Nicolette: 0:01

Welcome to the Health Pulse, your go-to source for quick, actionable insights on health, wellness and diagnostics. Whether you're looking to optimize your well-being or stay informed about the latest in medical testing, we've got you covered. Join us as we break down key health topics in just minutes. Let's dive in.

Mark: 0:26

Welcome to the Deep Dive. Today we're plunging into a topic that touches so many lives, yet often remains shrouded in silence.

Rachel: 0:37

Pancreatic cancer yeah, it's a tough one.

Mark: 0:39

It's frequently called a silent killer, and for good reason. The central question for our Deep Dive today is this why is it so incredibly challenging to detect? And for good reason. The central question for our deep dive today is this why is it so incredibly challenging to detect and treat Right and importantly, what are the crucial advancements that are truly changing the landscape?

Rachel: 1:00

for, you know, both early detection and personalized care. That's basically our mission today to unravel the complex realities of pancreatic cancer. We'll be drawing from some key sources, like the American Cancer Society and the National Cancer Institute, and we want to provide you with insights into its risk factors, symptoms, how it's diagnosed and the evolving strategies for treatment.

Mark: 1:16

And our goal for you, our listener, is to gain a thorough understanding of this critical health topic without getting bogged down in like super technical medical jargon.

Rachel: 1:25

Exactly.

Mark: 1:25

You'll walk away well-informed, ready to ask better questions and hopefully with a fresh perspective. Okay, let's dive in. Let's do it. So you mentioned, pancreatic cancer is often called a silent killer. What does that actually mean in practical terms? Why is it so insidious?

Rachel: 1:40

Well, the real issue, the core problem, is that it can progress for months, sometimes even years, without any obvious symptoms showing up.

Mark: 1:49

Wow Years.

Rachel: 1:50

Yeah, and the American Cancer Society highlights a really stark reality While pancreatic cancer accounts for only about 3 percent of all cancers in the US, which sounds relatively small. Right, it sounds small, but it's tragically responsible for about 7% of all cancer-related deaths.

Mark: 2:06

That 3% versus 7% statistic really jumps out, doesn't?

Rachel: 2:09

it, it does.

Mark: 2:10

It isn't just about late diagnosis. It speaks to the, I guess, the inherent aggression and rapid progression of this specific cancer.

Rachel: 2:17

Exactly, it's like a brutal race against time. It makes the window for effective intervention incredibly narrow, much more so than many other cancers window for effective intervention incredibly narrow, much more so than many other cancers and those early tumors. They often produce really mild, non-specific symptoms, things like fatigue, maybe some indigestion or subtle weight loss.

Mark: 2:34

Things you could easily brush off, totally, easily mistaken for much less serious everyday conditions, which is precisely the challenge, right? But despite that inherent stealth, are we seeing any progress? Is there hope there?

Rachel: 2:48

We are actually Advances in lab testing, more sophisticated imaging techniques and genetic screening. They're all steadily improving our ability to identify it earlier than we could before.

Mark: 3:00

Okay, that's good to hear. Before we go deeper into the disease itself, maybe it helps to zoom out a bit and really appreciate the pancreas.

Rachel: 3:07

Yeah, good idea.

Mark: 3:08

This small but incredibly vital organ, sort of tucked away deep behind your stomach? What exactly makes its function so critical?

Rachel: 3:16

It has this dual role, which is part of what makes things complicated when cancer strikes. First, it produces digestive enzymes. These are absolutely essential for breaking down the food we eat.

Mark: 3:26

Okay, digestion.

Rachel: 3:27

And second, equally vital, it releases hormones like insulin and glucagon. These are basically the master regulators of our blood sugar.

Mark: 3:34

Okay. So when cancer develops, it's because normal cells undergo these genetic mutations, they start growing uncontrollably and form tumors, and because these tumors interfere with both digestion and glucose metabolism. That's why the symptoms often overlap with things like diabetes or chronic pancreatitis.

Rachel: 3:54

That's a great way to put it. It's almost like the cancer is hijacking the pancreas' natural functions.

Mark: 3:59

Okay.

Rachel: 4:00

And according to the National Cancer Institute, pancreatic cancer is primarily categorized into two major types. About 90 to 95 percent of cases are what we call exocrine pancreatic cancers.

Mark: 4:12

Exocrine.

Rachel: 4:13

Got it. These arise from those cells that produce the digestive enzymes, and the most common subtype here is pancreatic ductal adenocarcinoma, or PDAC for short.

