An article published in February 2022 in ESMO Open: Cancer Horizons says EPI is common in both resectable (i.e., treatable with surgery) and unresectable pancreatic cancer. The likelihood of EPI occurring can depend on factors such as how much and what areas of the pancreas are removed. In people who have pancreatic cancer, the symptoms of EPI — such as weight loss, diarrhea, and bloating — often don’t show up until the cancer is in its advanced stages. And, explains Frank G. Gress, MD, chief of gastroenterology and hepatology at Mount Sinai South Nassau hospital in Oceanside, New York, when you don’t get the nutrients you need, drastic weight loss, malabsorption, and nutrition deficiencies can occur. It’s important to note that although EPI can occur along with pancreatic cancer, not all people with pancreatic cancer develop it. Here’s what you should know about the link between the two.
The conditions share a common risk factor: chronic pancreatitis. “Some studies suggest that people with chronic pancreatitis are at increased risk for pancreatic cancer,” says David Bernstein, MD, a gastroenterologist and hepatologist and the chief of the department of hepatology at Northwell Health in Manhasset, New York. Chronic pancreatitis, which is the long-term inflammation of the pancreas that results in permanent damage, can also lead to EPI. And, when the condition results from chronic pancreatitis, it tends to be severe.Pancreatic cancer surgery may cause EPI. According to the ESMO Open: Cancer Horizons article, which cites various reviews, the prevalence of EPI after total removal of the pancreas is 100 percent, compared with 74 percent after a pancreaticoduodenectomy (removal of the head of the pancreas, part of the small intestine, the gallbladder, and the bile duct) and 67 to 80 percent after a distal pancreatectomy (removal of the body and/or tail of the pancreas). “If most of the pancreas is normal and only a small part is removed during pancreatic cancer surgery, pancreatic insufficiency shouldn’t result,” Dr. Bernstein says. “However, if the pancreas is severely diseased and a significant portion is surgically removed, then the person will be more likely to develop exocrine pancreatic insufficiency.”EPI can occur if pancreatic cancer is located at the head of the pancreas. “Another mechanism by which pancreatic cancer can lead to exocrine pancreatic insufficiency is if the tumor causes complete blockage of the pancreatic duct, a tube that connects the pancreas to the bile duct,” says Deepak Agrawal, MD, MPH, chief of gastroenterology and hepatology at Dell Medical School at The University of Texas at Austin. “If a tumor blocks the head of the pancreas, none of the digestive juices can make it out of the organ. If this is the case, exocrine pancreatic insufficiency will be severe.”
Treating EPI Along With Pancreatic Cancer
In general, treatment for EPI will be the same for people with or without pancreatic cancer. “The main treatment for pancreatic insufficiency is pancreatic enzyme replacement therapy [PERT],” Dr. Gress says. “Pancreatic enzymes are delivered in the form of prescription pills and provide the body with the enzymes it can’t make itself.” Pancreatic enzymes are taken with food and help with the digestion issues, weight loss, malabsorption, and vitamin deficiencies associated with EPI. PERT can also help ease the pain associated with EPI by reducing the strain on the pancreas to make the needed volume of digestive enzymes. And, according to Gress, pancreatic enzymes have been shown to slow down the progression of chronic pancreatitis. Your doctor may also recommend taking vitamin supplements, says Gress. People who have EPI may have trouble digesting fat-soluble vitamins such as vitamins A, D, E, and K, and taking supplements can help reduce your risk of developing those deficiencies. Some research has suggested that treating EPI with antioxidants, such as selenium, zinc, and beta-carotene, may also help improve chronic pancreatitis and slow the progression to pancreatic cancer, though there isn’t enough evidence at this time to make this part of standard treatment. “More research on treatment with antioxidants is necessary, however,” Gress says.
