Overview

Pancreatic cancer occurs in the tissues of the pancreas gland, which is located behind the stomach.¹ The pancreas is split into three main parts.

• Head: This portion, which is the widest part of the pancreas, is situated towards the duodenum's curve (the small intestine's first segment) on the right side of the stomach. This area contains ducts where digestive liquids flow to the duodenum to continue digestion following the stomach
• Body: The central portion of the pancreas
• Tail: the small end portion that reaches the left side close to the spleen

The gland is essential for blood sugar levels and facilitating digestion. It produces hormones like glucagon and insulin that regulate blood sugar levels (endocrine function) as well as produce and release enzymes and digestive juices that aid in the breakdown of food (exocrine function).² When cancerous cells form in these parts of the pancreas it is often found at a later stage when the prognosis is poor. Consequently, it is important to understand the risk factors of pancreatic disease to identify and potentially prevent the development of pancreatic cancer. This process is by carrying out specific lifestyle changes to diet, exercise and smoking.

Types of pancreatic cancer

Pancreatic cancer can start in all parts of the pancreas, including the head, body or tail. Notably, between 60-70% of all pancreatic cancers start in the head portion of the pancreas.^3,4

Pancreatic ductal adenocarcinoma (PDAC) is the most common form of pancreatic cancer. It is a very aggressive cancer which grows very quickly. PDAC accounts for around 90% of cases. The ductal cells border the lining of the pancreatic ducts and transport digestive enzymes to the duodenum, impairing function.⁵ 

Another type of pancreatic cancer is acinar cell cancer. This is a rare form of pancreatic cancer, mainly affecting the acinar cells, which are responsible for producing digestive enzymes. Tumours affecting acinar cells cause overproduction of digestive enzymes, which can produce symptoms such as skin rashes and weight loss.⁶ 

Pancreatic Neuroendocrine Tumours (PNETs) develop from the pancreatic islets of Langerhans, which are hormone-producing cells. These tumours usually grow more slowly, and depending on whether they produce too much glucagon or insulin, hormonal balances can become altered and can induce symptoms associated with the respective hormones.

Risk factors: modifiable and non-modifiable

Making educated decisions regarding your health can be facilitated by being aware of the risk factors for pancreatic cancer. Modifiable and non-modifiable risk factors are the two main categories into which risk factors fall.

Non-modifiable:

• Age: People over 60 account for the majority of pancreatic cancer cases⁷
• Gender: Pancreatic cancer is more common in men than in women⁷
• Genetics and family history: It is uncommon for pancreatic cancer to be hereditary (passed from parents to children through a family), accounting for only 10% of cases.⁸ Additionally, there is an increased risk linked to other genetic abnormalities, such as Lynch syndrome.⁹ Research has indicated that mutations to the genes PALB2 and BRCA2 have been associated with a higher risk of pancreatic cancer¹⁰
• Ethnicity: Pancreatic cancer incidences are more common in black ethnic groups and Ashkenazi jews in comparison to other ethnic groups¹¹

Modifiable:

• Smoking: Cigarette smoking is a very important and notable risk factor for pancreatic cancer development. Research indicates that smoking is responsible for 20-30% of cases observed¹²
• Obesity: Research shows that approximately 12% of total pancreatic cancer incidences can be associated with excess body fat. Specifically, research highlighted that individuals with increased abdominal fat mass were 70% more likely to develop pancreatic cancer¹³
• Diet: A higher risk is connected to diets low in fruits and vegetables and heavy in red and processed meats
• Diabetes: Diabetes is known to be connected with a higher risk of pancreatic cancer, especially long-standing type 2 diabetes¹⁴

Lifestyle-based prevention

Smoking cessation

As mentioned earlier in this article, cigarette smoking has been identified as a contributing risk factor for pancreatic cancer. Research indicates that smokers have a 75% higher risk of developing pancreatic cancer compared to non-smokers, and this elevated risk may persist for at least a decade after quitting.¹² 

The pancreas is mainly exposed to harmful substances from tobacco through the bloodstream, which causes cancer to develop within the gland. However, despite the long-lasting risk, quitting smoking remains a crucial step. Stopping smoking prevents further exposure to carcinogens (cancer-causing substances) over time. The risk of getting pancreatic cancer will be reduced as a result of highlighting the importance of early and sustained cessation of smoking as part of effective cancer prevention.¹⁵

