Andrew Rhim, MD, is an instructor of medicine at the Perelman School of Medicine at the University of Pennsylvania. Dr. Rhim specializes in cancer risk evaluation, surveillance, and the medical management of gastrointestinal malignancies. His research focuses on defining the biology of early pancreatic tumor formation and progression and developing new technologies to detect pancreatic and other gastrointestinal cancers at their earliest stages, before they metastasize.
Pancreatic cancer is one of the deadliest cancers. It’s estimated 45,000 people will be diagnosed with pancreatic cancer this year, making it the ninth most common cancer in the United States.
Of those people diagnosed with pancreatic cancer, about 38,000 will die of the disease. Unfortunately, these statistics have remained the same for decades.
Why is pancreatic cancer so lethal?
Pancreatic cancer is so deadly because of metastasis.
Metastasis refers to when a cancer leaves its “home” organ, or where it was first found and diagnosed, and spreads to other parts of the body. As it spreads, it damages the other organs, either through the bloodstream or invading them directly.
Pancreatic cancer metastasizes more frequently than almost any other cancer. Currently, the only known way to cure pancreatic cancer, is to catch it early before the cancer has had the chance to spread beyond the pancreas. When caught at this early stage, surgery can lead to cure.
Cancer specialists at the Abramson Cancer Center are able to detect many pancreatic tumors before they grow to a large size, and potentially, before they spread. But, it is impractical and costly to screen everybody for pancreatic cancer. Penn’s cancer team focuses its efforts on those who are at increased risk for this disease.
Who is at risk for pancreatic cancer?
Risk factors for pancreatic cancer can be organized into high, medium, and low risk factors.
High risk factors for pancreatic cancer increase your risk by more than 10-fold over the general population. These factors are due to genetics that are passed on or inherited within a family. These include some rare genetic diseases such as Peutz-Jeghers syndrome, hereditary pancreatitis, and familial atypical multiple mole melanoma syndrome. There are many instances where pancreatic cancer runs in the family, but there isn’t any associated disease that raises a red flag for physicians. These “pancreatic cancer families” can be defined as having three or more members with pancreatic cancer or two first-degree relatives with pancreatic cancer.
Moderate risk factors for pancreatic cancer increase your chances for pancreatic cancer from 5- and 10-fold over the general population. These risk factors include having cystic fibrosis, chronic pancreatitis (an inflammatory disease of the pancreas), and carrying a mutation in the BRCA2 gene (a cause of hereditary breast and ovarian cancer). Patients with some types of pancreatic cyst lesions, which may be discovered on CT scans and MRIs, are also at elevated risk for pancreatic cancer.
Low risk factors for pancreatic cancer increase the risk 1- to 5-fold over the general population. These risk factors include being Ashkenazi Jewish descent or African American, having at least one first-degree relative with pancreatic cancer, and carrying a mutation in the BRCA1 gene.
What should you do if you’re at risk?
All people, regardless of their risk level, should make good lifestyle choices.
Those who smoke, are overweight and lead a sedentary lifestyle, and those who drink a lot of alcohol (four or more drinks per day) may be at increased risk for pancreatic cancer.
These lifestyle factors can combine with any of the genetic factors listed above to increase someone’s chances of pancreatic cancer to even higher levels.
Patients who are at high-risk, and perhaps those at moderate risk, should consider consultation at a specialized high-risk pancreatic cancer clinic, such the program at the Abramson Cancer Center. This clinic has a number of specialized physicians and genetic counselors who can estimate your risk for pancreatic cancer and guide your next steps.
As part of this team, specialized gastroenterologists and radiologists may use a combination of proven and high-tech non-invasive tests that can detect pancreatic tumors before they have spread. These tests include:
Patients at lower risk can discuss their risk with their physician. Some patients may have multiple risk factors, so it can be difficult to determine their actual risk for pancreatic cancer. If you have questions, ask your doctor, or make an appointment with a gastroenterologist at Penn
Learn more about pancreatic cancer treatment at the Abramson Cancer Center.
Learn more about the Gastrointestinal Cancer Risk Evaluation Program at the Abramson Cancer Center.
Learn more about the Gastrointestinal Cancer Evaluation Center at the Abramson Cancer Center.
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