Pancreatic Cancer: A deadly cancer with a very poor prognosis

This disease is in the news again because Steve Jobs underwent a liver transplant several months ago. Also, the movie actor Patrick Swazy announced several months ago that he too was in a battle with pancreatic cancer.

Pancreatic cancer is very difficult to detect, much like ovarian cancer in women. It is a deadly cancer with a very poor prognosis. It is hard to detect early, is resistant to therapy and spreads quickly. Most often, when you find out about it, it is too late. Few symptoms occur early. One can become jaundiced due to liver involvement. Weight loss and loss of appetite are probably the earliest but non-specific symptoms. Pain in the upper abdomen that radiates to the center of the back is suggestive. Risk factors include race (blacks have a higher incidence), smoking, obesity, and a family history of pancreatic cancer or inflammation. Some genetic syndromes like BRCA2 are related. Most cases occur in elderly people over 70 years of age.

The pancreas is essential to life. Its endocrine cells secrete insulin to control blood sugar. It also produces enzymes needed to digest foods. Endocrine cancers are very rare. The vast majority of pancreatic cancers come from the cells that make the digestive juices and are called exocrine. They are adenocarcinomas.

One should see their physician if they suffer any of the above cited symptoms. There are no screening tests specific for identifying pancreatic cancer. Blood tests could include liver functions tests to determine if the liver is involved. One other blood test is the Ca19-9. This appears to be a protein in the blood from pancreatic cancer cells. It is not entirely specific. Some doctors use it for prognosis and sequentially follow levels after surgery. It may be high if you have pancreatic cancer. More likely, from the history and physical the doctor will determine that CT or MRI scans be done to identify tumor. If they are suggestive, then more will be done. Chest X ray and bone scans can help show if there is metastasis. Invasive studies like laparoscopy and tissue biopsy or surgical staging with an open laparotomy can be done. The cancer stage is classified from I to IV depending on how far the tumor has spread. IV means tumor has metastasized to other tissues outside the pancreas.

Surgical resection of pancreatic tumors is rarely successful because the tumor has invaded so much tissue. A Whipple procedure can be done if the tumor is in the pancreatic head. The head, duodenum and some of the stomach is removed. If the tumor is in the tail, a distal pancreatectomy is performed. The spleen may be excised too.

More often, radiation therapy and chemotherapy are the basis for therapy after surgical resection. A new form of therapy called target cell therapy is now used too. Here, specific drugs are used that inhibit cancer spread and growth by blocking chemicals that give signals for growth etc. Liver transplant can be performed if the liver is involved.

Pancreatic cancer is mortal. Long term prognosis is very poor. Early detection is the key. If you have any significant and unexplained weight loss, or pain to the mid back, you should immediately see your doctor.