pancreatic cancer

Pancreatic cancer: The hidden danger that lurks deep in the abdomen

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Pancreatic cancer made headlines in 2011, when Steve Jobs died from it. Jobs battled his cancer for 8 years before succumbing to it at age 56. I became really alarmed about pancreatic cancer after losing my aunt to this dreaded disease last week. Looking at her dead body I couldn’t grasp how someone who was talking, laughing and joking just three days ago could be dead so soon. I was so shocked and stupefied that I decided to take a deeper look into this menacing disease. Here’s what I found:

Pancreatic cancer is an aggressive form of cancer with few symptoms until the disease progresses to an advanced stage. The cancer typically spreads fast to nearby organs. Because of its tendency to spread silently before diagnosis, it is considered the 4th deadliest cancer diagnosis.

According to American Cancer Society, only one fifth of Americans diagnosed with the disease survive for a full year.

“There is no early detection method for pancreatic cancer — the cancer is usually diagnosed only after it has metastasized,” says Julie Fleshman, president and CEO of the Pancreatic Cancer Action Network, a California-based organization that advocates for pancreatic cancer research and patient and family support.

Detection is very hard and survival is low

pancreatic cancer

This cancer has a very low survival rate: 75% of patients die less than a year after diagnosis, and 94% die within five years.

According to the National Cancer Institute, only 8% of pancreatic cancer cases are diagnosed before the disease has spread beyond the pancreas. Among these patients doctors predict their survival to be 5 more years.

The outcome is gloomier for patients diagnosed at later stages. Less than 2% of these patients, whose cancer has spread to other parts of the body, survive 5 years.

Steve Jobs was able to survive for 8 years because he had a rare form of the cancer, known as neuroendocrine cancer. This type of pancreatic cancer grows more slowly and is easier to treat.

The most common type of pancreatic cancer is called pancreatic ductal adenocarcinoma (PDAC).

Symptoms include upper abdominal pain, weight loss, and loss of appetite. As stated earlier, these symptoms occur only when the disease is in its advanced stage. Also, many doctors fail to pinpoint pancreatic cancer, because all of these symptoms can be caused by other diseases as well.

pancreatic cancer

Why people with pancreatic cancer die so fast?

Only about 10 to 15% of pancreatic cancers are diagnosed when they could be considered for surgery. Even worrisome is that the patients who do have surgery, the prognosis is poor because the cancer comes back about 85% of the time. At best, about 25 to 30% of patients survive five years after surgery.

When surgery is performed, doctors take out 95% of the pancreas, including the tumor. They only leave a small part of the pancreas inside the body to serve insulin-producing functions.

What is the pancreas?

pancreatic cancer
Pancreas

Pancreas is a long flattened gland in the abdomen, lying horizontally behind the lower part of your stomach. The functions of the pancreas are:

  • Releasing powerful digestive enzymes into the small intestine in order to help us digest our food.
  • Releasing hormones insulin and glucagon into the bloodstream. Insulin and glucagon are crucial in helping our body regulate the levels of blood glucose, or sugar, in our body. These hormones work together to balance our blood sugar levels. When there is lack of insulin, glucose stays in the bloodstream, keeping blood sugar levels high.

Why pancreatic cancer isn’t detected early?

Because the pancreas lies deep in the abdomen, tumors are rarely palpable, meaning the patients themselves or the health care professionals cannot feel it by pressing on the abdomen. In its early stage, even a CT scan may not spot a tumor. That is why most symptoms of the cancer are not felt until the tumor has grown. When the tumor gets bigger it interferes with the pancreas functions or other nearby organs such as liver, stomach, duodenum, or gallbladder.

Read more Tomato extracts can prevent and treat stomach cancer, new study suggests

Who is at risk of pancreatic cancer?

The factors that may increase your risk of pancreatic cancer are:

  • Chronic inflammation of the pancreas known as pancreatitis
  • Diabetes
  • Family history of pancreatic cancer
  • Family history of genetic syndromes that can increase cancer risk
  • Obesity
  • Smoking
  • Drinking alcohol. Alcohol consumption is a major cause of chronic pancreatitis, which in turn develops to pancreatic cancer.
  • Older age, since most patients are diagnosed after age 65

Signs and symptoms

In its early stages, pancreatic cancer often doesn’t show any signs or symptoms, making it hard to diagnose early. However, the cancer starts to show its presence as the tumor grows. All these depend on the type of pancreatic cancer and the part of the pancreas that is affected. Also, the symptoms and its severity varies from person to person.

