It seems every week a report surfaces of another person in the public eye suffering from pancreatic cancer. We watch as they battle this brutal cancer and waste away. What scares patients and physicians about this cancer is we don't have routine screening for it and the reality is most don't survive. Why is that?
How common is it? Pancreatic Cancer is the 4th leading cause of cancer-related death in the United States, and is second only to colorectal cancer as a cause of digestive cancer-related death. Surgical resection is the ONLY potentially curative treatment. Unfortunately, because of the late presentation of the disease, only 15 to 20 percent of patients are candidates for pancreatectomy.
What are the survival rates for pancreatic cancer? The prognosis of pancreatic cancer is poor even in those with potentially resectable disease. The five-year survival following pancreaticoduodenectomy (surgical resection) is only about 25 to 30 percent for node-negative, and 10 percent for node-positive tumors.
Have we made any progress on survival from Pancreatic Cancer? Recent data indicate that outcomes may be improving over time, possibly related to an increased proportion of patients undergoing surgery at teaching hospitals, and/or greater use of chemotherapy after tumor resection (adjuvant chemotherapy). One of the strongest predictors for survival is the use of adjuvant chemoradiotherapy; the three year survival rate was significantly higher among those who received it compared to those who did not (45 versus 30 percent, respectively).
Who gets pancreatic cancer? In the United States, the incidence of pancreatic cancer has been on the rise since the 1930s, but it has been relatively stable since the 1970s. Approximately 33,730 new cases were reported in 2006, with 32,300 deaths. Pancreatic cancer is rare before the age of 45, but the incidence rises sharply thereafter. The incidence of pancreatic cancer is 30 percent higher in men and 50 percent higher in blacks compared with whites and people of other races.
What are the known risk factors for pancreatic cancer? The major risk factors include chronic pancreatitis, smoking, diabetes (both adult onset and type I), obesity and sedentary lifestyle and hereditary predisposition to pancreatic cancer itself or to multiple cancers. The evidence is inconclusive when it comes to coffee and alcohol consumption.
What are the symptoms you would feel with pancreatic cancer? Most patients with pancreatic cancer experience pain, weight loss, or jaundice (yellowing of skin and whites of your eyes). Pain is present in 80 to 85 percent of patients. The pain is usually felt in the upper abdomen as a dull ache that radiates straight through to the back. It may be intermittent and made worse by eating. Weight loss can be significant and may be associated with decreased appetite and early satiety (feeling full early).
The reason mortality rates are so high with pancreatic cancer is that the majority of patients have unresectable disease by the time symptoms occur and the diagnosis is made.
Should we randomly screen for pancreatic cancer? At least three studies have addressed the use of CT scans for early detection of pancreatic cancer in adults with new-onset diabetes (since that is a known risk factor). A series from the Mayo Clinic suggested that CT scans done at the time of newly diagnosed diabetes in otherwise asymptomatic patients were more likely to show potentially resectable tumors. Whether higher resectability rates translate into higher cure rates was not addressed so we don't know if this would have changed mortality rates from pancreatic cancer.
Results of all studies indicate that CT screening of all older subjects with new onset diabetes in order to discover a small number of pancreatic cancers is not feasible. Thus, screening CT scans are not warranted in older asymptomatic adults with new-onset diabetes.
If you have symptoms and are worried it might be pancreatic cancer what imaging study can be done? Ultrasound of the abdomen is usually the initial study performed. Abdominal CT scan has a better sensitivity than ultrasound for the detection of pancreatic cancer but both are excellent.
Are there any blood tests for Pancreatic Cancer? Yes, but we don't use them for routine screening. Several markers for pancreatic cancer measured in the blood have been evaluated; the most useful is CA 19-9. The accuracy of CA 19-9 to identify patients with small surgically resectable cancers is limited and CA 19-9 is frequently elevated in patients with various benign disorders which is why CA 19-9 is not recommended as a screening test for pancreatic cancer.
So as we watch Ruth Bader Ginsberg, Patrick Swayze, and Steve Jobs struggle in the public eye, our thoughts are with them.