How to Manage Your Pancreatic Cancer Risk
Jan 23, 2023 Nicole Levine
Pancreatic cancer is projected to become the No. 2 cause of cancer-related death in the United States, surpassing colorectal and breast cancers.
“That’s important because it’s not a very common cancer, but it is a very aggressive one,” says Dr. Arsen Osipov, program lead at the Pancreatic Cancer Multidisciplinary Clinic and Precision Medicine Program at Cedars-Sinai Cancer.
“It’s not driven by an increase in incidence but rather by the fact that other tumors—such as breast or colon or lung cancers—are responding much better to medical advancements and treatments, especially immunotherapy.”
Below, Dr. Osipov shares how to manage your pancreatic cancer risk, discusses important research developments and promotes a team-based approach to treating the disease.
Arsen Osipov, MD
Arsen Osipov, MD
"Some of the risk factors we have control over can increase pancreatic cancer risk by up to 30%."
What are the main risk factors for pancreatic cancer? How do you manage them?
Dr. Arsen Osipov: Some of the risk factors that we have control over can increase risk by up to 30%. They’re the same factors that are linked to other cancers: Cigarette smoking, obesity and lack of physical activity can all increase your pancreatic cancer risk. Lifestyle changes to address these factors will reduce your overall chances of developing cancer.
There is ongoing research examining a potential link between diabetes and pancreatic cancer. We’re not sure if diabetes causes the cancer or if pancreatic cancer leads to diabetes, but we do know there is some association that can elevate your risk.
We also know pancreatic cancer can run in families. There is a genetic component. One example is the BRCA cancer gene, which most people recognize as being associated with breast and ovarian cancers. BRCA gene mutations are also linked to about 10% of pancreatic cancer patients.
What is the benefit of knowing you have a gene mutation?
AO: If you have pancreatic cancer or have a close family member with pancreatic cancer, we usually will do genetic testing to check for these mutations.
Unlike breast cancer, there isn’t a preventive treatment for pancreatic cancer. However, what we can do is screen you more regularly. If you have a genetic risk, we can use MRI or CT scans or, in some cases, we can do endoscopic ultrasounds.
If we know you’re at high risk, we can screen you regularly so that if cancer does develop, we can catch it early when it is the most treatable.
In the research setting, scientists continue to work toward developing a blood test for pancreatic and other cancers. Perhaps if we could detect tumor DNA in the blood, we’d have a way to do much broader screening with a blood test.
Can immunotherapy potentially treat pancreatic cancer? What other options are on the horizon?
AO: This is a question my patients ask all the time. We all see commercials on TV for these immunotherapy drugs that have had success in treating melanoma or lung cancer, and they want to know if it can work for their pancreatic cancer, too.
Immunotherapy is a broad class of treatments that work by turning on the immune system so the body itself fights the cancer.
These drugs have not worked as successfully for pancreatic cancer as they have for other cancers. That hasn’t stopped us, though. Research is underway to figure out how we can emulate the successes of immunotherapy that we see in other cancers.
We’re also looking at pancreatic cancer patients who did respond very well to immunotherapy because they have a unique biomarker that makes them sensitive to it. It won’t work for most patients, but we’re looking into how we can help other patients mimic that response.
Pancreatic tumor cells have this very hard shell as a protective mechanism—like a kind of fort that sits around them. So, how do you break through that shell to get those good immune cells in?
Around these cells are microenvironments, and we can use drugs that modulate and manipulate that environment to make it less welcoming to the cancer. That’s a huge goal of our research here. We are combining the chemotherapy that patients would normally receive with immunotherapy, plus a drug that can modify that microenvironment so those immune cells can do their work.
There’s also a completely different approach using a special kind of vaccine. We take a tumor, find its specific genetic code and then design vaccines to work against that tumor.
Lastly, one of the most important things—and something we do routinely at Cedars-Sinai—we really believe in fully understanding the genetics of both the patient and their cancer. So, we do comprehensive genetic sequencing to help find the best, most effective treatments available.
What is your clinic’s approach to treating people with cancer?
AO: Just getting a diagnosis can be such a long journey for patients. It starts with the patient discussing a symptom or suspicion with a primary care or emergency room doctor. They might do some tests and refer the patient to a gastroenterologist for a biopsy. Then there’s a wait. There are lots of starts and stops and waiting. On average, it takes about four to six weeks just to assemble the care team.
We try to cut out all that waiting. We bring together all the specialists: medical oncologists, gastroenterologists, surgical oncologists, radiation oncologists and genetics counselors—everyone you need to address your problem medically and surgically. We also have dietitians, social workers, pain management specialists and more. We all come together at one center so a patient can come in to get a comprehensive evaluation. We offer same-day imaging, so we are meeting the patient, getting their medical history and seeing their images in the first visit.
We review everything together and come up with a comprehensive plan with all the specialists in agreement. We also offer all the additional services someone going through cancer might need.
We simultaneously evaluate patients for clinical trials and let them know what additional options are open to them. Patients can choose to sign up for clinical research on day one, when we use the information from their blood and tumors to help plan for the future and identify ideal treatment options.
We’ve found a way to give someone a full evaluation and care plan in half a day rather than a month and a half. So, our patients walk away from their appointment with a plan in hand, and they can take it back to an oncologist in their community or begin treatment with us.
Our program is offering comprehensive care that is tailored to patients, with the urgency that comes with a cancer diagnosis. We continue that in our laboratories, as well. We’re looking for answers for our patients who need us today, and we’re constantly working to develop better treatments for the future.