Pancreatic Cancer

What is it?

Pancreatic cancer is a disease of the cells of the pancreas.

It develops from an initially normal cell that transforms and multiplies uncontrollably, eventually forming a mass called a malignant tumor (or cancer). Pancreatic cells sometimes undergo changes that cause their growth and behavior to become abnormal.

In 2020, approximately 495,773 new cases of pancreatic cancer were recorded worldwide, with a relatively balanced distribution between men and women, although the exact numbers may vary by region (Fondation ARC, Cancer Environnement).

The incidence rate is increasing, primarily among people over the age of 50, with a rise of +1.6% per year between 2010 and 2023 in men and +2.1% per year during the same period in women.

This disease mainly affects individuals over the age of 55, with an average age at diagnosis around 74 years for women and 71 years for men (Cancer Environnement and Ligue contre le cancer).

Causes and risk factors

Pancreatic cancer results from a complex interaction between constitutional and environmental factors.

Among the constitutional factors are genetic predispositions, family history, and demographic characteristics (such as age, sex, and specific populations). Environmental factors include diabetes, obesity, smoking, chronic pancreatitis, and occupational exposure.

These factors highlight the need to better understand genetic and environmental interactions to prevent and detect early this aggressive cancer.

Screening

Pancreatic cancer screening aims to detect precancerous lesions or cancers at an early stage in individuals at high risk.

Certain populations are particularly targeted by this screening :

• Individuals with more than 2 cases of pancreatic cancer in their first-degree relatives or more than 3 cases in the family overall (regardless of the relationship).
• Patients with hereditary chronic pancreatitis or genetic syndromes such as Lynch syndrome.
• Individuals carrying a genetic mutation that increases the risk of pancreatic cancer.

This screening involves a consultation with an oncogeneticist, an MRI, or pancreatic endoscopic ultrasound. It will occur annually starting at age 50 or 10 years before the age of the youngest affected family member.

Symptoms

Pancreatic cancer is often referred to as a silent disease because it usually causes no symptoms in its early stages.

Signs typically appear only when the tumor grows larger, but they are often vague or easily overlooked.

The most common symptoms include :

• General symptoms : Fatigue, loss of appetite (anorexia), and rapid, significant weight loss.
• Digestive symptoms : Abdominal pain, nausea, vomiting, bloating, a feeling of fullness after a small meal, and bowel issues (diarrhea, constipation, or abnormal greasy stools).
• Urinary and skin symptoms. : Dark urine and yellowing of the skin and whites of the eyes (jaundice).

Since many of these symptoms are non-specific, they can be mistaken for other conditions, making diagnosis challenging.

Diagnosis

The diagnosis of pancreatic cancer begins with a consultation with a general practitioner or gastroenterologist, who reviews personal and family medical history along with observed symptoms.

A physical examination includes checking for signs such as jaundice, an abdominal mass, or enlargement of organs (liver, spleen).

The diagnosis relies on various tests :

• Laboratory tests : Analysis of tumor markers (CA 19-9 and CEA) in the blood, although these are not specific to cancer.
• Medical imaging : Ultrasound, CT scan, MRI, or pancreatic endoscopic ultrasound to detect abnormalities.
• Biopsy : Collection of pancreatic tissue (via fine-needle aspiration or laparotomy) to confirm the diagnosis and analyze the tumor under a microscope.
• Staging tests : Procedures such as PET/CT and laparoscopy to evaluate the spread of the disease (metastases)

Cancer stages range from I (localized) to IV (metastatic cancer). This classification, along with the grade (aggressiveness), guides treatment decisions and helps predict disease progression.

Treatments

The treatment of pancreatic cancer involves a multidisciplinary team including an oncologist, a radiotherapist, a surgeon, and sometimes a pathologist. This team meets to propose the most suitable treatment, which is then explained to the patient during a consultation.

Treatments vary depending on the stage of the cancer :

• For operable stages I and II : surgery followed by adjuvant chemotherapy is the only curative treatment.
• Locally advanced cancers (stage III) are treated with chemotherapy, radiotherapy, or chemoradiotherapy, with surgery sometimes performed to alleviate symptoms.
• Stage IV tumors are treated with chemotherapy, with or without targeted therapy.

Chemotherapy aims to destroy cancer cells but can also affect normal, fast-renewing cells, causing side effects.

Targeted therapies, a recent advancement in pancreatic cancer treatment, specifically target molecules involved in the cancerization of cells.

Ongoing clinical trials offer new treatment perspectives, with 50 trials currently open in France.