The Etiology of Pancreatic Cancer

Li Liu, MD
Last Modified: November 1, 2001

Dear OncoLink "Ask the Experts,"
Hello. On Wednesday, I received the unfortunate news that my mother did indeed have a malignant tumor on her pancreas. The tumor has attached itself to the inferior vena cava and obviously cannot be removed. This is not the first time that I have experienced this in my family. Both of my mom's parents both died very recently with cancer of the pancreas.

Obviously, I have many concerns and questions. After reading through the literature made available on the Internet, I have learned a great deal about this type of cancer. One thing that seems to be very inconclusive is the etiology of this dreaded disease. Although the etiology is unclear, many of the possible reasons cited were based on environmental factors (ie. cigarettes, certain chemical carcinogens). No where did I see any mention of genetics. However, after now finding out my mother's fate, I can only feel that I am very much susceptible to this. One thing to note, my mother grew up directly in front of a smelter where nickel was refined. In her town, a nickel manufacturing company is the biggest employer. Also this week, they were cited as one of the worst water polluters in the province of Ontario.

Thank you very much,  

Li Liu, MD, OncoLink Editorial Assistant, responds:

Dear G:
Thank you for your interest and question.

Some epidemiologic studies have reported the importance of inherited genetic abnormalities in pancreatic cancer. One case-control study estimated that 3% of pancreatic cancers had a hereditary origin (Fernandez E, et al. Cancer Epidemiology, Biomarkers & Prevention, 1994; 3:209). Some of the rare hereditary disorders that predispose persons to pancreatic cancer include hereditary pancreatitis (Davidson P, et al. Annals of Internal Medicine, 1968; 68:88), multiple endocrine neoplasia type I syndrome (Jensen RT, et al. Gastrointestinal Disease: Pathophysiology, Diagnosis and Management. Philadelphia: WB Saunders, 1992), Lynch syndrome II (Lynch HT, British Journal of Cancer, 1985; 52:271), von Hippel-Lindau syndrome (Neumann HP, Gastroenterology, 1991; 101:465), and ataxia-telangiectasia (Swift M, et al. Cancer Research, 1976; 36:209).

Occupational exposures, including 2-naphthylamiine, benzidine, derivatives of gasoline, DDT and related compounds, have been reported to be associated with an increased risk of pancreatic cancer, although the mechanisms are not totally understood. To my knowledge, nickel exposure and/or close contact has not been reported to be associated with pancreatic cancer. Other than cigarette use, the firm etiology of pancreatic cancer is usually not known. I would recommend you to discuss your concerns with your doctor and perhaps a genetics counselor.