are other symptoms related to pancreatic cancer, such as the management of gastric outlet obstruction and management of pain for pancreatic cancer that we can treat endoscopically. I think that the GI doctors and nurses see this problem quite frequently, so it's good to have a knowledge base on the topic.
With advanced therapies for pancreatic cancer — such as pancreas directed therapy, whether that's the Whipple surgery, and distal pancreatectomy, etc. — we have found that the outcomes for those complex surgeries are better at centers that do a high volume of those surgeries. When you suspect pancreatic cancer, it may be wise to refer those patients to such centers.
I'm hopeful that when we talk about this problem in 10 or 20 years from now, that we see more patients surviving pancreatic cancer longer than they are today.
Dr. Mark Gromski was a presenter at SGNA’s 48th Annual Course and delivered the session, “Pancreatic Cancer: Detection and Management Strategies.” SGNA’s 49th Annual Course is around the corner, taking place May 22-24 in Salt Lake City, Utah. Learn more about the event here.
Dr. Gromski specializes in gastroenterology for IU Health Physicians Gastroenterology. He earned his medical degree at Harvard Medical School. He then completed an internship and residency at Beth Israel Deaconess Medical Center, Harvard Medical School, and a fellowship at Indiana University School of Medicine.