Pancreatic Cancer: A Silent Killer

By Jennifer LoConte

Before Sept. 27th, 2009, I knew nothing about pancreatic cancer. I didn’t know that it is the fourth deadliest cancer in the U.S., or that there is no early detection, limited treatment and finally, no cure. That early fall morning, my mother was diagnosed with Stage IV Metastatic Pancreatic Cancer. For 51 short days, she fought a losing battle. I watched her change from an active and doting grandmother, to a frightened, tired and weak pancreatic cancer patient. I felt helpless and while I cried on the inside or alone at the end of those few days I had left with her, I vowed to never give up my fight to raise awareness about this disease that kills 94% of its patients within five years of diagnosis and an alarming 74% die within one year.

The Facts

The pancreas is an important organ of the body and is well-hidden, lying between the stomach and spine, partly nestled in the curve of the small intestine. It serves two primary functions: (1) to produce enzymes to help break down carbohydrates, fats, proteins and acids and (2) to produce hormones that help regulate blood sugar levels. According to Dr. Ranju Gupta, MD of the Hematology Oncology Associates of Lehigh Valley Health Network, the pancreas does not appear on many routine medical tests like a colonoscopy, endoscopy or even gall bladder removal, which is done laparoscopically. Symptoms may include general abdominal discomfort, back pain, jaundice, significant weight loss, indigestion, build-up of fluid in the abdominal cavity, stool changes, tiredness and depression. Gupta says, “The symptoms of pancreatic cancer are perplexing and often go unnoticed by the patient until the cancer has metastasized to other parts of the body.” Dr. Jameel Durrani, Director of The Critical Care Unit of Westfield Hospital agrees. Durrani says, “Pancreatic cancer can actually lay dormant for years because there is no pain associated with its’ structure.” He compared it with symptoms of bone cancer, saying, “That type of cancer will be noticed much earlier due to physical pain and growths or lumps, but pancreatic can sit silent.”

Since there is no standard diagnostic test for pancreatic cancer, more in-depth procedures must be given. Gupta says, “Endoscopic ultrasound, ERCP and Magnetic Resonance Cholangiopancreatography (MRCP) take images of the digestive tract, including the pancreas. If cancer is suspected, a biopsy will be obtained in order to give an exact diagnosis.” Durrani adds, “Endoscopic ultrasound can provide valuable information about whether pancreatic cancer has invaded other areas, thus determining whether the patient is a candidate for surgery.” A PET scan–illuminating any abnormal tissue in the body–can also be performed, however, it’s an extremely expensive test and not available everywhere. None of these procedures are likely to be performed at initial visits to a doctor.

Statistically, risk factors that may increase the likelihood for developing pancreatic cancer include: smoking, alcohol abuse, chronic pancreatitis, family history, race, gender, age and diabetes, especially if developed as an adult. However, I have spoken with many families who lost a family member that didn’t fit any of the risk factors.

Treatment

There are two types of pancreatic cancer. Exocrine tumors (adenocarcinoma) account for 95% of the disease and are much more difficult to diagnose early. Endocrine tumors are rare (5%), but much easier to diagnose at an early stage because blood sugar levels will be either too low or too high. Durrani says, “Whipple surgery, which includes removal of the head of the pancreas, part of the stomach and duodenum, bile duct and the gallbladder, is the only way of eradicating pancreatic cancer and unfortunately less than 20% of those diagnosed are eligible for it.” He notes that it is one of the most extensive surgeries performed, lasting 6 to 10 hours and patients may suffer lifelong side effects.

