4 Things to Know about Pancreatic Cancer

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Illustration of human abdominal area with pancreas highlighted in red.

Pancreatic cancer is difficult to detect early and often has spread to nearby organs when it is diagnosed.

The announcement by Jeopardy! host Alex Trebek on March 6 that he has stage IV pancreatic cancer has many people asking questions about this disease and its prognosis. MSK surgeon-scientist Vinod Balachandran, who has a particular research interest in pancreatic cancer, studies personalized cancer vaccines and other immunotherapies to treat people with the disease. Here, he discusses current treatment options and the most promising research in the field.

Vinod P. Balachandran, MD

Vinod Balachandran

What is the outlook for someone diagnosed with pancreatic cancer?

Compared with most other cancers, pancreatic cancer has a less favorable prognosis. The five-year survival rate for people with all types of pancreatic cancer is approximately 9%. For someone diagnosed with stage IV pancreatic cancer — meaning the cancer has spread from the pancreas to other organs — the median survival time is approximately one year. Overall, pancreatic cancer remains one of the most difficult cancers to treat.

In fact, pancreatic cancer is expected to become the second leading cancer killer in the United States by 2025, second only to lung cancer. Other diseases such as breast cancer, prostate cancer, and colorectal cancers are far more common, but we have more-effective therapies for them. There could be a national pancreatic cancer crisis unless we find better treatments.

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What are some of the risk factors for developing pancreatic cancer?

The strongest risk factors for pancreatic cancer are smoking, obesity, and diabetes. You also are at a higher risk if you are older than 55 or if you are African American. You are at a much higher risk if you have a family history of pancreatic cancer, defined as two or more first-degree relatives [parents, siblings, or children] with pancreatic cancer.

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How is pancreatic cancer usually treated?

The mainstays of pancreatic cancer treatment are surgery, chemotherapy, and radiation. Patients have much better outcomes if we can remove the tumor with surgery. Most people, however, can’t have surgery because when they are diagnosed the disease has already spread outside of the pancreas into other organs such as the liver. Some newer treatments that have shown great success in other cancers, such as targeted therapies and immunotherapy, have not yet made significant inroads into pancreatic cancer care. But that is rapidly changing.

People today have many more options than they did ten years ago.
Vinod P. Balachandran surgeon-scientist
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What are some reasons to be optimistic about the future?

There has been great progress in pancreatic cancer research and treatment. First, we are getting significantly better at giving standard treatments. Last year, a study showed that a combination of four chemotherapy drugs given after surgery could extend overall survival to nearly five years. This applies only to a particular group of patients, but it might be possible to replicate this success for other groups.

We also are learning that targeted therapies could be helpful in subsets of people with pancreatic cancer. A class of drugs known as PARP inhibitors has shown promise in treating certain pancreatic tumors in people with inherited mutations in the BRCA genes. These are the same genes that have been linked to hereditary breast and ovarian cancer, and PARP inhibitors have shown they can be effective against these cancers.

The other new area of research is immunotherapy. So far, pancreatic cancers have been resistant to this form of treatment. But as we learn more about the molecular makeup of pancreatic cancers, it will help us to develop better immunotherapy approaches. For example, we have learned that people with pancreatic cancer whose tumors had a certain type of mutation called mismatch repair will respond to immunotherapy drugs called checkpoint inhibitors. The FDA approved a checkpoint inhibitor drug, pembrolizumab (Keytruda®), for patients with this mutation in 2017. Even though pembrolizumab has helped only a small fraction of people with pancreatic cancer, it proves that immunotherapy can actually work for this disease.

Overall, people today have many more options than they did ten years ago. Even if standard therapies stop working, there are more treatment choices and clinical trials available. For the first time in a long while, there is a real belief in the pancreatic cancer community that we can effectively treat this disease. But more research is needed to develop better treatments. Progress requires research.