Mark: 4:23

PDAC. That's the main one we hear about. So that covers the most common type. What about the rarer forms? How do they differ?

Rachel: 4:29

So the rarer form, making up about 5 to 10 percent of cases, are neuroendocrine tumors or NETs.

Mark: 4:34

NETs.

Rachel: 4:35

These actually arise from the hormone-producing cells. Now, while they're often slower growing than PDFs, some types can be quite aggressive in producing excess hormones.

Mark: 4:44

Ah, so they cause different symptoms then?

Rachel: 4:46

Exactly. They can lead to unique symptoms related to those specific hormonal imbalances, think low blood sugar or severe diarrhea, depending on the hormone.

Mark: 4:55

It's striking how that deep location in the abdomen really plays such a big role here you mentioned earlier. It's hard to spot.

Rachel: 5:02

It's huge. More than half of cases are diagnosed after the cancer has already spread, which just underscores that critical need for earlier detection methods.

Mark: 5:10

Yeah, definitely. Okay, we've called it the silent killer, but you mentioned there are these subtle whispers of the disease, things easily missed. What exactly are those early nonspecific signs that maybe we should be a bit more alert to?

Rachel: 5:26

Okay. So when we look at early signs to watch for, they include things like unexplained weight loss. This is often due to impaired digestion or metabolic changes the tumor itself is causing.

Mark: 5:36

Makes sense.

Rachel: 5:37

Then there's loss of appetite Sometimes tumor-related inflammation can just disrupt normal hunger signals and, of course, general fatigue and weakness may be caused by nutrient malabsorption or even anemia.

Mark: 5:48

Those sound pretty vague though.

Rachel: 5:49

It is, but here's where it gets really interesting, potentially a bit more specific New onset diabetes.

Mark: 5:56

Oh, okay, tell me more.

Rachel: 5:58

Imagine someone suddenly developing type 2 diabetes, but they don't really have the usual risk factors. Or maybe someone with diabetes finds it suddenly worsening significantly for no clear reason. In some cases, these pancreatic tumors are directly messing with insulin production. That leads to these sudden, unexplained blood sugar imbalances. It's a clue that's unfortunately, often missed.

Mark: 6:23

Wow, that's a really important connection. So those are the subtle early signs. But what happens as the disease progresses or in more advanced stages? What are the clearer, more pronounced symptoms that typically emerge then?

Rachel: 6:34

Yeah, as the disease advances, the symptoms usually become more insistent, harder to ignore. We're talking persistent abdominal or back pain. This is often because the tumors are literally pressing on nearby nerves and organs.

Mark: 6:46

Okay, that sounds more noticeable, Definitely, and jaundice.

Rachel: 6:49

You know the yellowing of the skin and eyes. That's a common sign. It often happens because tumors are blocking the bile ducts.

Mark: 6:55

Right, I've heard of that one.

Rachel: 6:56

Other progressive symptoms can include changes in stool. It might become greasy and pale again due to reduced pancreatic enzyme secretion, and nausea and vomiting, often related to some kind of digestive obstruction caused by the tumor.

Mark: 7:11

It's really sobering to realize how easily these nonspecific symptoms, even the later ones, sometimes get misattributed to other common conditions.

Rachel: 7:20

It is. It really highlights the challenge.

Mark: 7:22

And underscores the critical need for advanced testing, doesn't it.

Rachel: 7:25

It absolutely does. This is precisely why lab testing and imaging are so utterly essential for trying to catch it earlier.

Mark: 7:32

So let's talk about risk. Who's most at risk? You hear it's not just one single cause, right? It's more like a complex interplay of genetic stuff, metabolic factors, lifestyle.

Rachel: 7:41

That's exactly right. It's multifactorial. Understanding these different pieces helps us identify individuals who might benefit from earlier or perhaps more frequent screening.

Mark: 7:50

OK, so break that down for us why, what about?

Rachel: 7:54

the metabolic and hormonal factors. Sure On the metabolic and hormonal front, people with longstanding type 2 diabetes and insulin resistance seem to have an increased risk. The NCI suggests this might be due to chronic high insulin levels, hyperinsulinemia and inflammation.

Mark: 8:10

Okay, diabetes is a link. What else?

Rachel: 8:12

Obesity, particularly excess visceral fat that belly fat also contributes. It tends to drive systemic inflammation and insulin resistance, both of which are linked to higher risk and, importantly, chronic pancreatitis, that's, repeated inflammation of the pancreas itself, often triggered by things like heavy alcohol use, very high triglycerides or even gallstones. That significantly raises the risk.

