Early Detection of Pancreatic Cancer
The Pancreatic Cancer Early Detection Clinic brings together the best minds in pancreatic disease care to focus on detecting early signs of pancreatic cancer in individuals and families who may be at risk. Our collaborative, team approach gives patients access to nationally known gastrointestinal interventional endoscopists and pancreatic surgeons in one convenient clinic visit on Friday afternoons.
Thanks to advances in genetics and improved diagnostic tools, physicians can now offer sophisticated screening services to individuals who are at risk for developing pancreatic cancer. Screening is important for these patients because pancreatic cancer often does not produce symptoms until it has reached an advanced stage, when the cancer is difficult to treat. Through close monitoring, doctors can identify early signs of cancer -- and more lives will be saved through effective care when the cancer is at a "treatable" stage.
- Who should be screened for pancreatic cancer?
- What kind of pancreatic screening services are available?
- What happens if suspicious lesions are present?
- What should I do if I suspect that I am at risk for pancreatic cancer? How can I make an appointment for pancreatic cancer screening?
Q. Who should be screened for pancreatic cancer?
A. Not everyone should be screened for pancreatic cancer. Screening makes sense for people who are at risk for the disease, typically due to new abnormalities detected on an imaging study (e.g. cyst on a CT scan), hereditary factors or genetic syndromes that increase the likelihood of developing pancreatic cancer. The list below can help you determine if you and your family may benefit from an evaluation.
Factors that Increase the Risk for Pancreatic Cancer:
- Pancreatic cysts. There are many types of benign cysts and pseudocysts, as well as precancerous cysts, such as intraductal papillary mucinous neoplasm (IPMN) or mucinous cystic neoplasm (MCN). While most pancreatic cysts will not cause pancreatic cancer, it's important to be evaluated by a pancreatic expert to determine the cyst type and best treatment options. » What happens if a suspicious cyst or lesion is present?
- Two or more first-degree relatives (parents, sibling, child) with pancreatic cancer
- One first-degree relative diagnosed with pancreatic cancer at an early age (under the age of 50)
- Two or more second-degree relatives (grandparent, aunt/uncle, niece/nephew, half-sibling) with pancreatic cancer, one of whom developed it at an early age
- Patients above the age of 50 who have new onset diabetes are at higher risk of having pancreatic cancer. Up to 85 percent of people with pancreatic cancer have diabetes or hyperglycemia, which frequently manifests as early as two to three years before the diagnosis of cancer is made. Patients with new onset diabetes have a five- to eight-fold increased risk of being diagnosed with pancreatic cancer within one to three years of developing diabetes.
- History of a genetic syndrome associated with pancreatic cancer (see table below)
Genetic Syndromes Associated with Pancreatic Cancer
| Genetic Syndrome | Genetic Mutation | Clinical Clues |
PRSS1 |
History of pancreatitis starting at an early age | |
Breast-ovarian cancer syndrome |
BRCA2 |
History of breast and/or ovarian cancer |
Hereditary nonpolyposis colorectal cancer syndrome |
Mismatch repair genes |
Personal or family history of early colorectal cancer |
Familial atypical multiple mole melanoma syndrome (FAMMM) |
CDK2NA/p16 |
Multiple melanomas with or without history of pancreatic malignancy |
Peutz-Jeghers syndrome |
STK11/LKB1 |
Benign polyps of the gastrointestinal tract with pigmented macules on the lips, inner lining of the cheeks, and hands/feet |
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Q. What kind of pancreatic screening services are available?
A. At the University of Chicago Medicine, we offer a customized approach to early detection of pancreatic cancer. Our team includes experts in gastrointestinal interventional endoscopy, pancreatic surgery, genetics, radiology and pathology, as well as genetic counselors, nurses and laboratory technicians. Together, these specialists create screening and treatment plans tailored to each patient's needs, and can recommend screening measures for family members who may also be at risk.
Before the first clinic appointment, each patient speaks with an advanced practice nurse navigator to discuss prior health concerns, family medical history and previous diagnostic tests. If appropriate, the patient may be scheduled for a diagnostic 3-D CT scan or MRI that will be interpreted by a radiologist who specializes in pancreatic disease. These tests can be conveniently scheduled to occur the same day as the clinic evaluation.
In some cases, patients may meet with a genetic counselor and may have genetic tests to look for mutations that increase the risk for pancreatic cancer.
If a predisposition to cancer is present, our physicians may recommend one or a combination of the following imaging tests:
- Endoscopic ultrasound (EUS), a minimally invasive imaging test that uses an endoscope (thin, flexible tube) to evaluate the pancreas for lesions or early cancers. If suspicious lesions are present, doctors obtain tissue biopsies during the same procedure.
- Magnetic resonance cholangiopancreatography (MRCP), a type of magnetic resonance imaging (MRI) test that focuses on the pancreas and bile duct.
- Computed tomography (CT) scans, another imaging test that can show some types of suspicious lesions. Here, our experts can offer high-resolution 3-D pancreatic CT imaging, which produces better, more detailed diagnostic images.
- Endoscopic retrograde cholangiopancreatography (ERCP), a test that combines the use of endoscopes and X-rays to visualize the pancreas and biliary tree. Biopsies can also be performed during ERCP.
Not all tests and services are appropriate for everyone. Depending upon your risk factors and medical history, our physicians may recommend follow-up testing at predetermined intervals.
After clinic ends, our multidisciplinary team of experts meets to review each patient's case. Treatment plans are finalized during these meetings and patients receive care recommendations the following week.
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Q. What happens if a suspicious lesion or cyst is present?
A. The quality of abdominal imaging has significantly improved, allowing for better detection of small pancreatic cysts (lesions). Some people who have suspicious lesions, which may be precursors to pancreatic adenocarcinoma, need surgery. Others may benefit from yearly follow-up appointments. The recommended care plan is determined by symptoms and the type, location and size of the lesion (e.g. intraductal papillary mucinous neoplasm (IPMN) or mucinous cystic neoplasm (MCN), among others).
If surgery is necessary, a general surgeon who specializes in pancreatic surgery will remove the lesions. At the University of Chicago Medicine campus, our general surgeons are highly experienced at performing the full range of pancreatic surgeries, from minimally invasive procedures to complex surgeries such as the Whipple procedure for treatment of pancreatic cancer. We understand that waiting for surgery may be stressful and aim to schedule surgeries promptly after diagnosis.
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Q. What should I do if I suspect that I am at risk for pancreatic cancer? How can I make an appointment for pancreatic cancer screening?
A. If you are susceptible to pancreatic cancer due to the hereditary or genetic factors outlined above, please talk with your doctor or contact us for a comprehensive consultation. We'll review your risk factors with you and develop a customized screening plan. For more information and to make an appointment, call 1-855-702-8222.
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