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Comments

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Dr. Balachandran, thanks for the explanation. My sister-in-law of 44 yr old was diagnosed with pancreatic cancer, spread already, but not to major organs. I have requested consultation on web, but would like to get your care. She is in China and we are in US.

Dear Danping, we’re very sorry to hear about your sister-in-law’s diagnosis. If she is interested in coming to MSK from China, we recommend that she contact our International Center at international@mskcc.org. Thank you for your comment and best wishes to you and your family.

Dear Team

My father passed away on the 4th of March : we only found out 3 weeks prior he had cancer ...

Unfortunately we were unable to determine what kind of cancer he had but what I do know is that he had 50 or more tumors in liver , cervical , thoracic and tale bone was compromised .

His father also passed away : cancer unknown ..Alledgedly he may have even passed at Sloan but we were estranged : hence why we don’t know .

Plus I have countless other relatives on my mothers side who passed : Colon, pancreatic ,prostate and lung.

I don’t want to feel like I’m a dead man walking ; how can I be proactive in my pursuit to be ahead of the cancer and not behind it

Dear Laura, we’re sorry to hear about your family history. If you would like to make an appointment to speak with one of our genetics counselors, you can contact our Clinical Genetics Service at 646-888-4050. Thank you for your comment and best wishes to you.

hello from Canada. my husband, age 53 recently had a Whipple to remove a choledochal cyst he was born with, and which had become intensely painful and problematic in recent years. The surgeon said everything looked healthy (aside from the cyst). The lab results found the cyst had become a T3 tumour at 8cm, and there were some cancers in the margins of the nerves and blood vessels, but all the 33 extracted lymph nodes were clear.

On the post-surgery visit, the surgeon called this a Cholangiocarcinoma and referred him to an oncologist. When we met with the oncologist he was calling it pancreatic cancer, and said chemotherapy treatment with Gemcitabine & Capecitabine would only have a 15% efficacy with a 75% likelihood of recurrence. Unfortunately my husband was also born with Tetralogy of Fallot and has quite low LVEF, and is not a good candidate for the Gemcitabine. The doctor also stated radiation is not a good treatment, post-operatively.

Needless to say this is all very fresh, confusing and painful news, but his gut reaction is to just leave it be. If he has limited time left, he doesn’t want to spend it suffering through ineffective chemotherapy treatments.

In my flurry of googling more information after our appointment, I came across many of the posts from Sloan Kettering, and felt a glimmer of hope.

So, my questions are numerous, but i’ll limit it to these: does this all sound normal? Could he be one of those special ones with strong immune systems? and is there any way to find out if he does have a strong immune system? and how does one find out what stage his cancer is at?

We’re very sorry to hear about what your husband is going through. We are not able to provide medical advice or answer specific questions online, but if you would like to arrange for a records review you can contact our International Center at international@mskcc.org. Thank you for your comment and best wishes to both of you.

Dear Doctor, Can you mention total cost for online review / study of MRI reports and CD of MRI, showing IPMN 9mm and few scattered cysts in pancreas , low Hb, low ferritin, low IgM , high Amylase .I am 60 male , diabetic , non smoker , obese . Surgery -for severe obs sleep apnea done last year in Canada.

Dr Balachandran: My endoscopic Pathology Report came thru late Thursday, Dr advised, and quickly arranged for me to see a surgeon, which happened this afternoon.
The conversation was bleak, Dr stating that my colon now occupies, what I thought was an empty space, the area between the removed spleen and the pancreatic staples (distal pacreatectomy 3 years ago), a distance of milimeters. He said the nodule was an atypical finding, in the ct scan, pet scan and endoscopy, as there are generally multiple findings throughout the stomach, on scans and the endoscopic procedure. Nevertheless, his experience has shown that its impossible to believe that there arent more cancerous bodies lurking, and that i should start chemo immediately.. and not do a laparascopy-- which i thought was possible.. He appeared to give up immediately.. He further indicated, that to get to the nodule he would need to cut the colon and said whats the point, as in his opinion these cancerous bodies would return..
He gave me a very dismal survival rate, saying there is nothing after a second chemo and if it doesnt disappear or there is indication of additional cancer while chemo is going on...typically 2 month regimen, and the usual cocktail., its a matter of time. He took a CA-19 blood test to see how much it went up since last month's ct and pet scans. Further he said that the cancer grows every two weeks.
PLease Reply..f. garner

