There are typically no symptoms of pancreatic cancer early on, which can delay diagnosis and treatment. But new studies suggest that watching out for new-onset diabetes, which means it was diagnosed it three years ago or less, may help providers detect and treat pancreatic cancer earlier.
The National Cancer Institute notes that those diagnosed with new-onset diabetes are at higher risk of being diagnosed with pancreatic cancer. Notably, Black and Latinx persons who have long-standing diabetes are two times more likely to develop pancreatic cancer than other ethnic groups. Additionally, Black and Latinx persons who have new-onset diabetes are nearly two-and-a-half times more likely to develop pancreatic cancer than those with long-standing diabetes.
Pancreatic cancer is the third-leading cause of cancer-related deaths in the U.S. The American Cancer Society estimates 62,210 Americans will be diagnosed with pancreatic cancer in 2022. The question becomes: can diabetes cause pancreatic cancer or could diabetes be a sign of pancreatic cancer? Maybe both. Researchers are investigating that.
What Is Pancreatic Cancer?
The pancreas is an organ about the size of your hand that sits behind the stomach. It makes juices full of enzymes that help with digestion in the form of proteins that help break down sugar, starch and fats from food. The pancreas also produces specialized hormones that help the body control blood sugar levels.
Adenocarcinoma is the most common type of pancreatic cancer, responsible for about 95 percent of all cases. Adenocarcinoma starts in the cells lining the pancreatic duct or less frequently in cells that make pancreatic juices. When these cells change and grow in unusual ways, they lead to the development of pancreatic cancer.
Another less common type is a pancreatic neuroendocrine tumor, or NET. Pancreatic NETs happen when the cells that make hormones in the pancreas change and grow abnormally.
No one knows what causes pancreatic cancer. But there are risk factors that may make you more likely to develop it. However, sometimes people without risk factors will develop pancreatic cancer and some with many risk factors will not.
Risk factors for pancreatic cancer that you can control include:
- Exposure to certain chemicals that are often used in metalwork or dry cleaning
- Obesity
- Smoking or exposure to secondhand smoke
There are also risk factors you can’t control, such as:
- Being age 45 or older
- Being Black or of Ashkenazi Jewish heritage
- Having a family history of pancreatic cancer
- Having Type 2 diabetes
- Having personal or family history of chronic pancreatitis, an inflammation of the pancreas
- Some inherited genetic syndromes
The Pancreas and Diabetes
Insulin is a hormone made in the pancreas, which controls blood glucose (sugar) levels in the body. Glucose enters the blood from the food you eat and insulin helps move glucose from the blood into cells for energy.
Diabetes is a disease that happens when blood glucose is too high for a long time. This can occur if the pancreas doesn’t make enough insulin as in Type 1 diabetes or if the insulin isn’t able to move glucose from the blood to the cells as it should which is the case for Type 2 diabetes. More than 90 percent of people with diabetes have Type 2 diabetes.
There are connections between diabetes and other diseases of the pancreas. For example, acute pancreatitis, a sudden inflammation of the pancreas, may increase the risk of developing diabetes. And having diabetes may raise the risk of having acute pancreatitis.
There is also a connection between diabetes and pancreatic cancer. Around 1 percent of patients with new-onset diabetes will be diagnosed with pancreatic cancer within three years. This may seem like a small number, but it represents nearly a quarter of all people with pancreatic cancer.
Older adults with new-onset diabetes may be eight times as likely to develop pancreatic cancer compared to other groups of people. And up to 80 percent of people with pancreatic cancer have either diabetes or high blood glucose due to another cause.
Signs and Symptoms of Pancreatic Cancer
Pancreatic cancer often does not have noticeable early signs or symptoms. In many cases, cancer has spread to other parts of the body before its ever detected.
What’s more, later signs and symptoms can be confused with those of other health conditions, which can delay diagnosis even further.
Some symptoms that may point to later-stage pancreatic cancer include:
- A blood clot in a large vein known as a deep vein thrombosis
- Decreased appetite
- Feeling very tired for no reason
- Jaundice, a yellowing of the eyes and skin that is often combined with dark urine, greasy or light-colored stool, and intensely itchy skin. (Jaundice may be an early sign of pancreatic cancer, however most of signs or symptoms of pancreatic cancer are not specific and may only appear at late stage.)
