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Pancreatic cancer: Symptoms, treatment, and prevention

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 grim.

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.

Symptoms

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.

Treatment

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 cancer.

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 gemcitabine combinations.

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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