Mark: 8:36

Wow, okay, so those are metabolic issues. What about lifestyle Things we can potentially change?

Rachel: 8:40

Lifestyle plays a huge role, a very significant one, actually. Tobacco use is one of the strongest modifiable risk factors.

Mark: 8:46

Really how strong.

Rachel: 8:47

According to the American Cancer Society, it's responsible for about 25 percent of cases one in four.

Mark: 8:53

That's huge.

Rachel: 8:54

It is Also diets high in refined carbohydrates and added sugars can contribute, probably by promoting that insulin resistance and inflammation we talked about. And of course, heavy alcohol consumption is a known factor because it chronically damages the pancreas and promotes inflammation.

Mark: 9:10

And then, inevitably, there are the factors. We can't change our genes and family history.

Rachel: 9:14

Exactly. We know that inherited gene mutations, specifically in genes like BRCA1, BRCA2, PALB2, and ATM.

Mark: 9:22

The BOCA genes often link to breast and ovarian cancer too right.

Rachel: 9:26

Very same ones. Mutations in these can significantly elevate lifetime risk for pancreatic cancer as well. And then there's family history. Having relatives, especially first-degree relatives like a parent or sibling, with pancreatic cancer increases personal risk. If you have two or more first-degree relatives, the risk can go up substantially, maybe even up to six-fold.

Mark: 9:46

Okay, so quite a few factors to consider there. Given all these challenges in just recognizing the symptoms, how has the diagnostic process improved? You mentioned advances in lab testing, imaging genetic screening. How does that diagnostic toolkit actually work to move us beyond just symptoms?

Rachel: 10:04

Well, blood tests and biomarkers are definitely key pieces of the puzzle. The most commonly used one is CA-19-9. That stands for carbohydrate antigen 19-9.

Mark: 10:14

CA-19-9. Okay.

Rachel: 10:16

It's found to be elevated in about 70-80% of patients who have pancreatic cancer. Now the NCI points out it's not specific enough to use for general population screening.

Mark: 10:25

Meaning other things can make it go up too.

Rachel: 10:27

Exactly, but once someone is diagnosed, it's crucial for tracking how the disease is progressing and how well treatment is working.

Mark: 10:33

Okay, so it's more for monitoring.

Rachel: 10:35

Primarily yes. Another marker that might be elevated, especially in more advanced stages, is CEA, carcinoembryonic antigen.

Mark: 10:42

CEA got it.

Rachel: 10:43

And, of course, because pancreatic tumors often disrupt glucose metabolism. Like we discussed with the diabetes link, sudden new onset diabetes or just unexplained big swings in blood sugar can definitely prompt doctors to order further testing, looking at blood sugar and insulin levels more closely.

Mark: 10:59

It really sounds like we're leveraging the body's own chemistry to try and get these early clues. But often seeing is believing right. What role do the advanced imaging techniques play in this whole diagnostic puzzle?

Rachel: 11:12

Oh, they're critical. Imaging studies like CT scans and MRIs provide these really high-resolution pictures. They help doctors locate tumors and assess if and where they might have spread.

Mark: 11:21

Okay.

Rachel: 11:22

Then there's something called endoscopic ultrasound or EUS. This is pretty sophisticated it uses an endoscope to get an ultrasound probe right up close to the pancreas from inside the body. Wow yeah, it offers incredibly detailed imaging and, crucially, it allows for a guided biopsy of any suspicious areas they see. Pete scans are also useful sometimes, especially for detecting cancer spread elsewhere in the body and helping plan treatment.

Mark: 11:45

So, after all these advanced scans and blood tests, what's the sort of gold standard for a definitive diagnosis, what truly confirms, yes, this is cancer?

Rachel: 11:53

That's where the biopsy comes in. Usually through that EOS procedure or sometimes guided by CT, they perform a fine needle aspiration or FNA.

Nicolette: 12:03

FNA.

Rachel: 12:03

That collects actual tissue samples which are then examined under a microscope for cancer cells. That gives the definitive histological confirmation. And increasingly important now is molecular profiling of that biopsy tissue.

Mark: 12:17

What does that tell you?

Rachel: 12:18

It identifies specific genetic mutations within the tumor cells, like those BRCA1 or BRCA2 mutations we mentioned earlier. Knowing about these mutations can directly influence treatment choices, opening the door for targeted therapies.

Mark: 12:31

That makes sense.

