Is pancreatic cancer hereditary? Causes and risk factors

The article was written by Master - Doctor Mai Vien Phuong - Head of Department of Gastrointestinal Endoscopy - Department of Medical Examination & Internal Medicine - Vinmec Central Park International General Hospital

Pancreatic cancer is a type of cancer that forms in certain cells of the pancreas. Most patients with pancreatic cancer (about 95%) start in the exocrine pancreas. Tumors can also form in the endocrine pancreas but these are uncommon and are usually benign (not cancerous).

The pancreas is a leaf-shaped organ that produces digestive enzymes and hormones such as insulin. The pancreas is located high in the abdomen, near the major arteries and veins. The pancreas has three parts - the head, the tail, and the body of the pancreas. Digestive enzymes and hormones produced in the pancreas travel from the pancreas to the duodenum (first part of the small intestine) through a tube called the pancreatic duct. The part of the pancreas that produces hormones is called the endocrine pancreas, and the part that produces digestive enzymes is called the exocrine pancreas.
Pancreatic cancer begins when cells in the pancreas develop mutations in their DNA. These abnormal cells do not die like normal cells but continue to reproduce. It is the accumulation of these cancer cells that creates the tumor.
This type of cancer usually starts in the cells lining the ducts of the pancreas. It can also start in neuroendocrine cells or other hormone-producing cells. Pancreatic cancer runs in some families. A small percentage of the gene mutations associated with pancreatic cancer are inherited.

The direct cause of pancreatic cancer is not always determined. Several gene mutations, both inherited and non-inherited, have been linked to pancreatic cancer.
Among them, the genetic syndromes associated with this disease are:
Ataxia - vasodilatation, caused by inherited mutations in the ATM gene. Familial (or inherited), acute pancreatitis is usually caused by mutations in the PRSS1 gene. Familial adenomatous polyposis, caused by a faulty APC gene. Familial atypical multiple mole melanoma syndrome, caused by mutations in the p16/CDKN2A gene. Hereditary breast and ovarian cancer syndrome, caused by mutations in the BRCA1 and BRCA2 genes. Li-Fraumeni syndrome, the result of a defect in the p53 gene. Lynch syndrome (hereditary non-infectious colorectal cancer), usually caused by a faulty MLH1 or MSH2 gene. Endocrine dysplasia type 1, caused by faulty MEN1 gene. Neurofibromatosis type 1, caused by mutations in the NF1 gene. Peutz-Jeghers syndrome, caused by a defect in the STK11 gene. Von Hippel-Lindau syndrome, the result of mutations in the VHL gene. "Inherited pancreatic cancer" means that it occurs in a family, specifically where:
At least two first-degree relatives (parents, siblings or children) have had pancreatic cancer . In the same family, there are three or more relatives with pancreatic cancer. Having a known familial cancer syndrome plus at least one family member with pancreatic cancer.

Other conditions that can increase the risk of pancreatic cancer are:
Chronic pancreatitis. Cirrhosis . Helicobacter pylori (H. pylori) infection. Type 2 diabetes. Other risk factors include:
Age. More than 80% of pancreatic cancers develop in people between the ages of 60 and 80. Gender. Men are at a slightly higher risk than women. Race. African-Americans are at a slightly higher risk than whites. Lifestyle factors can also increase the risk of pancreatic cancer. Example:
Smoking doubles the risk of developing pancreatic cancer. Cigars, pipes and smokeless tobacco products also increase the risk of the disease. Obesity increases the risk of pancreatic cancer by about 20%. High exposure to chemicals used in the metalworking and dry cleaning industries can increase your risk. Pancreatic cancer is a relatively rare type of cancer. Only about 1.6% of people will develop pancreatic cancer in their lifetime.

Most symptoms are not obvious in early-stage pancreatic cancer. As the cancer progresses, signs and symptoms may include:
Pain in the upper abdomen, which may spread to the back. Eat well. Weight loss. Tired. Yellow skin and eyes. New-onset diabetes. Depression.

There is no routine screening test for people at average risk of pancreatic cancer. You may be considered at higher risk if you have a family history of pancreatic cancer or have chronic pancreatitis. If this is the case, your doctor may order a blood test to screen for genetic mutations associated with pancreatic cancer.
These tests can tell you if you have a mutation but not pancreatic cancer. Also, having a gene mutation does not mean you will get pancreatic cancer. Whether you are at moderate or high risk, symptoms such as abdominal pain and weight loss do not mean you have pancreatic cancer. These can be signs of many different conditions, but it's important to see your doctor for a diagnosis. If you have signs of jaundice, see your doctor as soon as possible.

Your doctor will want to take a thorough medical history. After a physical exam, diagnostic tests may include:
Imaging tests. Ultrasound, CT scans, MRIs, and PET scans can be used to create detailed images that look for abnormalities of the pancreas and other internal organs. Endoscopic ultrasound. During this procedure, a thin, flexible scope (endoscope) is inserted down your esophagus and into your stomach to view your pancreas. Biopsy . Your doctor will insert a thin needle through your abdomen (backward) or biopsies via endoscopic ultrasound and into the pancreas to take a sample of suspicious tissue. A histopathologist will examine the specimen under a microscope to determine if the cells are cancerous. Your doctor may do blood tests to look for signs of tumors that are related to pancreatic cancer. However, this test is not a reliable diagnostic tool; It is often used to assess how effective a treatment is.

Once diagnosed, the cancer needs to be classified according to how far it has spread. Pancreatic cancer is divided into stages from 0 to 4, where 4 is the most severe stage. This helps determine your treatment options, which may include surgery, radiation therapy, and chemotherapy.
For therapeutic purposes, pancreatic cancer can also be subdivided into:
Resectable. The tumor can be surgically removed in its entirety. The border of the tumor is resectable. The cancer has reached nearby blood vessels, but it's possible that the surgeon can completely remove it. Cannot be cut. Cannot be completely removed surgically. Your doctor will review this, along with your complete medical record, to help decide the best treatments for you.
Currently, Vinmec International General Hospital has been implementing cancer screening packages. At Vinmec, there are a full range of modern diagnostic facilities such as: PET/CT, SPECT/CT, MRI, myelogram blood test, histopathology, immunohistochemistry test, gene test, stool biology test death, as well as a full range of targeted drugs, the most advanced immunotherapy drugs in cancer treatment. Multimodal cancer treatment from surgery, radiation therapy, chemotherapy, hematopoietic stem cell transplantation, targeted therapy, immunotherapy in cancer treatment, new treatments such as autoimmunotherapy body, heat therapy...
After having an accurate diagnosis of the disease and stage, the patient will be consulted to choose the most appropriate and effective treatment methods. The treatment process is always closely coordinated with many specialties: Diagnostic Imaging, Biochemistry, Immunology, Cardiology, Stem Cell and Gene Technology; Department of Obstetrics and Gynecology, Department of Endocrinology, Department of Rehabilitation, Department of Psychology, Department of Nutrition... to bring the highest efficiency and comfort to patients. After undergoing the treatment phase, the patient will also be monitored and re-examined to determine whether the cancer treatment is effective or not.
Thanks to modern facilities, a team of qualified doctors, perfect medical services, have brought confidence, health and good quality of life to patients who come to visit and treat diseases at the hospital. Vinmec.

References: cancer.gov, jhu.edu, mayoclinic.org