The pancreas plays a key role in our digestive system: It helps us break down food and use sugar for energy. When the pancreas doesn’t function properly, it can cause a host of issues, from digestive problems to diabetes—and even cancer.
While there are a few different types of pancreatic cancer, pancreatic adenocarcinoma is the most common. It accounts for about 95% of pancreatic cancer cases. (When people talk about pancreatic cancer, this is usually the type they’re referring to.) But there’s another type of pancreatic cancer, called pancreatic neuroendocrine tumors—or pNETs—that can be confused with pancreatic adenocarcinoma. Both types originate in the pancreas, but that is where their similarities end.
Pancreatic adenocarcinoma occurs when exocrine cells (cells that produce digestive enzymes) grow out of control. Pancreatic neuroendocrine tumors occur when endocrine cells (cells that make blood sugar-stabilizing hormones like insulin) grow out of control.
“When you’re diagnosed with pancreatic cancer, it’s important to know which type you’re dealing with,” says Philip A. Philip, M.D., Ph.D., a medical oncologist at Henry Ford Health who specializes in both types of cancer. “If you have a pancreatic neuroendocrine tumor, it’s important to see a doctor who specializes in it, because neuroendocrine tumors are very rare. The treatment is completely different and requires a highly personalized treatment plan.”
How do these two cancers differ? Here’s the breakdown.
Risk Factors Of Pancreatic Cancer Vs. Neuroendocrine Cancer
Risk factors for pancreatic adenocarcinoma include: smoking, obesity, a history of pancreatitis (or inflammation of the pancreas), type 2 diabetes and genetics (for example, carrying the BRCA mutation). That said, fewer than 10% of pancreatic cancer cases are currently due to genetics.
Risk factors for neuroendocrine tumors are less known. “We haven’t seen a strong correlation with either diabetes or smoking when it comes to developing neuroendocrine tumors,” says Dr. Philip. “Genetics might be important, but right now they're responsible for less than 5% of neuroendocrine tumors--the most common one being the MEN1 gene.”
Age is one risk factor for both pancreatic adenocarcinoma and neuroendocrine cancer: adenocarcinoma is diagnosed at a median age of 71, while a neuroendocrine tumor is diagnosed at a median age of 60.
Symptoms Of Pancreatic Cancer Vs. Neuroendocrine Cancer
Symptoms of pancreatic adenocarcinoma include back pain, abdominal pain, bloating, jaundice and weight loss, and they often take a rapid course. Neuroendocrine tumors are often diagnosed without any symptoms.
“They’re not infrequently found incidentally, meaning a scan will be performed for another reason and a neuroendocrine tumor is found,” says Dr. Philip. “That said, around 20% of neuroendocrine tumors are functional, meaning the tumor cells cause issues related to the release of chemicals into the blood. One example is hypoglycemia (or low blood sugar) from the excess insulin secreted by the tumor.”
Screenings For Pancreatic Cancer Vs. Neuroendocrine Cancer
There aren’t standardized screening guidelines for pancreatic or neuroendocrine tumors, as there are for breast, prostate, lung, cervical and colorectal cancers. However, if you suspect you have pancreatic adenocarcinoma or a neuroendocrine tumor, a doctor will order a CT scan or an MRI. An endoscopic exam with ultrasound (EUS) can also be performed.
“Blood tests can also look for tumor markers, but the ultimate diagnosis is taking a biopsy of a suspected tumor to determine what it is,” says Dr. Philip. “For neuroendocrine tumors, something called a dotatate PET scan can help determine where the cancer has spread and how aggressive it is. But although these tests can help determine the extent of the disease, and can be used to monitor its activity, they are not helpful in making the definitive diagnosis. A biopsy-based diagnosis is absolutely needed.”
Outcomes Of Pancreatic Cancer Vs. Neuroendocrine Cancer
Pancreatic adenocarcinoma is more aggressive than neuroendocrine tumors. For pancreatic cancer, the average five-year survival rate is 11%. If someone is diagnosed with pancreatic cancer after it has spread to distant organs, the five-year survival rate is 3%.
For neuroendocrine tumors, the average five-year survival rate is over 50%, but that percentage is lower if the tumor has spread to distant organs. “Nevertheless, survival also depends on what we call the grade of the neuroendocrine tumor,” says Dr. Philip. “A small number of patients have an aggressive, high-grade tumor that has a worse prognosis.”
Treatments For Pancreatic Cancer Vs. Neuroendocrine Cancer
If the cancer is caught before it has spread outside of the pancreas—whether it’s pancreatic adenocarcinoma or a neuroendocrine tumor—treatment consists of surgery to remove part of the pancreas and the tumor. In certain situations, the tumor may be intimately attached to a blood vessel, making resection (or surgery) impossible.
If the cancer has spread, drug therapies such as chemotherapy, are used. “While chemotherapy can be used for both cancers, the type of chemotherapy used is different," says Dr. Philip. "There are better and more treatment options for neuroendocrine tumors – and we recommend every patient who comes in with a pancreatic neuroendocrine tumor to consider a clinical trial.”
At Henry Ford Health, in fact, there are separate tumor boards (or teams of experts who regularly meet to formulate management plans for patients) for those with pancreatic adenocarcinoma and pancreatic neuroendocrine tumors.
Sometimes, patients can live with neuroendocrine tumors for a long time, which is why Dr. Philip says it’s important to utilize the help of a multidisciplinary team—so that you’re surrounded by people who are familiar with this rare disease to not only treat it, but also to help maintain your quality of life in the process.
Whether you are going through cancer treatment or serve a loved one as a caregiver, there are resources to help you. Learn more about pancreatic cancer treatment at Henry Ford Health.
Philip A. Philip, M.D., Ph.D., F.R.C.P., is an internationally renowned medical oncologist specializing in gastrointestinal cancers. He has led numerous breakthroughs in the areas of pancreatic and neuroendocrine tumors. He is the director of gastrointestinal oncology, co-director of the Pancreatic Cancer Center and medical director of research and clinical care integration at Henry Ford Health—Cancer. He sees patients at Henry Ford Cancer in Detroit and Henry Ford Medical Center – Columbus.