- Nausea or vomiting
- Pain in the upper or middle abdomen or back
- Swelling of the gallbladder or liver
- Weight loss without trying to lose weight
Some research has shown that new-onset diabetes symptoms improve after surgery to remove cancer from the pancreas. This suggests that diabetes may be a symptom of pancreatic cancer as well as a risk factor.
Talk with your health care provider if you notice any possible signs or symptoms of pancreatic cancer. People aged 50 or older with new-onset Type 2 diabetes who have lost weight since being diagnosed may have an especially high risk and should make an appointment with their provider as soon as possible.
Diagnosing Pancreatic Cancer
Approximately 5 to 10 percent of pancreatic cancer is caused by genetics. Some of these cases may be prevented or detected early with genetic testing for cancer. Talk with your provider about genetic testing if you have a personal or family history of pancreatic cancer.
If you are at a higher risk, monitoring your blood glucose level regularly may help you discover unusual changes that might point to pancreatic cancer or other serious conditions even if you have not been diagnosed with diabetes.
If you have symptoms of pancreatic cancer, your provider will start by getting your medical history, doing a physical exam, and will likely check your blood to determine liver function or to look for certain substances in the blood that might be signs of a tumor. Your provider might also run other blood tests to rule out other conditions or to check your general health.
Imaging tests might be ordered to get a picture of the inside of the body. This might include a CT scan, MRI, ultrasound or another type of imaging test. You may need more than one type of imaging test.
Your provider may also order a biopsy tissue sample for further testing if a tumor is found or tissue looks suspicious.
Treating Pancreatic Cancer
Surgical resection of the cancer (removing cancerous tissue by surgery) is the only treatment to cure the cancer, however it is only possible in about 20 percent of patients with pancreatic adenocarcinoma. Other types of treatment that aim to control cancer will depend on the type of cancer you have, how much it has grown or spread, and personal factors, like age or having other health conditions.
Some other possible treatment options for pancreatic cancer are:
- Ablation (using extreme heat or cold to destroy a tumor)
- Chemotherapy
- Embolization (cutting off the blood supply to a tumor)
- Immunotherapy to strengthen the body’s natural immune system
- Medications that target specific parts of cancer cells, a treatment known as local control
- Radiation
The American Cancer Society gives some helpful tips on what to ask your provider to figure out the best treatment options for you.
It is also important to treat and manage diabetes and other chronic conditions during treatment for pancreatic cancer. The Diabetes and Endocrinology Centers at the University of Maryland Medical System can provide you with diabetes education and support if you need help.
Taking care of your mental health during cancer treatment is essential as well. Let your care team know how you are feeling. Many cancer centers offer counseling and support services to help patients through this difficult, often scary time. The University of Maryland Medical System offers resources to help.
Your provider may recommend cancer rehabilitation when you finish cancer treatments to ease your transition back into a cancer-free life.
Preventing Pancreatic Cancer and Diabetes
There is no known way to fully prevent pancreatic cancer. But certain steps may help with cancer prevention:
- Avoid alcohol
- Eat a healthy diet
- Don’t smoke or, if you smoke, try to quit
- Stay active and get regular exercise
Unlike pancreatic cancer, Type 2 diabetes can often be delayed or prevented by maintaining a healthy weight, eating a healthy diet and getting enough exercise.
Follow the diet and physical activity guidelines from the American Cancer Society to start lowering your risk of cancer and Type 2 diabetes.
Talking with Your Provider
It’s essential to talk with your provider if you are at high risk for pancreatic cancer or Type 2 diabetes or if you have signs or symptoms of pancreatic cancer. Thinking about pancreatic cancer and diabetes may feel scary or overwhelming, but your providers are experts at helping you get the care you need.
Taking steps to prevent diabetes or manage your diabetes may lower your risk of pancreatic cancer. The providers at the University of Maryland Medical System Diabetes and Endocrinology Centers can help you learn how to stay healthy and active with diabetes if you aren’t sure where to start.
