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Seven years ago, Matt Wilson went to the Emergency Room. He had stomach pain, which he assumed to be a kidney stone. It was not. CT scan showed an abnormal location, later diagnosed as early pancreatic cancer. This chance discovery could save his life. Pancreatic cancer usually grows in silence without symptoms, and successful treatment is rare.
Thursday is the World Day of Pancreatic Cancer in the hope that awareness of the disease can help save lives.
What is pancreatic cancer?
Pancreas, an organ in the abdomen, is responsible for the secretion of digestive enzymes and hormones that regulate metabolism. Pancreatic cancer is the third leading cause of cancer deaths in the U.S. – may even overcome lung and colorectal cancer by 2020. The risk of developing this cancer is 1 to 63 in men and 1 to 65 in women; the risk increases with age. Almost 90% of the diagnosed persons are over 55 years of age. Other risk factors include a family history of cancer, obesity, smoking, diabetes and a diet rich in red and processed meat. A diet that includes lots of fruits and vegetables can work to reduce the risks.
Matt WilsonWhy is it so deadly?
Most people who are diagnosed, including Matt Wilson, have only vague symptoms: abdominal or upper back pain, unintended loss of weight, fatigue, recent diagnosis, or diarrhea (yellowing of the skin and eyes). Because these symptoms apply to a lot of diseases, cancer is often diagnosed too late for significant treatment. There is a 9% frightening survival rate 5 years after diagnosis. This year only 55,440 people will be diagnosed and 44,330 will die.
Are there different types?
There are two major types of pancreatic cancer: endocrine and exocrine tumors.
The most common and most aggressive form is the exocrine tumor. This is an adenocarcinoma that starts in pancreatic channels and gland cells that produce enzymes. These cells have a thick coating to protect them from the digestive enzymes they produce. But that thick layer also reduces the effects of chemotherapy.
Only a few cases of pancreatic cancer – about 1% – are endocrine tumors. These affect the cells that produce insulin and glucagon, the hormones that manage the blood sugar. These types of cancer have a significantly increased survival rate of 5 years after diagnosis of about 50 to 80%.
Treatment options
The gold standard treatment option is a surgical procedure known as Whipple. This technique was invented by Dr. Allen Whipple in 1935 at the Columbia-Presbyterian Hospital in New York City. Physicians eliminate many of the digestive organs: biliary bile, common bile duct, part of the stomach and the pancreatic head. Unfortunately, this procedure is only possible in about 20% of patients; can not work with patients diagnosed with cancer at a later stage. Other treatment options include chemotherapy, a series of drugs designed to kill cancer cells. This can be done after Whipple or with radiation for those who are not eligible for surgery. Treatment is difficult because it is so difficult to diagnose pancreatic cancer when the tumor is small. When it increases and obstructs pancreatic channels or produces abnormal levels of hormones, it is often too late for surgery.
Pancreatic transplants, another treatment option, have also recently been caught. That used Steve Jobs, in part, to fight the disease. However, doctors warn that measures taken to prevent the body from rejecting the new pancreas may allow the remaining cancer cells to grow, which means an increased risk of cancer recurrence.
An oncologist will have to rely on science and the art of medicine to help a patient determine the treatment that is the best choice for them, Lynn Matrisian Ph.D., Chief of the Pancreatic Cancer Network of Action, ABC said News.
Matt WilsonCan not we see pancreatic cancer as we do for breast cancer?
International Cancer of the Pancreas Screening Consortium recommends that people with hereditary pancreatitis, those with first-degree relatives who have been diagnosed, or those with BRCA1 / 2 mutations be examined more often by doctors when they come to office with vague stomach pain . Unfortunately, there are no other specific guidelines.
What's on the horizon?
Matt, the ER patient, had surgery to remove some of the pancreas, spleen and more than 20 lymph nodes. A challenging recovery and the discovery of a new cause means that Matt now divides his time as a university professor and supports others with the same diagnosis. Now part of the Pancreatic Cancer Network.
Organizations such as the Pancreatic Cancer Action Network are constantly trying to seek additional funding to find out what might be doing against this aggressive cancer. It also investigates biomarkers for a blood test that could help diagnose earlier. At this point, tests remain unsafe, but perhaps further research can open new gates. Drug therapy targeting specific DNA mutations can help create drugs that better penetrate tumor cells. But unfortunately, these screening tools will take years to develop.
Dr. Sumir Shah, MD, is an emergency physician at the New York-New York-Presbyterian Queens / Weill Cornell Medical Center in New York City and a member of the ABC News medical unit.
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