Spotting pancreatic cancer early: Insights from a surgical oncologist

Transcript

Scott Webb (Host): The pancreas is an essential organ in our body. It wears many hats, and knowing the warning signs of pancreatic cancer and our family history can greatly improve our chances of survival. Joining me today to share his insights is Dr. Jesse A. Clanton. He’s a surgical oncologist with Prisma Health.

This is Flourish, the podcast brought to you by Prisma Health. I’m Scott Webb. Doctor, it’s nice to have you here today. I said we’re going to talk about pancreatic cancer and that you’re the right person to have on: a surgical oncologist, the right medical expert, if you will. So, let’s start there. Just foundational, just to make sure we’re all on the same page here, what is the pancreas and what does it do?

Jesse A. Clanton, MD: The pancreas is an organ in your upper abdomen that is responsible for a number of different endocrine and exocrine functions. Basically, the pancreas makes chemicals that help control your blood sugar and also makes other juices that mix in with the food you eat and helps you digest and absorb that food so you can get all the nutrients from, hopefully, the nutritious things that you eat.

Host: Yes, hopefully, of course. And I knew that the pancreas wore many hats, if you will. But, now, you’ve given us an idea of, you know, the actual hats that it wears, which is good. So, let’s talk alcohol and its relationship to the pancreas. How does it affect the pancreas?

Jesse A. Clanton, MD: Alcohol can cause inflammation of the pancreas, and that can show up in a lot of different ways. That inflammation over time, especially with repeated exposure to alcohol, can cause chronic inflammation and damage to the pancreas over time. Sometimes that can result in pancreatitis, which is acute inflammation of the pancreas. And then, if that keeps happening, some people can end up getting what’s called chronic pancreatitis, especially associated with heavy alcohol use.

Host: Yeah. And I sort of teased at the beginning we were going to talk specifically about pancreatic cancer. So, what’s the relationship then between heavy alcohol use and pancreatic cancer?

Jesse A. Clanton, MD: We know that chronic pancreatitis is a risk factor for developing pancreas cancer, and alcohol use as well can be an independent risk factor. And so, you know, I advise all of my patients to reduce whatever risk factors they can. There are some risk factors that are out of your control. Things like your family history, things like your genes or your DNA. But things like alcohol or smoking, those are in our control. And we know and we’re learning more and more how those can increase our risk of getting pancreas cancer.

Host: Right. As you say, we can’t really outrun our family history and genetics. But there are things, behavior, lifestyle, diet, all those things. So when we think about those other risk factors, things that could contribute to pancreatic cancer, what would be your recommendations in terms of behavior, lifestyle? So if you’re smoking, quit smoking, of course, but anything else?

Jesse A. Clanton, MD: Yeah, I mean, it’s a lot of common sense stuff to be honest with you. So, eating a healthy diet and avoiding obesity, because we know that obesity or being overweight is also a risk factor for developing pancreas cancer. So, eating a diet rich in fruits and vegetables and lean proteins and limiting processed foods, processed meats, and then certainly avoiding– and it doesn’t have to be strict avoidance, but limiting and in moderation any alcohol and probably avoiding tobacco use.

Host: Yeah, moderation, sure. So, are there any symptoms of pancreatic cancer? Like, do folks know? And, Doctor, when I speak with, you know, cancer experts, they never say that delayed diagnosis is good, right? So, I’m assuming that early diagnosis is important.

Jesse A. Clanton, MD: You’re absolutely right, and I’m glad you asked. Pancreas cancer is often called a silent disease, because it doesn’t cause symptoms until it’s advanced. But there are early signs and risk factors that we’ve talked about that we pay attention to, and we’re doing a better job picking up more and more of these cancers earlier and earlier.

So, some of the early warning signs that some people might notice; the first obvious one is jaundice. And that’s yellowing of the skin or eyes. Some patients might notice that right away themselves. Sometimes your family members might be the first ones to point that out. “Hey, you look a little yellow. ” Before you notice the yellowing of your eyes or skin, sometimes you might notice real dark urine or pale stools or even itching. And that’s all related to the jaundice, and that’s a very common early warning sign of pancreatic cancer. But there can be other ones.

It could be unexplained weight loss or loss of appetite. It could be persistent upper abdominal or back pain or digestive changes like bloating or nausea, or some people can develop new-onset diabetes, especially later in life. Most cases of diabetes happen between 45-years-old and 65-years-old. And so, if you’re in your 70s or 80s and all of a sudden develop new or worsening diabetes, that could actually be an early sign.

