New profile IDs patients at higher risk of pancreatic cancer

Volume 4, Issue 3, 2015

Summary

Study findings help refine guidelines for treating pancreatic lesions.

Photograph of Michael B. Wallace, M.D., of Mayo Clinic

Michael B. Wallace, M.D.

When patients learn that they have a lesion on their pancreas that may turn into pancreatic cancer, they may panic and want frequent scans and biopsies to monitor the lesion. In addition, physicians don't always know if such lesions are dangerous, so patients often end up having surgery.

Now a team of physicians led by researchers at Mayo Clinic's campus in Florida has developed a profile of the patient most at risk of developing lesions that are most likely to become cancerous. The team's analysis is published in the June 2015 issue of the journal Digestive and Liver Diseases.

"The factors we found that increase risk of pancreatic cancer now allow us to separate patients as either low or high risk," said the study's senior author, Michael B. Wallace, M.D., a gastroenterologist at Mayo Clinic's campus in Florida. "High-risk patients can then be scanned and biopsied more frequently or can opt for surgery, but low-risk patients don't need such surveillance. They can be watched much less intensively."

Pancreatic cancer is typically difficult to detect early. Most patients are diagnosed at later stages, when the disease is usually fatal, Dr. Wallace said, so it's important to understand more about who's at risk.

In this study, the lesions were intraductal papillary mucinous neoplasms. "Between 10 and 40 percent of people have them," Dr. Wallace said. "Obviously the vast majority of those folks are not developing pancreatic cancer, which is not that common."

To find ways to identify patients with these lesions who are at high risk of developing pancreatic cancer, Dr. Wallace and his collaborators examined data for 1,126 patients with the lesions. Of the group, 84 were found to have invasive pancreatic cancer.

Patients in the group of 84 had all or some risk factors that put them at high risk: a history of smoking and obesity, and two symptoms of the disease — jaundice and steatorrhea, which are fat droplets in stool indicating that the pancreas isn't producing sufficient digestive enzymes. Other risk factors were a larger cyst size on an imaging scan, cysts in the main pancreatic duct, and the presence of nodules on the cyst wall.

"This study refines the current guidelines for treating these lesions, which are not very specific," Dr. Wallace said. "Hopefully, we can reassure worried patients who have these common lesions that they are not at high risk."