Signs and symptoms of pancreatic cancer include:

  • Pain in the upper abdomen that radiates to the back
  • Jaundice (Yellowing of skin and the whites of eyes)
  • Loss of appetite
  • Unexpected weight loss
  • Depression
  • Difficulty swallowing
  • Blood clots
  • Recently diagnosed diabetes
  • Fatigue

It should be noted that these symptoms do not necessarily mean that someone has pancreatic cancer. These symptoms can be caused by other conditions such as indigestion, heartburn, gallstones, and irritable bowel syndrome. But, if you have these symptoms and you are worried, you should see a doctor immediately.

Diagnosis of pancreatic cancer

Pancreatic cancer may remain undetected until it reaches advanced stage. When the symptoms start to occur, diagnosis is relatively easy but unfortunately, cure is almost impossible at that point. A doctor may use the following methods to diagnose pancreatic cancer:

  • CT scans, MRI, and PET scans
  • Endoscopic retrograde cholangiopancreatography (ERCP). The doctor inserts a flexible tube fitted with camera and other tools on one end through the mouth to the small intestine. This procedure records images of the area, and take a small biopsy with a brush.
  • Endoscopic ultrasound (EUS). This is similar to ERCP. An ultrasound probe on the endoscope finds the mass, and a needle fitted on the endoscope extracts some tissue from the mass.
  • Percutaneous needle biopsy. During this procedure, also known as fine needle aspiration (FNA), a radiologist inserts a needle into the mass to remove a small sample of tissue for examination under a microscope.
  • Blood tests. Pancreatic cancer patients have high levels of certain substances, such as carcinoembryonic antigen (CEA) and CA 19-9 in their blood. But unfortunately, these elevated levels may not show in blood tests because they may not rise until the cancer is at its advanced stage.

Stages of pancreatic cancer

Stage 1: In this stage the cancer is remained in the pancreas and can be removed by surgery.

Stage 2: Cancer at this stage has spread beyond the pancreas to nearby tissues and organs and may have spread to the lymph nodes. Surgery may be possible to remove the cancer.

Stage 3: At this stage the patient is in grave danger because the cancer has spread beyond the pancreas to the main blood vessels around the pancreas and may have attacked the lymph nodes. Surgery may or may not be possible to remove the cancer.

Stage 4: Cancer has spread to the farthest points beyond the pancreas, such as the liver, lungs and the peritoneum (the lining that surrounds the abdominal organs). This is the end stage and surgery isn’t possible.

pancreatic cancer

Treatment

Treatment depends on the stage and location of the cancer as well as on the patient’s overall health.

First goal of a healthcare professional is to eliminate the cancer, if possible. When eliminating the cancer is not possible, the focus may be on improving the patient’s quality of life and halting the cancer tumor from growing and causing more harm.

Treatment may include surgery, radiation, chemotherapy or a combination of these.

pancreatic cancer

Surgery

There are different types for surgery for removing the cancer:

Whipple procedure

If the cancer is located in the head of the pancreas, then a surgery called Whipple procedure may be conducted to remove the pancreatic head, the first part of the small intestine, gallbladder and part of the bile duct. This is a technically difficult operation. In some instances, the doctor may remove part of the stomach and nearby lymph nodes. The remaining parts of the pancreas, intestines, and stomach are later reconnected to allow the patient to digest food.

Distal pancreatectomy

This surgery is done to remove tumors in the pancreatic body and tail. This is conducted on the left side of the pancreas where the body and tail are located. The surgeon may also remove the spleen.

Surgery to remove the entire pancreas

Sometimes the doctor may need to remove the entire pancreas. The patient may live relatively normally, but will need insulin and enzyme replacement for the rest of his/her life.

Surgery to remove tumors that affect nearby blood vessels

This surgery calls for very highly specialized and experienced surgeons. This surgery removes and reconstructs parts of blood vessels in the affected patients.

Chemotherapy

Drugs are used to kill cancer cells. The drugs can be taken orally or injected into a vein. Patient may receive one chemotherapy drug or a combination of both. This is done to control the cancer growth and prolong survival.

Radiation therapy

High-energy beams, such as those made from X-rays and protons, are used to destroy cancer cells. This therapy may be performed before or after the surgery, sometimes in combination with chemotherapy.

Treatments to ease the pain caused by pancreatic cancer

When the tumor presses on nerves near the pancreas, it may become very painful. When medicine isn’t enough to ease the pain, doctor may inject medicine into the region around affected nerves or cut the nerves to stop the feeling of pain.

Alternative medicine

Although these will not cure the cancer, they may ease the signs and symptoms.

Early signs of pancreatic cancer

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Salahuddin Ahmed is a freelance medical writer and blogger, who has been writing about medicine and health for more than a decade. A former New York transplant, he now lives in his native Dhaka. He received a Bachelor's degree from the University of Louisiana and a diploma on eTechnology from NIIT, Dhaka. A voracious eater, Salahuddin only dines at restaurants that offer free refills on rice.

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