November is Pancreas Cancer Awareness Month and with the recent passing of Patrick Swayze and Steve Jobs, now is as good a time as ever to educate ourselves about this deadly disease. Almost 40,000 people per year will die of this disease in the U.S., making it the 4th most common cancer killer. It is through education and research that we can continue to improve survival and outcome for this aggressive cancer.
The pancreas is an organ that makes hormones (like insulin) and also makes enzymes to help digest the food we eat. The deadliest form of pancreas cancer, or pancreas adenocarcinoma, comes from the cells that make the digestive enzymes. This type of cancer makes up 95% of pancreas cancers and is the form Luciano Pavarotti and Patrick Swayze had. Steve Jobs had the hormonal type of pancreas cancer, neuroendocrine cancer, which is likely the reason he lived so long with the diagnosis. These two forms of pancreas cancer behave and are treated very differently, so an accurate diagnosis is critical.
The biggest hurdle in the treatment of pancreas cancer is that in most cases, the disease is detected late. This is because the symptoms surface late in the progression and no good screening tests are available. In fact, less than 10% of patients are detected in the earliest stage, making curative treatment difficult.
There are a few factors that put a person at greater risk for developing pancreas cancer, including smoking, obesity and chronic pancreatitis (long term inflammation of the pancreas).
Treatment for this disease can be with surgery, chemotherapy, radiation, and sometimes even a combination of the three. Surgery is the only modality that can cure the disease (and yes, some patients are cured), but unfortunately only 40% of pancreas cancer patients are considered surgical candidates. If the disease has already spread, and the surgery is not possible, chemotherapy can be used to prolong patient’s lives, but not cure them.
Where and by whom you are treated is also key in obtaining the best outcomes. The surgical technique for pancreatic cancer has become fairly routine, but only in experienced hands. It is clear that an experienced surgeon and the proper hospital setting are important for outcome so make sure are you are informed about your options. A patient of mine was originally told he had unresectable pancreas cancer and went ahead with chemotherapy and radiation to control its spread. On a friend’s suggestion, he got a second opinion with me. His scan looked ok, and we took him to surgery where he did great. That was December 2008. We are coming up on his 3-year anniversary free of disease. Of course, we need to keep following up with him, this is just the nature of pancreatic cancer, but he went from “getting his affairs in order” to having a chance to live the life he thought he was going to lose.
No doubt, this is a life threatening disease, but with a dedication to educate ourselves, perform excellent care and conduct cutting edge research, we can help find a cure for this deadly disease.
Daniel Labow is Chief, Surgical Oncology at The Mount Sinai Medical Center in New York City.
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