Pancreatic Cancer Genetic Mutations

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All cancer begins with a mutation in the DNA of one cell, causing the cell to grow and divide uncontrollably. Mutations that occur during a person’s lifetime, rather than inherited mutations, seem to cause most pancreatic cancers. But in some families hereditary factors play an important role. While only about 10% of pancreatic cancers are considered familial or hereditary, researchers are interested in understanding these mutations and syndromes to understand the biology of pancreatic cancer better.

Ataxia Telangiectasia (AT)

Ataxia Telangiectasia is a rare inherited condition caused by mutations in the ATM gene. Patients with AT present with a 38% lifetime risk of developing cancer. Approximately 2-3% of patients with familial pancreatic cancer have a mutation in the ATM gene.

BRCA Mutation

BRCA 1 and 2 mutations are often related to inherited breast and ovarian cancer. However, the BRCA1 mutation may also cause a small increased risk of developing pancreatic cancer. Mutations in the BRCA2 gene are associated with a 3- to 10-fold increased risk of developing pancreatic cancer. A mutation in this gene can be found in approximately 1% of individuals of Ashkenazi Jewish descent. This is higher than in other populations. People with BRCA2 mutations have a 10% lifetime risk of developing pancreatic cancer.

Cystic Fibrosis

Cystic fibrosis affects the pancreas by causing pancreatic insufficiency and chronic pancreatitis. The risk of developing pancreatic cancer is 5 to 6 times greater in people who have cystic fibrosis compared to average risk.

Familial Adenomatous Polyposis (FAP)

FAP is a rare, hereditary form of colon cancer in which a person develops hundreds to thousands of noncancerous polyps in the colon that eventually become malignant. It is associated with higher rates of thyroid, small bowel, stomach, and pancreatic cancers.

Familial Atypical Multiple Mole Melanoma (FAMMM)

FAMMM is characterized by younger age of melanoma diagnosis, many skin moles and multiple primary melanomas. People with FAMMM have a 20-to-47 fold increased risk of developing pancreatic cancer.

Hereditary Nonpolyposis Colorectal Cancer (HNPCC) or Lynch Syndrome

This is an inherited condition that is associated with 5% of colon cancer cases. Patients with HNPCC have an approximately 9-fold increased risk of developing pancreatic cancer.

Hereditary Pancreatitis

Hereditary pancreatitis is a rare, inherited condition that usually starts before age 20. It is characterized by recurrent episodes of severe inflammation of the pancreas that can lead to chronic pancreatitis and approximately a 40-55% lifetime risk of developing pancreatic cancer. Individuals with hereditary pancreatitis who also smoke may develop earlier onset pancreatic cancer.

PALB2 Mutation

About 1-3% of patients with familial pancreatic cancer have inherited mutations in the PALB2 gene. Mutations in the PALB2 gene have also been associated with an increased risk of breast cancer.

Peutz-Jeghers Syndrome

Peutz-Jeghers Syndrome is characterized by polyps in the small intestine and pigmented spots on the lips and nose. Patients with this syndrome have an 11-36% risk of developing pancreatic cancer in their lifetime.

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