May 27, 2017 02:55 AM PST
SINCE 2007

Deadly pancreatic cancer

By Philip S. Chua, MD, FACS, FPCS

Around 50,000 persons in the United States will be diagnosed with pancreatic cancer this year alone, and about 49,000 others who already have this malignancy would die. That’s how fatal this cancer, the 4th highest cause of

cancer-related deaths, is. While annual death rate from pancreatic cancer among those in the Philippines is listed as about 1,400, I could not find any reliable statistics on this. The number of cases could also be underestimated because of undiagnosed and untreated cases. Most patients with pancreatic cancer are dead within six months or sooner after the diagnosis is made because of the nature of this malignancy.

What is pancreatic cancer?
Cancer of pancreas is a malignant tumor of the pancreas, which is a gland that produces insulin and regulates blood sugar level and also aids in digestion. It is located behind the stomach, making it hard to examine and often undetected early, the reason why most of patients are with stage 4 advanced cancer (with distant spread) by the time they are seen by the physician. It is a treacherous stealth form of cancer, and there is no screening test and the symptoms could be very subtle, non-specific (loss of appetite, weight loss, pain in the abdomen and back, etc.) and mimic other lesser serious conditions.

What are the risk factors?
Anything that increases the chance to get the disease is a risk factor, like genetic, behavior, habits, diet, environmental conditions, etc. For pancreatic cancers, the following are the risk factors: smoking (twice higher than non-smokers), either cigar, pipe, or cigarettes, or even e-cigarettes; overweight/obesity, with 20% increase in risk; exposure to chemicals, like pesticides, dyes, and metal-refining chemicals. Heavy alcohol intake likewise raises the risk. These factors above are modifiable. The following risk factors can’t be changed: age - the older, the higher the risk, almost all are above 45, 2/3 are at least 65, with average age at diagnosis is 71; gender - males are 30% more prone than females; race - African Americans have higher risk than whites; family – pancreatic cancer appears to be common in some families with genetic syndrome (inherited gene mutation) PRSS1. In these cases, genetic testing could help in the vigilance and prevention.

Is diabetes a factor?
Yes, pancreatic cancer is more common among type-2 diabetics for unknown reason. Chronic pancreatitis (inflammation) is also associated with increased risk for the development of cancer of the pancreas, but most persons with pancreatitis do not develop cancer of the pancreas. Those with chronic pancreatitis due to an inherited familial form have a high lifetime risk for pancreatic cancer. People with cirrhosis of the liver (from hepatitis or alcohol abuse) and those with stomach ulcer caused by Helicobacter pylori bacteria have increased risk for pancreatic cancer.

How about diet?
Numerous studies have reported association of diet high in meat, pork, processed meats (sausage, bacon, etc.) with increased risk of pancreatic cancer. Charred portion of barbequed meats has also been mentioned, pointing to the burning saturated fat drippings on the charcoal emitting vapors of toxic (carcinogenic) chemical upwards back to the meat. It is best not to burn grilled foods, and to remove the black burnt portion of the meat, fish, seafood, etc. Others have stated that diet high in vegetables, spices, fruits may reduce the risk for pancreatic cancer and other cancers. Inactivity, lack of physical exercise, might also increase the risk for cancer formation and not only cardiovascular diseases and diabetes. Studies are ongoing on these issues.

What is the treatment for cancer of the pancreas?
Depending on the stage, which is usually advanced by the time it is detected, the treatment is individualized, according to the patient’s age, over-all health, other attendant health issues, and the patient’s decision. It may include surgery, chemotherapy, radiation treatment, mental health care and palliative care for end-stage cancer.

What treatment did Steve Jobs have?
The late Apple CEO Steve Jobs must have had done Google searches for the treatment of his pancreatic cancer, when he was first diagnosed. Since 95% of pancreatic cancer has adenocarcinoma as the cell type, which is a fatal form of this cancer, he obviously refused the recommended surgery thinking it would be useless. But his pancreatic cancer was an Islet Cell tumor, a neuroendocrine tumor, a well-differentiated Islet Cell cancer which is curable by surgery --- a medical subtlety he may not have understood. Instead, he opted for alternative (acupuncture, herbal, vegan diet, even psychic) treatment, and only consented to have surgery 9 months later when his own treatment of choice had failed, by which time the cancer had already spread to the liver and other organs. Had he followed his surgeon’s recommendation at the very start, he would most likely still be alive today. Before his death, he expressed his regret for his wrong decision. It is, indeed, best to leave the practice of medicine to the experts and simply enjoy the great advances in science and cutting-edge technology

What are the 5-year survival rates, prognosis?
Five-year survival rate means how many patients are still alive in 5 years.

The natural (untreated or undiagnosed) 5-year survival rates are: Stage 1A, 14%; 1B, 12%; 2A, 7%; 2B, 5%; 3, 3%; and Stage 4, 1%, a most common stage at diagnosis, the reason it is a deadly disease.

With surgery, the 5-year-survival rates are: Stage 1, 61%; 2, 52%; 3, 41%, and Stage 4, 16 %. Statistically, surgery is better, unless the cancer has spread all over the body.

Is pancreatic cancer preventable?
In view of the aggressive nature of adenocarcinoma of the pancreas, the absence of a screening test for pancreatic cancer, and the deep-seated location of the pancreas, there is no effective way of totally preventing cancer of the pancreas. However, we can lower our risk for this deadly cancer by living a healthy lifestyle and behavioral modification as recommended above, and a regular medical tune-up.

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