What You Need to Know About Pancreatic Cancer

According to the American Cancer Society, approximately 53,670 people (27,970 men and 25,700 women) will be diagnosed with pancreatic cancer in the United States this year.  About 43,090 people (22,300 men and 20,790 women) will die of the cancer.

Pancreatic cancer accounts for about 3 percent of all cancers 7 percent of all cancer deaths in the US.

November is Pancreatic Cancer Awareness Month, so we’ve interviewed Sasan Roayaie, MD, a hepatobilliary and pancreatic surgeon at White Plains Hospital — and a leader in developing minimally invasive hepatobiliary and pancreatic surgery — to shed some light on this very serious disease.

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What is pancreatic cancer? 

The most common type of pancreatic cancer is called adenocarcinoma and usually develops from the cells lining the ducts of the pancreas. Depending on where the cancer starts within the pancreas, it can either cause early symptoms, usually by blockage of the bile duct, or can grow and present later. A different and more rare type of pancreatic cancer, called neuroendocrine tumors, can arise from the islet cells, like the insulin-producing cells, of the pancreas. These are less aggressive than the standard adenocarcinoma. Steve Jobs had neuroendocrine cancer of the pancreas.


What are the causes, risk factors, and odds of developing pancreatic cancer? 

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Pancreas cancer is the fourth leading cause of death in men and also women. The incidence in both men and women is rising. The risk factors we can change include: tobacco use, obesity, chemical exposures at work (dry cleaning, metal work), diabetes, and chronic pancreatitis. The risk factors we can’t change include: age, gender (men are at higher risk than women), race (African Americans are at higher risk), family history, and inherited genetic disorders (BRCA1 & 2, FAMM, Lynch syndrome, Peutz – Jeghers, for NET:  Neurofibromatosis, Multiple endocrine neoplasia type I).


Is there anything people should know to prevent it or lower risk?

The best preventative measures to reduce risk for all cancers are to maintain a healthy weight, avoid excessive alcohol, and quit smoking.


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Why is surgery that involves the pancreas and surrounding areas so difficult and what kind of challenges does it pose for you?

Because of the complex anatomy in this part of the body, many of the tumors in the liver, pancreas, and bile duct involve vital arteries, veins, and other structures that must be preserved. Many surgeons would consider tumors involving these structures as inoperable. Having trained and worked as a transplant surgeon, I am comfortable in resecting and reconstructing these structures if needed.


Has anything changed over the last 10 years in pancreatic cancer treatment? Any new treatments or developments on the horizon?

Significant improvements in chemotherapy can now convert many inoperable cancers to ones that can undergo surgery. Improved techniques in surgery and perioperative care have led to significant decreases in morbidity and mortality after surgery.


What type of screening is available for pancreatic cancer and who should be screened?

White Plains Hospital offers a pancreatic screening early-detection program as part of a clinical trial for people with a family history of pancreatic cancer and other risk factors. 


Are there any symptoms, even subtle ones, that might indicate someone has pancreatic cancer?

Symptoms can include dark urine, itchy skin, yellow eyes, pain above the belly button that goes to the back, or new-onset diabetes.


Is there a blood test or any other test short of a biopsy that can determine if a person does pancreatic cancer?

There are now “liquid biopsies” that detect tumor DNA and tumor cells in the circulation that can sometimes find cancers before they are visible on CT scan or MRI. However, they are not FDA approved for clinical use yet.


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