Rachel: 12:32

And it's worth noting here, you know the practical side of getting these tests done. The emergence of convenient mobile lab services is actually making a difference. How so lab services is actually making a difference. How so Well they can bring critical tests like CA-19-9, fasting glucose, hba1c lipid panels right to a patient's home. This cuts down on logistical hurdles, especially for people who aren't feeling well, and ensures the care teams get timely data, which is really important for monitoring.

Mark: 12:56

That convenience factor sounds like a big deal, especially for ongoing care. Okay, so once someone is diagnosed, what are the treatment options? It sounds like a challenging disease to treat, but you mentioned advancements are improving outcomes.

Rachel: 13:10

That's right. It is challenging, but there are options and they're getting better. For early-stage disease, when the cancer hasn't spread, surgery currently offers the best chance of long-term survival, potentially even a cure.

Mark: 13:23

Okay, Surgery first. It's possible. What kind?

Rachel: 13:26

The most common operation, especially for tumors in the head of the pancreas, is the Whipple procedure. It's technically called a pancreaticoduodenectomy. It's a major operation.

Mark: 13:37

Whipple Heard of that.

Rachel: 13:38

If the tumor is in the tail or body of the pancreas, they might do a distal pancreatectomy, which often involves removing the scline as well, and very rarely a total pancreatectomy removes the entire pancreas.

Mark: 13:50

But you said early stage. What's the catch?

Rachel: 13:52

The crucial limitation, unfortunately, is that, because it's often caught late, only about 15, 20 percent of patients are actually eligible for surgery when they're diagnosed. That's according to data from places like Johns Hopkins Medicine.

Mark: 14:04

Only 15, 20 percent. Wow. So for the other 80, 85 percent. What are the mainstays?

Rachel: 14:09

For those patients, or sometimes in addition to surgery, chemotherapy and radiation therapy are frequently used. Chemo drugs like fulfironox or gemcitabine are common.

Mark: 14:18

How are they used Before surgery after?

Rachel: 14:21

Both. Actually, it can be given before surgery, which we call neoadjuvant therapy, the goal being to shrink the tumor to make surgery possible or more effective. Or it can be given after surgery, that's adjuvant therapy, to try and kill any remaining cancer cells and prevent recurrence.

Mark: 14:36

And radiation.

Rachel: 14:37

Radiation therapy is often combined with chemo. It can be used to control local tumor growth target areas surgery couldn't reach, or sometimes just to help relieve symptoms like pain.

Mark: 14:46

Okay, so surgery, chemo, radiation, those are the established approaches. Are there any truly cutting edge, or say experimental therapies emerging that are changing the treatment landscape?

Rachel: 14:59

Absolutely. Yeah, this is where things are getting more personalized. For patients whose tumors have those BRCA1 or BRCA2 mutations we talked about, there are targeted drugs called PRP inhibitors. These interfere with the cancer cell's ability to repair their DNA, making them more vulnerable.

Mark: 15:17

Interesting.

Rachel: 15:18

Immunotherapies like checkpoint inhibitors are also being explored. These are designed to basically take the brakes off the patient's own immune system so it can better attack the cancer cells. They're still largely experimental for most pancreatic cancers, but showing promise in certain subsets.

Mark: 15:34

Okay.

Rachel: 15:35

And for some of those rarer pancreatic neuroendocrine tumors, the NETs.

Mark: 15:39

Right the hormone-producing ones.

Rachel: 15:41

There's a novel therapy called peptide receptor radionuclide therapy, or PRRT, that targets specific receptors on those tumor cells. It's showing good results for some patients.

Mark: 15:50

Okay, prp inhibitors, immunotherapy, prrt a lot's happening Now. Here's where you said earlier. It gets really interesting the emerging metabolic approaches.

Rachel: 15:59

Yes.

Mark: 16:00

This sounds like a completely different angle than just attacking the tumor directly.

Rachel: 16:04

It is, and it really represents a fascinating potential paradigm shift. Imagine if we could not only attack cancer cells with chemo or radiation, but also kind of starve them by manipulating their preferred fuel source.

Mark: 16:18

Starve the cancer.

Rachel: 16:19

By making them uniquely vulnerable metabolically. That's the revolutionary idea behind these metabolic approaches. Research, for instance, from Dr Thomas Seyfried at Boston College is exploring how altering cancer cell metabolism. How do you? Do that, for instance, through things like very low carbohydrate or ketogenic dietary strategies, how these might actually enhance the effectiveness of traditional treatments like chemo.

Mark: 16:45

So using diet to make chemo work better.

