Oncology

Metastatic Pancreatic Cancer

Diabetes and the Diagnosis of Pancreatic Cancer

patient care perspectives by Margaret A. Tempero, MD

Overview

Metastatic pancreatic cancer is associated with a low survival rate; however, early screening and detection remains a challenge. The most commonly seen presenting symptoms include weight loss, fatigue, jaundice, pain, and anorexia. Diabetes and pancreatic cancer often arise at the same time in a patient; nearly 45% of patients with pancreatic cancer are likely to present as patients with new-onset diabetes. Recent studies evaluating the relationship between diabetes and pancreatic cancer have shown that long-standing diabetes is a risk factor for pancreatic cancer, while new-onset diabetes appears to be a manifestation of the disease. In fact, a meta-analysis examining the association of type 2 diabetes with pancreatic cancer in 14,399 patients concluded that new-onset diabetes is possibly a manifestation of pancreatic cancer, while long-term diabetes is likely a risk factor. In addition, prospective epidemiologic studies have suggested that new-onset diabetes is a potential platform for the early diagnosis of pancreatic cancer because of metabolic pathways associated with pancreatic cancer–related diabetes mellitus. Because approximately 50% of all patients develop diabetes mellitus before their cancer diagnosis, screening individuals with new-onset diabetes might allow earlier diagnosis of metastatic pancreatic cancer.

Expert Commentary

Margaret A. Tempero, MD

Director, Pancreas Center
Professor of Medicine
Division of Hematology and Oncology
UCSF
San Francisco, CA

Diabetes is very complex, and it has a very complex relationship with pancreatic cancer. Longstanding diabetes is a risk factor but new-onset diabetes is actually caused by the disease. So, a subset of patients with new-onset diabetes will have an underlying pancreatic cancer. Therefore, we have a nationwide effort to establish a cohort, a very large cohort of patients with new-onset diabetes from whom we are going to be collecting biospecimens for later analysis and following them to understand which of those patients develop pancreatic cancer.

“Diabetes is very complex, and it has a very complex relationship with pancreatic cancer.”

Margaret A. Tempero, MD

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