Warning Signs of Pancreatic Cancer and Advances in Treatment

Delivering more with guided radiation therapy

Norman Kravetz, of Boynton Beach, Florida, was diagnosed with stage 3 pancreatic cancer in 2019. He had six months of intensive chemotherapy, followed by cutting-edge MRI-guided radiation therapy at the Dana-Farber/Brigham and Women’s Cancer Center in Boston. The new technology combines two ways of targeting the tumor to increase precision.

Without magnetic resonance imaging (MRI) guidance, radiation therapy can be technically challenging because of the location of the pancreas in the middle of the abdomen. “MRI guidance allows us to visualize and accurately deliver radiation treatment in order to treat the tumor with high doses of radiation while reducing the radiation dose to nearby vital structures, thereby reducing the risk of side effects,” explains Joseph Mancias, M.D., Kravetz’s radiation oncologist at Dana-Farber.

After the six months of chemo and just one week of the new radiation treatment (usually available at major medical centers across the country), Kravetz saw his tumor shrink, and in early 2020 he was able to have surgery to remove it.

“Everything is back to normal. I go to the gym five to six times a week. … I am healthy and feel great,” Kravetz told AARP in 2022. “[The doctors] call me the miracle guy.”

Using artificial intelligence to read scans

Early pancreatic cancer can be subtle enough that it’s missed on scans 30 percent of the time, which means that about half of all cases aren’t caught until later stages, as was true with Jeopardy! host Alex Trebek, who died of the disease in November 2020.

“We should be able to do better,” says Elliot Fishman, M.D., professor of radiology and radiological science at the Johns Hopkins School of Medicine in Baltimore. To that point, he’s been using artificial intelligence to teach the computer to read CT scans to detect tumors at earlier stages so they can be surgically removed. As of February 2022, Fishman had screened several thousand pancreatic cancer patients with the technology and has been able to detect tumors with 90 percent accuracy.

Using blood and urine screenings to detect pancreatic cancer early

As is done for many other cancers, a simple urine or blood test may one day be used to screen for pancreatic cancer in its earliest stages, since body fluids contain bits of DNA from tumor cells. Research teams are developing methods of blood-based DNA analysis to detect pancreatic cancer with high accuracy, says Brian Wolpin, M.D., associate professor of medicine at Harvard Medical School and director of the Gastrointestinal Cancer Center at Dana-Farber.

“Scientists have made quite a bit of progress in the last five years in developing these multicancer early detection tests, and large studies are now ongoing to define their utility,” says Wolpin, who notes that such procedures may be able to detect cancerous tissue 90 percent of the time. Meanwhile, in clinical trials in the United Kingdom and Finland, researchers are studying urine analysis to detect pancreatic cancer this way. 

Exploring a vaccine for pancreatic cancer

While vaccines are often thought of as a tool to prevent an illness, researchers are studying their use to treat certain cancers, including pancreatic cancer. 

In a small clinical trial, a research team from Memorial Sloan Kettering Cancer Center found that a personalized mRNA vaccine was able to prevent the most common type of pancreatic cancer from returning in about half of study participants. 

“It’s exciting to see that a personalized vaccine could enlist the immune system to fight pancreatic cancer — which urgently needs better treatments,” study coauthor Vinod Balachandran, M.D., a surgical oncologist at Memorial Sloan Kettering Cancer Center, said in a news release. “It’s also motivating as we may be able to use such personalized vaccines to treat other deadly cancers.”

The research was published in May the journal Nature.

Know — and lower — your risk factors for pancreatic cancer

“Increasing awareness of the risk factors associated with pancreatic cancer development — such as having a family history of pancreatic cancer, having a pancreas cyst on a CT or MRI scan, or developing new onset diabetes — offers the opportunity for us to diagnose pancreatic cancer early and intervene, with the overall hope of improving patient outcome overall,” says James Farrell, who has a MB.Ch.B degree, of the Yale Center for Pancreatic Diseases at the Yale Cancer Center.

You can lower your risk for pancreatic cancer by changing unhealthy lifestyle behaviors you can control, such as smoking, drinking alcohol and being overweight:

• About 25 percent of pancreatic cancers are thought to be caused by cigarette smoking. Cigar smoking and using smokeless tobacco raise your risk, too, according to the ACS.

• People who have obesity (BMI of 30 or higher) are about 20 percent more likely to develop pancreatic cancer, according to the ACS. Type 2 diabetes is more common among overweight adults, and this condition raises the risk for pancreatic cancer, too, especially in those over 50 who suddenly develop type 2 diabetes without having a family history of it, Dana-Farber’s Wolpin says. 

• Drinking can lead to chronic pancreatitis, or inflammation of the pancreas, which has been linked to an increase in pancreatic cancer.

Certain risk factors for pancreatic cancer can’t be changed, but they’re important to know, and you should share yours with your doctor:

• About 10 percent of pancreatic cancers are thought to be the result of genetics. If you have a family history of the disease, talk with your doctor about whether you should be screened for it.

• A family history of other cancers and syndromes can also raise your risk for pancreatic cancer. These include hereditary breast and ovarian cancer caused by BRCA1 or BRCA2 mutations, and Lynch syndrome, an inherited disorder associated with colon cancer.

Data has been mixed about whether long-term use of proton pump inhibitors to reduce stomach acid, or infection with Helicobacter pylori (a bacteria that can cause ulcers), increase the risk of pancreatic cancer, Wolpin says.

Other risk factors include age, gender and race. Men develop pancreatic cancer slightly more often than women. The risk of developing it increases with age. And African Americans are more likely to get pancreatic cancer than any other racial group.

Editor’s Note: This story, published Feb. 4, 2022, has been updated with new information.