We’re very sorry to hear about your diagnosis and what you’re going through. We are not able to make treatment recommendations on our blog, but if you would like to come for a second opinion at MSK you can make an appointment online or call 800-525-2225. Thank you for your comment and best wishes to you.

My dad underwent a surgery few weeks ago, diagnosed with pancreatic head mass. But the operation wasnt finished, the doctors didnt push through cos the mass already spread through his blood vessels. Dr said chemo wouldnt help him now and giving him few months to live. We are so worried i dont wanna lose my dad. Is there any way or procedure that could help him survive? Praying he’ll be able to be in the 2%!

We’re very sorry to hear about your dad. If he would like to come to MSK for a consultation to learn about treatment options, he can make an appointment online or call 800-525-2225. Thank you for your comment and best wishes to you and your family.

I have stage 4 now PC 2017 was when I was diagnosed was a stage 2 at the time 28 months still tryed surgery but it's in tail around artery and blood vessels was to risky to remove so went thru many rounds of chemotherapy different ones I'm now at point if we need to go another route like radiation or clinical trials what is a good recommendation or even maybe try oral chemotherapy next would you give advice to me on thank you for all this great info I am reading on this subject everyday for over 2 years now found your blog so thank you

Dear Bob, we’re very sorry to hear about your diagnosis. We’re not able to offer treatment advice on our blog, but if you’d like to arrange a consultation with one of our doctors, you can make an appointment online or call 800-525-2225. Thank you for your comment and best wishes to you.

My father is diagnosed with a pancreatic cancer stage 4 and has spread to liver and gall bladder.. Doctors suggested to start chemo..
Despite of these facts my father is a healthy person with no history of diabetes, blood pressure problem or any other disease
I am quite optimistic about his survival
Is there any treatment that you offer which differentiate it from chemo avaliable in Pakistan?
Or do you have any advances in this disease?
As i have read a blog stating that may be Israeli scientists will be able to introduce a complete cure for cancer.. Is it possible?

Dear Alina, we’re sorry to hear about your father’s diagnosis. We are not able to offer treatment advice on our blog, but if he is interested in getting his medical records reviewed, you can contact our International Center at international@mskcc.org.

The study you are referring to from Israel got a lot of media attention, but what much of the press coverage did not acknowledge was that the research is very early stage and it’s too early to know how effective it will ultimately be. Thank you for your comment and best wishes to you and your family.

My father in-law has recently been diagnosed with stage II pancreatic cancer the tumor is 2.5 cm
My Q is how rapid does this cancer spread
As he was just diagnosed in June and tests are still being done
Surgery for Whipple procedure is scheduled for end of July

Dear Jo, we’re sorry to hear about your father-in-law’s diagnosis. Unfortunately we are not able to answer specific medical questions on our blog, because there is so much variation among individual patients. If he would like to come to MSK for a consultation, he can make an appointment online or call 800-525-2225. Thank you for your comment and best wishes to you and your family.

Since 5 months I have a tumor in the pancreas (3.4 cm) with 3 metastases tumors in the liver (biggest with 2.4 cm and all went to 0.9 cm) after chemotherapies in a hospital in Connecticut, where I will be doing my 8.chemotherapy tomorrow. A CT-Scan evaluation will be done again on mid-September and I'm afraid about it since feeling weak recently. Would MSK take me for treatment ahead if I change hospitals?

We’re sorry to hear about your diagnosis. If you’d like to speak with someone about becoming an MSK patient, you can make an appointment online or call 800-525-2225. Thank you for your comment and best wishes to you.