Warning Signs of Pancreatic Cancer and Advances in Treatment

Survival rates have risen and there are new treatments, but early diagnosis is key

Twenty years ago, getting a pancreatic cancer diagnosis was often devastating. The cancer usually wasn’t caught until later stages, partly because the pancreas is tucked behind the stomach, making it hard to detect tumors. Plus, many of the warning signs — abdominal discomfort, back pain, unintended weight loss and fatigue — are easy to overlook or write off as something else entirely, and they often arise late in the game.

“[Pancreatic cancer] almost sits silently in the body, and then it shows up when it's advanced,” says Shubham Pant, M.D., a professor in the Department of Gastrointestinal Medical Oncology at the MD Anderson Cancer Center in Houston.

Today, however, the five-year survival rate for pancreatic cancer has more than doubled from where it was two decades ago. If the disease is caught early and the tumor is small and confined to the pancreas, the survival rate is around 44 percent, according to the American Cancer Society.

Several recent medical advances have helped prolong the lives of many people with pancreatic cancer, says Brian Wolpin, M.D., a professor of medicine at Harvard Medical School and co-director of the Pancreas and Biliary Tumor Center at Dana-Farber Cancer Institute in Boston. Systemic treatments, like chemotherapy, have improved, and radiation delivery has gotten better and more precise, he says. What’s more, breakthroughs in targeted therapies are generating “major excitement in the field,” Wolpin adds.

Here's a look at some of the latest progress taking place in pancreatic cancer.

Advances in detection and treatment

8 Warning Signs of Pancreatic Cancer

Treatment is more likely to be effective the sooner the cancer is caught.

Abdominal discomfort in the mid- to- upper abdomen that often radiates to the back
New onset diabetes or worsening blood sugar levels, especially with weight loss
Darkening of urine and lightening of stool
Jaundice (yellowing of the skin and whites of the eyes)
Itching
Nausea and vomiting
Fatigue
Loss of appetite and unintentional weight loss

The great promise of targeted therapy

Researchers are learning more about unique changes in pancreatic cancer cells that help them grow, and are developing treatments to target these changes. These medications are known as targeted therapies.

“When you talk about targeted therapy, it's on the assumption that there's a specific molecular alteration — whether a gene mutation or a protein over-expression — that is an Achilles heel for that cancer and is something that's very actively driving that cancer,” says Michael Pishvaian, M.D., director of Gastrointestinal, Developmental Therapeutics and Clinical Research Programs for the Johns Hopkins Kimmel Cancer Center. “And by shutting down its activity, usually with a drug, then you can significantly impede or reverse the growth of the cancer.”

There are a number of targets researchers have identified in pancreatic cancer — a big one is a mutation on the KRAS gene, which is present in the vast majority of pancreatic cancer cases. Pisvaian says there has been “an absolute tidal wave of new therapies” targeting KRAS that have emerged, and early data is showing promising results.

Pant explains that these experimental therapies — all are still in clinical trials — work by turning the mutation off, just like a light switch turns the lights off.

“If you have the [KRAS] mutation, the light is always turned on in your house, and you cannot turn it off because it's stuck in the ‘on’ position,” Pant says. “So these inhibitors bind to that switch and turn it off. So just like the light would go off in your house, this mutation leads to cancer-cell death once you turn that switch off.”

Progress is being made with other targets as well, which is why molecular testing of pancreatic cancer is crucial, doctors say. “There's a lot more going on now where we've been able to design drugs against targets in pancreatic cancer that just didn't have drugs before,” Wolpin says.

Using artificial intelligence to discover cancer

Early pancreatic cancer can be subtle enough that it’s missed on imaging scans 30 percent of the time, which means that about half of all cases aren’t caught until later stages.

“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 (AI) to teach the computer to read CT scans to detect tumors at their smaller, 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.

Researchers are using AI in other ways as, well. “Early pancreatic cancers affect the normal body in many ways, and there may be ways you can see differences in the liver or in the spleen or other areas of the body that might again give you a sense of elevated risk for the disease,” Wolpin says. “So I think work is expanding beyond just looking at the pancreas.”

Scientists are also studying how AI could help predict a person’s pancreatic cancer risk by reading a patient’s medical records, Wolpin adds.

Using blood tests 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.

Scientists have made progress on these tests in recent years, but none are available yet, and Pant says it could still be a few years before we get a screening test for pancreatic cancer.

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.

There are multiple clinical trials going on in the United States looking at vaccine approaches, Wolpin says, and they are mostly with patients who have had surgery to remove their cancer.

“These patients have a high risk for recurrence because in many patients, even though we remove the tumor by surgery, there are cancer cells left behind elsewhere in the body,” he says. “If we could use a vaccine that would then harness the immune system to attack those residual cells, maybe we could cure more patients after their surgery.”

In a small clinical trial published in 2023 in the journal Nature, 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.”

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 American Cancer Society.
People who have obesity (BMI of 30 or higher) are about 20 percent more likely to develop pancreatic cancer, according to the American Cancer Society. 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 alcohol 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:

Some 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.

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.