Pancreatic cancer: Symptoms, treatment,
Hard to detect and quick to spread, pancreatic cancer is among the
deadliest of cancers. Scientists hope that genetic research will make
it more like other cancers-a treatable disease. But even if it's caught
while confined to the pancreas-and it rarely is-just 16% of patients
are alive five years after the initial diagnosis. By comparison, the
five-year survival rate for localized breast cancer is 86%. If the
cancer has spread beyond the pancreas, the likelihood of living another
five years is just 2%. Only the statistics for liver cancer are as
Fortunately, pancreatic cancer is uncommon compared with other major
cancers. About 30,000 new cases are diagnosed every year in the United
States, in contrast to about 200,000 new cases of breast cancer, and
170,000 new cases of lung cancer. But because it's so untreatable, pancreatic
cancer causes about the same number of deaths each year (30,000) as prostate
cancer, although over six times as many new cases of prostate cancer
are diagnosed each year.
No one knows exactly what causes pancreatic cancer. Like many cancers,
it's an older person's disease - the median age at diagnosis is 71. Because
Americans are living longer, there are more cases now than a half-century
ago. Pancreatic cancer does run in families. Former President Jimmy Carter's
father, brother, and two sisters died of the disease. Familial cases
account for 5%-15% of the total, but no one has identified the genetic
mutation that causes pancreatic cancer-and possibly no one ever will.
The genetics seem to be complex, with perhaps several mutations in just
the right combination leading to cancer.
Common symptoms include severe abdominal pain and weight loss. The pain
is often gnawing and radiates from front to back. Because the pancreas
is near the spine, backaches are common. For reasons that aren't understood,
it sometimes causes people to itch all over their bodies. About 70% of
pancreatic cancers start in what doctors refer to as the head of the
pancreas, which is the bulbous end of the gland Cancer there may cause
jaundice, yellow discoloration of the skin and the eyes, because the
tumor blocks the common bile duct, which drains the gallbladder and liver.
As a result, the waste product bilirubin backs up and gets into the blood.
Surgery. Sometimes the surgeon discovers that even a localized
tumor is inoperable. If the tumor can be cut out, the surgeon may remove
all or part of the pancreas, as well as parts of nearby organs. Salvaging
some of the pancreas is preferred because otherwise the patient must
cope with a sudden loss of insulin production as well as a life-threatening
If the cancer is in the head of the pancreas, the surgeon may perform
the Whipple procedure, a major operation that involves removing parts
of the small intestine, bile duct, and stomach, in addition to the head
of the pancreas. If the tumor is another part, surgeons may remove that
part of the pancreas along with the spleen.
Chemotherapy. Gemcitabine (Gemzar) improves the quality of life
for some, but hasn't led to any great gains in survival. Investigators
are now studying whether it might if it were used in combination with
other drugs. The National Cancer Institute is sponsoring 13 Phase III
clinical trials of pancreatic cancer treatments. Ten of those are testing
Researchers are also testing trastuzumab (Herceptin), the breast cancer
drug, and IMC-C225 (Erbitux), the controversial colon cancer drug developed
by the embattled biotech company, ImClone Systems.
Prevention is the best medicine
But preventing the disease is by far the best course of action. Smoking
is the clearest risk factor, so not lighting up is the surest prevention
tip. After you've kicked the habit, in several years your risk becomes
the same as if you never smoked.
More good news: the low-dose (81 mg) aspirin that many people take to
lower their chances of having a heart attack and stroke may also be a
defense against pancreatic cancer. University of Minnesota researchers
found last year that aspirin slashes the risk almost in half. Regular
use of ibuprofen and other anti-inflammatories didn't confer that benefit.
August 2003 Update
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