Rachel: 16:47

Potentially. Yes, it's an exciting area of research. But and this is really important to clarify these are currently considered adjunctive strategies, meaning they're meant to support and possibly improve traditional treatments, not replace them. They are not standalone therapies for pancreatic cancer at this point.

Mark: 17:04

Got it Supportive, not replacement. That's a critical distinction. It's clear that treatment doesn't just stop after the initial diagnosis and therapy right.

Rachel: 17:12

Not at all.

Mark: 17:13

The ongoing monitoring, watching for disease progression, checking treatment response, looking out for recurrence risk. That seems like a critical lifelong challenge.

Rachel: 17:22

It absolutely is, and lab testing plays a crucial role in this continuous care.

Mark: 17:27

How so? What are you tracking?

Rachel: 17:29

Well. Monitoring those tumor markers we discussed, especially CA 19 to 9, after surgery or during chemotherapy, is really important. It helps doctors assess if the treatment is working.

Mark: 17:40

And if it starts rising again?

Rachel: 17:41

A rising CA 19-9 can be an early warning sign that the cancer might be recurring, sometimes even before it shows up on scans. Cea levels can also be tracked alongside CA19-9 for additional information.

Mark: 17:53

Okay, tumor markers are key for recurrence watch, and because pancreatic cancer itself or its treatment often affects insulin production and glucose regulation, evaluating metabolic health must be a big part of ongoing care too.

Rachel: 18:06

Indeed, it's vital. Tests like fasting, glucose and HbA1c are routinely done. They help detect new-onset diabetes, which can happen after surgery or worsening insulin resistance.

Mark: 18:19

What else metabolically?

Rachel: 18:20

Lipid panels are important, too, to assess cardiovascular risk. Cancer and its treatments can increase inflammation, which impacts cholesterol and, of course, liver function tests are essential.

Mark: 18:31

Why liver function specifically.

Rachel: 18:32

To monitor for any bile duct obstruction caused by the tumor or spread, and just to check general liver health, as the liver is a common site for pancreatic cancer to spread to.

Mark: 18:42

So this ongoing monitoring, this is where those mobile lab services you mentioned earlier could really shine right in supporting that long-term care.

Rachel: 18:49

Precisely Think about it. For someone managing a chronic, serious illness like pancreatic cancer, having to constantly go to a lab for blood draws can be a significant burden.

Mark: 18:58

Yeah, I can imagine.

Rachel: 18:59

Convenient mobile lab services support this ongoing care by offering at-home testing for all these key markers CA 19 to 9, cea, glucose, hba1c, full metabolic profiles and they often have fast turnaround times.

Mark: 19:12

So the doctors get the data quickly.

Rachel: 19:14

Exactly. It ensures that the care teams have timely data, which is just paramount for managing a complex disease like pancreatic cancer effectively over the long term, makes adjustments possible sooner.

Mark: 19:25

So we've really journeyed through the complexities of pancreatic cancer. Today it remains well a formidable opponent, often dubbed the silent killer, for all the reasons we've discussed. But what we've also seen is that advancements in early diagnosis tools, targeted therapies, personalized care they are certainly offering more options and maybe more hope than ever before.

Rachel: 19:48

That's really the key takeaway, I think Recognizing those subtle early warning signs we talked about, understanding your own personal risk factors and leveraging comprehensive lab testing and imaging it truly can make a significant difference in outcomes. Knowledge is power here, especially with a disease that often hides in plain sight for so long. Imaging it truly can make a significant difference in outcomes. Knowledge is power here, especially with a disease that often hides in plain sight for so long.

Mark: 20:06

Absolutely so. As we wrap up, what does this all mean for you, our listener? Given pancreatic cancer's insidious silent killer nature, how might future technologies really push the envelope?

Rachel: 20:17

Yeah, where do we go from here?

Mark: 20:19

Could we move beyond even the current biomarkers and imaging to truly predict risk much earlier, maybe through advanced genetic profiling on a wider scale, or perhaps detailed metabolic profiling even before any symptoms appear? How could we realistically transform early detection into truly pre-symptomatic identification for a much wider population? That feels like the next frontier, doesn't it?

Rachel: 20:44

It really does A challenging goal, but an incredibly important one, definitely something to ponder.

Nicolette: 20:56

Thanks for tuning into the Health Pulse. If you found this episode helpful, don't forget to subscribe and share it with someone who might benefit. For more health insights and diagnostics, visit us online at wwwquicklabmobilecom. Stay informed, stay healthy and we'll catch you in the next episode.