Tips and support for quitting

Quitting smoking can be incredibly challenging, but it is also one of the most important steps you can take for your health. The following practical strategies and support systems can be used to make the process of quitting more manageable and increase the chance of success:¹⁶

• Pick a date and make a plan: Choosing a specific day to quit gives you something to work towards, and having a clear plan can boost your chances of following through with it 
• Think ahead: Consider what might make quitting difficult, like being around others who smoke. Try to come up with ways to handle those situations ahead of time so you’re not caught off guard
• Reach out for support: Talk to your doctor or contact a free stop smoking service, which can offer advice, tools, and encouragement tailored to your needs
• Let others know: Telling your friends and family that you’re quitting can help. They can be a great source of support and celebrate your progress with you 
• Try to keep going: Most people need more than one attempt to quit for good. If it doesn’t work the first time, reflect on what went well and what didn’t- alter your plans subsequently 
• Remember why you’re quitting: Stopping smoking can significantly lower your risk of pancreatic cancer and lead to great improvements in your overall health 
• Alter your routine: If you usually smoke at certain times, change your habits to break the association

Following a healthy diet

It is estimated that half of pancreatic cancer cases are linked to poor dietary habits, which can be prevented. Research indicates that a diet can influence how a tumour develops and progresses, highlighting the growing importance of understanding the connection between food consumption and the risk of cancer.¹⁷

A lower risk of pancreatic cancer has been linked to diets that include the following:

• Fruit
• Vegetables
• Whole grains
• White meat
• Fiber
• Low-fat dairy products
• Folate 
• Vitamin C
• Vitamin A

On the other hand, diets high in the following have been linked to an increased risk of pancreatic cancer: 

• Refined grains
• Potatoes
• Red meat
• High-fat dairy products
• Sweets and desserts
• Beer
• Coffee¹⁸

Maintaining a healthy weight

Studies have found that having a high body mass index (BMI) is correlated with a greater risk of developing pancreatic cancer. Research suggests that exercise can decrease the risk of pancreatic cancer by 12-37%.¹⁹

The risk can be reduced by achieving and maintaining a healthy weight with healthy food and exercise.

Tips and support to achieve a healthy weight:

• Aim for 150 minutes per week of moderate aerobic exercise, this could be cycling, dancing, hiking, swimming or walking
• Eat less of the high-calorie, low-nutrient meals and keep an eye on portion sizes and alcohol consumption. Following recommendations from a professional dietitian who can also provide expert help and guidance through this journey

Diabetes management

Cancer risk can be indirectly increased through long-term medical disorders. Effective management is crucial. A heightened risk of pancreatic cancer can be related to type 2 diabetes, particularly when it is not appropriately controlled. It is essential to regulate blood sugar levels by:

• Follow a diet and exercise plan that is good to diabetes as recommended by your healthcare advisors
• Regularly check your blood sugar levels
• As directed by medical professionals, follow diabetes medication

Taking these preventive measures of lifestyle changes is notably very important given that the disease is very aggressive and has a poor prognosis. Talking with doctors, like the primary care physicians and nutrition experts, can help give you custom tips on how to use these safe preventative steps. While no change in how you live can fully guarantee preventing the risk of pancreatic cancer, using researched information and healthcare professional advice is the best path to lower risks and keep the pancreas healthy.

Summary

Pancreatic cancer is a disease affecting the pancreas gland situated below the stomach and adjacent to the duodenum. This cancer mainly manifests in the ducts of the pancreas, where abnormal cell growth occurs, altering digestive function and hormonal control. It is more likely to affect men, those who are over 60, and individuals who are perhaps of a black or Ashkenazi Jew ethnic origin. Rarely, it may be inherited from predecessors in the family, which accounts for 10% of pancreatic cancer cases reported.

Whilst pancreatic cancer is an aggressive and challenging condition, there are many things that individuals can do to limit their risk of the disease. Understanding the risk factors such as smoking, obesity, diet, and diabetes, is a vital step for beginning this journey. Lifestyle changes can have a positive effect on reducing the risk of pancreatic cancer. This includes quitting smoking, eating a healthy diet, maintaining a healthy weight, and limiting alcohol intake. Seeking advice from healthcare professionals such as dieticians and doctors can have a significant impact on reducing the risk of developing pancreatic cancer.