Chemotherapy is the most common treatment for pancreatic cancer patients, especially those in later stages where it is used as palliative care. “Gemcitabine® is still the most common chemo, however, when used in combination with other treatments, it can prolong life,” says Gupta. Dr. Sonyo Shin, Medical Oncologist at Easton Hospital was involved in a two-year pancreatic cancer research program, concentrating on targeted therapy and says, “Targeted therapy attacks only cancer cells, whereas traditional chemo will attack both healthy and cancerous cells. We have seen greater success in patients whose treatment includes this type of therapy.” Tarceva® is the current drug of choice for targeted therapy. Several years ago, Gupta and other oncologists were seeing positive results from a combination of chemotherapies. Gupta notes, “Patients’ lives were prolonged from six months to 11 months, which was quite remarkable in the world of pancreatic cancer.” However, she also stated that side effects could be more severe which makes that specific treatment not acceptable for every patient.

Clinical trials offer hope for the future of pancreatic cancer treatment while prolonging a patients’ life. Shin says, “We encourage patients to participate in these trials, especially those whose cancer has metastasized. There are ongoing trials done both nationally and through specific institutions.” Find additional information on clinical trials at clinicaltrials.gov.

The Future

According to the American Cancer Society’s statistics for 2011, an estimated 44,000 Americans were diagnosed with pancreatic cancer and approximately 37,000 died. The Pancreatic Cancer Action Network reports that the numbers are increasing and that the expected number of new cases is projected to increase by 55 % between 2010 and 2030. With only 2% of the National Cancer Institute’s $5 billion annual budget allotted towards this disease, it’s no wonder there has been little change in research and treatment for the past 40 years. Currently, advocates are fighting to push Congress to pass The Pancreatic Cancer Research and Education Act. Find additional information on this bill at pancan.org. Gupta reports that she is seeing an increase in younger patients being diagnosed and adds, “We are seeing correlations between gene mutations and pancreatic cancer but more research needs to be conducted into the cause of the disease and how we can stop it.”

Getting Involved

There are several national organizations that are making a difference. The Pancreatic Cancer Action Network, founded in 1999, raised approximately $7.5 million last year through its nationwide fundraising events. The Lustgarten Foundation, founded in 1998, underwrites all of its administrative expenses through Cablevision Corporation, so 100% of every donation goes directly to research (lustgarden.org).  Additionally, smaller fundraisers are taking place all across the country, led by dedicated individuals who lost a loved one to this frightening cancer.

In terms of the disease, my mom thought she was being proactive, returning to her doctor repeatedly and seeing various specialists, with no conclusive results. Had our family been aware of this silent killer, perhaps we could have been more vigilant in suggesting further testing, but with no present cure, the end result would not have changed.  Although those 51 days were excruciating, looking back, I realize that they were some of the most important ones in my life. I was able to actively care for my mom, hold her hand and tell her I loved her. I fed her a piece of my birthday cake (her last solid food) and then prepared milkshakes with her favorite ice cream, vanilla bean.  I made sure she had a comfortable bed set up in her sunny living room, and we decorated early for Christmas, a holiday she loved. It brought me closer to her than ever before and I was able to give back to her what she had given me throughout my life, unconditional love.

Editor’s Note: Jennifer LoConte is the founder of J’s Run, a locally based non-profit organization that holds an annual 5k run/walk in memory of both her mother, Joan Stein and a second local woman, Jennifer Reeves, who lost her battle to this disease while still in her thirties. The mission of J’s Run is to increase awareness of pancreatic cancer and raise dollars for research and ultimately a cure. Registration is through active.com.

SOURCES:
Dr. Jameel Durrani, Director of The Critical Care Unit, Westfield Hospital
4815 Tighlman Street, Allentown, PA 18104
Westfieldhospital.com

Dr. Sonyo Shin, Medical Oncologist, Easton Hospital
250 S. 21st Street, Easton, PA 18042
Easton-hospital.com

Dr. Ranju Gupta, MD of the Hematology Oncology Associates of LVHN
1240 S. Cedar Crest Blvd., Suite 103, Allentown, PA 18103
Lvhn.org

The Pancreatic Cancer Action Network
Pancan.org

The Lustgarten Foundation
Lustgarten.org

The American Cancer Society
Cancer.org

The National Cancer Institute
Cancer.gov

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