Sunday , November 29 2020

Pancreatic cancer, a quiet killer?



Seven years ago today, Matt Wilson went to the emergency room. He had stomach which he assumed was a kidney stone. It was not. His CT scan showed an abnormal site, which was later diagnosed as an early pancreatic cancer. The temporary discovery may have saved their lives. Pancreas usually grows quietly, without symptoms, and successful treatment is rare.

Thursday is the World Pancreatic Cancer Day, hoping that awareness of the disease can help save lives.

What is pancreatic cancer?

The pancreas, an organ of the abdomen, is responsible for the secretion of digestive enzymes and hormones that regulate metabolism. Pancreatic cancer is the third leading cause of cancer death in the United States – it may even exceed lung and colorectal in 2020. The lifetime risk of developing this cancer is 1 in 63 for men and 1 in 65 for women; the risk increases with age. Nearly 90 percent of the diagnosed persons are over 55 years old. Other risk factors include a family history of cancer, obesity, smoking, diabetes and a diet high in red and processed meat. A diet that contains plenty of fruits and vegetables can work to reduce risks.

PHOTO: Matt Wilson with his surgeon, Dr. Harish Lavu of Jefferson University Medical Center.Matt Wilson
Matt Wilson with his surgeon, Dr. Harish Lavu of Jefferson University Medical Center.

Why is it so deadly?

Most diagnosed, including Matt Wilson, show only vague symptoms at first: abdominal or upper back pain, accidental weight loss, fatigue, new diabetes diagnosis or jaundice (yellowing of skin and eyes). Because these symptoms apply to many diseases, cancer is often diagnosed too late for meaningful treatment. There is a scary 9 percent survival 5 years after diagnosis. This year, 55,440 people will be diagnosed and 44,330 will die.

Are there different types?

There are two main types of pancreatic cancer: endocrine and exocrine tumors.

The most common and most aggressive form is the exocrina tumor. It is an adenocarcinoma that begins in the pancreatic ducts and gland cells, which produce enzymes. These cells have a thick coat to protect them from the digestive enzymes they produce. But the thick coat also reduces the effects of chemotherapy.

Only a few cases of pancreatic cancer – about 1 percent – are endocrine tumors. They affect the cells that produce insulin and glucagon, the hormones that handle our blood sugar. These cancers have a significantly increased survival 5 years after diagnosis of about 50 to 80 percent.

Treatment

The Gold Standard Treatment option is a surgical procedure called Whipple. This technique was made by Dr. Allen Whipple Back in 1935 at Columbia-Presbyterian Hospital in New York City. Doctors remove many of the digestive tract: gall bladder, common bile duct, stomach part and pancreas. Unfortunately, this procedure is only possible for about 20 percent of patients. It can not work with patients diagnosed with cancer at a later stage. Other treatment options include chemotherapy, a variety of drugs designed to kill cancerous cells. This can be done after whipple or along 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 enlarges and inhibits pancreatic canal or produces abnormal levels of hormones, it is often too late for surgery.

Pancreatic transplants, another treatment option, have also been captured recently. That was what Steve Jobs used, in part, to fight for his illness. However, doctors warn that measures taken to stop the body from rejecting the new pancreas can allow remaining cancer cells to grow, which means a high risk of the cancer coming back.

"An oncologist will probably need to rely on science and the art of medicine to help a patient decide the treatment that is the best choice for them," Lynn Matrisian Ph.D., Chief Scientific Director of the Pancreatic Cancer Action Network, told for ABC News.

PHOTO: Matt, others from the left, with ABC News & Robin Roberts and Pancreatic Cancer Action Network staff and Lustgarten Foundation for Pancreatic Cancer Research, visiting Good Morning America to honor the world's pancreatic cancer day.Matt Wilson
Matt, others from the left, with ABC News Robin Roberts and employees of the Pancreatic Cancer Action Network and Lustgarten Foundation for Pancreatic Cancer Research, visiting Good Morning America to commemorate the World Pancreatic Cancer Day.

Can we not tighten for pancreatic cancer as we do for breast cancer?

The international cancer in 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 should be screened by physicians closer to entering the office with vague gastric pain. Unfortunately, there are no other specific guidelines.

What is on the horizon?

Matt, the ER patient, had surgery that took away the part of his pancreas, spleen and more than 20 lymph nodes. A challenging recovery and discovering a new cause means that Matt now shares his time as a university professor and advocates for others with the same diagnosis. He is now part of the Pancreatic Cancer Action Network.

Organizations like pancreatic cancer care networks are constantly working to call for additional funding to find out what can work against this aggressive cancer. They also research biomarkers for a blood sample that can help diagnose it early. At this point, the test is unreliable, but perhaps further research can open new doors. Drug therapy that targets specific DNA mutations can help to create drugs that penetrate the tumor cells better. But unfortunately these screening tools will take years to evolve.

Dr. Sum Shah, M.D. is an emergency medical practitioner at NewYork-Presbyterian Queens / Weill Cornell Medical Center in New York City, and a member of the ABC News Medical Unit.


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