Early Detection Will Build The Foundation of Pancreatic Cancer Care

A house is only as solid as its foundation. That foundation, however, is only as solid as the ground it’s built on. Growing up near the beach, I learned firsthand how easily the sand can shift and how digging a hole all the way to the water can cause the surrounding area to collapse. This translates to “solid” ground as well, especially where karst geology occurs. Karst is a system of rocks that get eroded by water, causing sinkholes. Sinkholes become more common as aquifers are depleted, and they are otherwise invisible from the surface and hard to detect or predict. As interesting as the geology is, this gets scary when you remember that houses are built on the ground. A sinkhole can quietly erode away beneath a foundation before catastrophically collapsing, often damaging or destroying the house above with little warning. In some cases, the resulting damage is so severe that the house becomes a total loss. Another insidious, but much more devastating, silent killer is pancreatic cancer.

The pancreas is a lumpy, tadpole-shaped organ tucked in around the stomach and upper intestinal tract. Its main job is to produce digestive enzymes that help break down food and regulate things like blood sugar.^[1] With pancreatic cancer, the cells of the pancreas mutate to grow out of control, avoid dying, group together, and build new blood vessels in a mass called a tumor. Pancreatic cancer tumors create their own tumor microenvironment, which is flooded with chemicals and hormones that suppress the immune system make the tumor very resistant to the body’s repairmen.^[2] Pancreatic cancer is relatively uncommon, with around 67,000 new cases in the US estimated for 2026.^[2,3] This rate has been increasing steadily.^[2] Men and African Americans have a higher risk of developing pancreatic cancer.^[4] Risk also increases with age, with most people being diagnosed in their early 70s.^[2,4] Other risk factors include smoking, heavy drinking, obesity, diabetes, poor diet, some bacterial infections, and genetics.^[2,4]

Symptoms of pancreatic cancer are similar to those of a developing sinkhole: vague, nonspecific, and often undetected. Symptoms may include indigestion, decreased appetite, abdominal pain, and back pain, but these symptoms do not differentiate between those with and those without pancreatic cancer.^[2] This actually points to why pancreatic cancer is so dangerous: there may be little indication anything is wrong until the cancer has spread too far. Resection, the surgical removal of a tumor, is the only potentially curative treatment for pancreatic cancer, but at diagnosis, only 10-15% of tumors are able to be surgically removed.^[2,4] This is in part because the pancreas is nestled between several major blood vessels, making surgery too dangerous and risky. More importantly, pancreatic cancer often spreads before it is detected.^[2,4]

Back to the sinkhole analogy; in 2024 the Florida Office of Insurance Regulation reported that, of the approximately five million homeowner insurance policies in the state, there were only 319 sinkhole claims.^[5] For those 319 people, the event was devastating, but for the vast majority of homeowners it’s impractical to pay for a geologist to come use sound-penetrating radar or take soil samples; especially because they are time-consuming, expensive, and have a limited chance of detecting exactly where a sinkhole will develop.^[6] Similarly, there are currently no effective pancreatic cancer screening methods available.^[2] Pancreatic cancer may be detected by a PET or CT scan, but these aren’t considered screening tools and indications would have to be confirmed with another method like MRI, magnetic resonance cholangiopancreatography, endoscopic ultrasound, and/or biopsy.^[2,4] The relatively low (~1%) risk of developing pancreatic cancer and lack of screening methods means it is unlikely to be caught early, when surgical resection is most effective.^[2,4] To combat this, several clinical trials are currently recruiting that are testing new screening methods in an effort to close this gap and provide early, treatable detection.

If pancreatic cancer is detected, what can be done? Five-year survival rates for pancreatic cancer are very low, but have more than tripled since the 90s and quadrupled since the 70s.^[3] As mentioned above, the only potentially curative treatment is surgical resection.^[4] This is tricky, comes with side effects, and must be customized for each tumor.^[2] In addition, the placement and spread of the tumor can affect which ones are resectable, with around 30-35% being classified as “locally advanced” to the point where surgery is not deemed beneficial.^[2,4] Presurgical treatment (also called Neoadjuvant and/or perioperative therapy) involves chemotherapy or radiation aimed at shrinking the tumor so it can be surgically removed.^[2] For non-surgical tumors, chemotherapy and radiation therapy may provide modest improvements to life expectancy by attacking tumor DNA and keeping cancer cells from replicating.^[2] Clinical trials continue to look for more effective treatments. These include implanted radiation devices at the location of the tumor, altering the tumor microenvironment, and targeting specific gene alterations in cancers.^[2] Another exciting area of study is targeting tumor pathways, including how they interact with other cells, signaling pathways, tumor metabolism, and the immunosuppressive environment.^[2] New screening methods will be the foundation of pancreatic cancer care, and ongoing research will hopefully lead to the building of new tools and, ultimately, a NEW cure for this devastating disease.

Creative Director Benton Lowey-Ball, MWC, BS, BFA

References:

[1] Marieb EN, Hoehn K. The urinary system. Human anatomy & physiology. [11th Edition]. [Hoboken, New Jersey]: Pearson; [2019]. p. 898-899.

[2] Park W, Chawla A, O’Reilly EM. Pancreatic cancer: a review. Jama. 2021 Sep 7;326(9):851-62. https://doi.org/10.1001/jama.2021.13027

[3] Siegel RL, Kratzer TB, Wagle NS, Sung H, Jemal A. Cancer statistics, 2026. Ca. 2026 Jan 13;76(1):e70043.https://doi.org/10.3322/caac.70043

[4] McGuigan A, Kelly P, Turkington RC, Jones C, Coleman HG, McCain RS. Pancreatic cancer: A review of clinical diagnosis, epidemiology, treatment and outcomes. World journal of gastroenterology. 2018 Nov 21;24(43):4846. https://doi.org/10.3748/wjg.v24.i43.4846

[5] Insurance Stability Unit, Florida Office of Insurance Regulation. Property insurance stability report. January 1, 2024. Tallahassee (FL): Florida Office of Insurance Regulation; 2024.

[6] Florida Department of Environmental Protection. Sinkhole FAQs. May 22, 2026. Accessed July 29, 2026. https://floridadep.gov/fgs/sinkholes/content/sinkhole-faq