But many of these signs are vague. So, I guess my overall advice is don’t ignore persistent unexplained changes in your bodies. And if something doesn’t feel right, you should go get it checked.

Host: Yeah. That’s such great advice from an expert. I think a lot of us, Doctor, as we age, we just sort of say, “Well, you know, this doesn’t feel right or that hurts, or this is a little different. But I am older.” And from speaking with experts again, you know, PRISMA Health and otherwise, you know, I’ve come to learn that just because we’re older, that doesn’t mean that things should hurt or that things should be wrong or things be different, right?

Jesse A. Clanton, MD: Absolutely. Yes. Yes.

Host: So then, maybe this is a little bit of a loaded question, but we’ll do what we can here within the framework of a podcast. But how do you treat pancreatic cancer?

Jesse A. Clanton, MD: It is a loaded question because there’s several different treatments, and we’re developing new treatments all the time. So, the mainstays of pancreas cancer treatment are similar to many other cancers. Sometimes we do surgery, sometimes patients get chemotherapy, sometimes patients get radiation therapy. And we’re developing even newer medications such as immunotherapies to treat pancreas cancer as well. Because pancreas cancer is often an aggressive disease, the patients who do best often get more than one sort of treatment. So, they may get surgery and chemotherapy, or maybe even radiation therapy or immunotherapy along with that.

Host: I wanted to ask you about survival of pancreatic cancer. So just in general, are folks living longer? Is early diagnosis and some of these new treatment options, immunotherapy and otherwise, is it helping folks to live longer and survive longer from pancreatic cancer?

Jesse A. Clanton, MD: So, pancreas cancer unfortunately remains really challenging to treat, especially in terms of survival, but outcomes can vary significantly depending on when it’s diagnosed. So, that’s why it’s so important about what we talked about earlier, is recognizing some of the early symptoms. If you diagnose this in an early stage, then if it’s localized, if it’s just in the pancreas itself, we’re getting significantly improved survival, maybe up to 50% five-year survival. But if the diagnosis is only made after it’s had a chance to spread to other parts of your body, and that’s a late stage where there’s metastatic disease, stage IV cancer, then the five-year survival rate drops down to the single digits.

Host: Of course. Yeah, I know. It’s like, you know, with cancer, it’s one of those things where I keep hearing all this good news and great work and studies, and there’s so much room for optimism. But of course, when it comes to pancreatic cancer, there are things we can do to help ourselves, right? As we talked about, your family history, genetics, DNA, those things are what they are. Maybe knowing what they are is helpful. So, family history would be good. But when we think and wrap up here, Doctor, where we talk about prevention of pancreatic cancer, is it as simple as that? Like, we have to do our part– don’t smoke, drink in moderation, eat better, lose weight, all those things?

Jesse A. Clanton, MD: That’s a big part of it. I would say that there is a focus on prevention. Avoiding tobacco and excess alcohol and maintaining a healthy weight. Watching for early symptoms. But there continues to be advances constantly in screening and research. There’s no universal screening test yet.

We do screen in high risk individuals, so if you have more than one risk factor, if you have a family history, if you have some genetic syndrome or other things like, you know, chronic pancreatitis that might put you at high risk, then sometimes you may be a candidate for screening. We’re learning more and more about the role the DNA plays.

And so, more and more patients are getting referred to genetic counselors where they can do tests to see if there is some genetic risk for you or family members that puts you at higher risk for developing pancreas or other types of cancers, and then enter into a screening program.

I’m really happy we just talked about survival a minute ago. Since the time I finished training, the survival has more than doubled, just in the short time that I’ve been practicing surgery and doing this and taking care of patients with pancreas cancer. And so, that makes me really optimistic that we’re going to continue to improve our treatments, that we’re going to continue to be able to offer these treatments to more patients at an earlier stage and continue to see that grow.

Host: Well, like I said, you know, there’s room for optimism and I can hear it in your voice. And, you know, when I get experts on who treat some of these deadly conditions and diseases and all of that, and they’re optimistic about the future, survival or surviving pancreatic cancer, it brings a smile to my face too. So, thank you so much.

Jesse A. Clanton, MD: My pleasure.

Host: And for more information, go to prismahealth.org/news. For more information and other podcasts just like this one, head on over to prismahealth.org/flourish. This has been Flourish, a podcast brought to you by PRISMA Health. I’m Scott Webb. Stay well.