November is National Pancreatic Cancer Awareness Month. Pancreatic cancer is the 4th most common cancer in the United States. The average lifetime risk of developing pancreatic cancer is about 1 in 67 (1.5%). The incidence of pancreatic cancer is expected to rise by 2020 and is projected to become the second most common cancer in the country. Pancreatic cancer is one of the most aggressive types of cancer in the body. Even with the best treatments, the survival after diagnosis remains low despite advances made in medical field. Therefore we should all be aware of it and be prepared to fight this lethal cancer. We, at Esse Health would like to increase the public awareness of pancreatic cancer.
First, before we talk about the cancer itself, I would like to make some points about the pancreas. The pancreas is a mysterious organ located in the mid upper abdomen. It is located deep in the upper abdomen (almost above the spine). It helps digest food (by producing pancreatic enzymes) and plays a key role in metabolic functions in the body, especially with glucose regulation. Insulin, the hormone responsible for glucose metabolism, is produced by the pancreas. There are a few types of pancreatic cancer with different prognosis. The type of cancers and prognosis depends on the cell type from which they arise. The development of pancreatic cancer is due to a complex interaction between environmental and genetic factors. Patients with a history of smoking, alcohol use, family history of pancreatic cancer, history of chronic pancreatitis, history of pancreatic cystic lesions, and patients with certain genetically inherited disorders (such as hereditary breast and ovarian cancer syndrome, Lynch syndrome, hereditary pancreatitis, Peutz-Jeghers syndrome, etc.) are at increased risk of developing pancreatic cancer. There is immense interest among researchers to diagnose pancreatic cancer in the early form (pancreatic intraepithelial neoplasm) but the current diagnostic tests are still lagging behind in accurately diagnosing pancreatic cancer in the earliest form.
To treat any cancer, it is very important to diagnose it early. Screening for cancer in otherwise asymptomatic patients has been a standard of care for colon and breast cancer. However, no tests are approved for pancreatic cancer screening, primarily due to the subtle nature of the disease and inherent limitations of currently available tests. The biggest challenge with pancreatic cancer is that there is no single best or “gold standard” test that can be used as a screening test because pancreatic cancer tends to be occult at the early stages and often is missed on commonly performed tests such as CT scan. If there is a pancreatic cancer or lesion found on CT scan, often times it is too late to remove it by surgery. MRI is considered better than CT scan but it has its own limitations. A blood test (ca19-9) is available for pancreatic cancer but it lacks sensitivity and specificity, so it is not used to diagnose pancreatic cancer. Even if the blood test is abnormal, an imaging study and/or biopsy are needed for definitive diagnosis. Endoscopic Ultrasound (endoscopic procedure that combines endoscopic skill and ultrasound technology) has emerged as the most
valuable test. It can pick up small cancers that are often not seen by a scan (CT or MRI). Even though it is considered the ‘gold standard’ test, it has a few limitations (invasive test and operator dependent). Diagnosing pancreatic cancer is difficult and often requires using clinical information, laboratory, and imaging tests to help in the evaluation. Patients have survival advantage when diagnosed early-on or when the tumor is small, highlighting the need for early diagnosis. Of the available tests, Endoscopic ultrasound is the best test to diagnose and obtain biopsy of the tumor if found during the procedure.
Treatment of pancreatic cancer is as difficult as diagnosis. Surgery with curative intent is possible in only 20% of patients diagnosed with pancreatic cancer, again underscoring the importance of finding better diagnostic tools so that the cancer can be diagnosed early. Surgery for pancreatic cancer (called Whipple’s surgery) is a long and complicated surgery that, for best results, should be undertaken in otherwise fit individuals in whom the cancer has not spread to other parts of the body and major abdominal blood vessels. Chemotherapy and radiation therapy are often part of the treatment for pancreatic cancer. Even with combination treatment modalities, the prognosis remains dismal with pancreatic cancer. For example, 5-year survival for stage 1 pancreatic cancer is 12-14% with 1% for stage 4 cancer. Hence, in a small subset of patients with advanced disease, no therapy is recommended as the risks of treatment can outweigh benefits. In those situations, palliative care and hospice teams provide education to the caring family and keep patients comfortable. If you put all this information together and think about it, you will understand that the incidence of pancreatic cancer is increasing, the disease is difficult to diagnose and once diagnosed, the treatments, at best, offer survival benefit of months to a few years.
At Esse Health Gastroenterology group, our goal is to bring awareness to the public, patients, and physicians. We aim to be a good resource and prepared to take care of patients with possible and known pancreatic cancer. Our approach is multidisciplinary and involves doctors, nurses and ancillary staff. My advice to patients is to be aware of pancreatic cancer, know their family history and prior pancreatic problems, to live health fully by eating a healthy diet and not smoking or drinking alcohol. If they are 50 years old and have or had unexplained pancreatitis, weight loss, abdominal pain, jaundice, have a family history or risk factors for pancreatic cancer, they should seek help from their primary care physician or Gastroenterologist. I urge physicians to take a lead and improve awareness to the public so that together we all can put an end to this serious disease.
The internet is a good source if anyone wants to read or know about it. There are a few good informational websites such as cancer.org, cancer.gov, nccn.org, etc. available. But beware that the information in the internet can be overwhelming and in some cases could cause a situation where end up with more questions than answers, so do not hesitate to see your doctor if you have any symptoms or risk factors.
