Cancer of the Pancreas

Although pancreatic cancer ranks as the 12th most common form of cancer it now represents the 3rd most frequent cause of cancer related death outnumbering even breast cancer. Fatalities from pancreas cancer appear poised to surpass deaths from colon cancer within this decade. Over the past 40 years the likelihood of surviving 5 years after diagnosis has remained in single digits.

This year in the United States about 53,000 individuals will receive the diagnosis with the death toll exceeding 44,000. Worldwide both numbers are in the mid-400,000 range. Genetic alterations play a central role in development of pancreatic cancer. The incidence appears markedly greater in developed countries of Western Europe and North America compared to the risk in Africa and Asia. Gut microbes, diet and family history appear the most likely culprits. Cigarette smoking and alcohol, especially in quantities sufficient to cause chronic pancreatitis, compound the problem.

Pancreatic cancer grows slowly with an estimated 10 year interval from the original genetic insult until the appearance of an early malignancy. Typically another decade passes before the cells gain enough heft to finally form a mass, metastasize and result in the individual’s demise. In spite of this lengthy multi-decade progression, it rarely causes symptoms until a year or so before death. Worse yet, treatable forms cannot be detected with routine blood testing or radiologic investigations. The annual physical examination does not detect even a hint of the underlying problem until too late.

Symptoms fail to appear until the disease appears far advanced. Presenting complaints remain non-specific and include fatigue, loss of appetite, indigestion, nausea, feeling full soon after starting a meal and unexplained weight loss. At times manifestations include bloating, itchy skin, shoulder pain and change in bowel habits with more bulky, malodorous movements requiring two or more flushes to clear the toilet. Ultimately abdominal pain supervenes, sometimes severe and with radiation to the back.

At diagnosis fewer than 10-15% of patients have potentially resectable tumors. Even among this group and after extensive surgery most patients experience recurrent disease within about 6 months. Some evidence hints that chemotherapy before operative intervention may allow more successful surgery and reduce the rate of recurrence.

In spite of this the overwhelming majority of patients diagnosed with pancreas cancer will not be candidates for surgery. At present the most that can be expected with combination chemotherapy is brief life extension. With the fate almost sealed, it behooves individuals suffering from this condition to discuss a plan of action with family and loved ones before the doctor.

One needs to decide how to weigh the expected short term increase in life expectancy measured in months against the side effects of the toxic chemotherapy. Some choose quality of life over quantity. The decisions are difficult and realistic unbiased information is required. But only the individual involved should make the final choice.
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Added on July 21st, 2019
Last updated: April 27th, 2020