Pancreatic cancer occurs when abnormal cells in the pancreas grow uncontrollably, forming a tumor. The pancreas, located behind the stomach, aids digestion and regulates blood sugar. While most cases affect individuals over 70, its occurrence in younger adults is being studied.
How Common is Pancreatic Cancer in Young Adults?
Pancreatic cancer is uncommon in young adults compared to older populations. For instance, between 2014 and 2018, the incidence rate was 0.4 per 100,000 for individuals under 40, versus 31.1 per 100,000 for those 40 or older.
Despite its rarity, incidence rates in younger age groups have increased in recent decades. In the UK, data shows a 42% increase in individuals aged 25-49 and a 308% increase in those aged 0-24 since the early 1990s. In the United States, incidence increased among both sexes from 2000 to 2018, with a greater rise in women younger than 55, especially those aged 15 to 34.
This observed increase may be due to better detection of early-stage endocrine cancers and solid pseudopapillary neoplasms, rather than the more common pancreatic adenocarcinoma. Despite more diagnoses, the mortality rate for pancreatic cancer in young adults has remained stable.
What Increases Risk in Younger Individuals?
Genetic predispositions significantly increase the risk of pancreatic cancer in younger individuals. Approximately 10% of pancreatic cancers are linked to inherited gene mutations.
Several inherited syndromes are associated with an elevated risk. Peutz-Jeghers syndrome (PJS), caused by STK11 gene mutations, can increase lifetime risk by up to 26% by age 70. Lynch syndrome, caused by mutations in mismatch repair genes, shows an 8.6-fold higher risk compared to the general population and a cumulative risk of about 3.7% by age 70.
Hereditary pancreatitis, often caused by PRSS1 gene mutations, leads to recurrent pancreatic inflammation and carries a high lifetime risk, affecting 40% of individuals with the condition. Familial atypical multiple mole melanoma (FAMMM) syndrome, linked to CDKN2A mutations, increases the risk of both melanoma and pancreatic cancer. Mutations in genes such as BRCA1, BRCA2, PALB2, and ATM are also recognized risk factors.
Identifying Symptoms in Young Adults
Symptoms of pancreatic cancer can be vague and may not appear until the disease has progressed. Abdominal or back pain is a common symptom, often dull and worsening after eating or lying down.
Unexplained weight loss is another frequent sign. Jaundice, characterized by yellowing skin and eyes, dark urine, and light-colored stools, can occur if a tumor blocks the bile duct.
Other symptoms include loss of appetite, nausea, vomiting, changes in bowel habits like fatty stools, and new-onset or difficult-to-control diabetes. Because these symptoms can be attributed to many less serious conditions, they are often overlooked in younger individuals.
Navigating Diagnosis for Younger Patients
Diagnosing pancreatic cancer in young adults presents challenges due to its rarity and the non-specific nature of its symptoms. The initial vagueness of symptoms can lead to diagnostic delays, as healthcare providers may not immediately suspect pancreatic cancer.
When pancreatic cancer is suspected, a range of diagnostic tests are employed. Imaging techniques like computed tomography (CT) scans, magnetic resonance imaging (MRI), and endoscopic ultrasound (EUS) visualize the pancreas and detect tumors.
EUS can also facilitate a biopsy, where a tissue sample is collected for laboratory testing to confirm cancer. Blood tests, including tumor markers like CA 19-9, may be performed, though CA 19-9 levels are not definitive for diagnosis. Genetic testing is also important for younger patients to identify inherited mutations that increase risk.