Seven years ago today, Matt Wilson went to the emergency room. He suffered from a stomach ache, which he suspected was kidney stones. It is not that. The CT scan showed an abnormal point, then it was diagnosed as early pancreatic cancer. The discovery of opportunities might have saved his life. Pancreatic cancer usually grows without sound, without symptoms, and successful treatment is rare.
Thursday is pancreatic cancer awareness day, with the hope that awareness of the disease can help save lives.
What is pancreatic cancer?
The pancreas, the organ in the stomach, is responsible for the secretion of digestive enzymes and hormones that regulate metabolism. Pancreatic cancer is the third leading cause of cancer deaths in the US – it can even outperform the lungs and colorectal in 2020. The lifetime risk of developing this cancer is 1 in 63 for men and 1 in 65 for women; risk increases with age. Nearly 90 percent of people diagnosed are over 55 years old. Other risk factors include family history of cancer, obesity, smoking, diabetes, and a diet high in red meat and processed. A diet that includes lots of fruits and vegetables can serve to reduce risk.
Why is this so deadly?
Most diagnosed people, including Matt Wilson, only display vague symptoms at first: stomach or upper back pain, unintentional weight loss, fatigue, a recent diagnosis of diabetes, or jaundice (yellowing of the skin and eyes). Because these symptoms apply to many diseases, cancer is often diagnosed late for meaningful treatment. There is a frightening 9 percent survival rate, 5 years after diagnosis. This year alone 55,440 people will be diagnosed, and 44,330 will die.
Are there different types?
There are two main types of pancreatic cancer: endocrine and exocrine tumors.
The most common and most aggressive form is exocrine tumor. That is adenocarcinoma which starts in the pancreatic duct and glandular cells, which produce enzymes. These cells have a thick layer to protect them from the digestive enzymes they produce. But the thick coat also reduces the effects of chemotherapy.
Only a few cases of pancreatic cancer – about 1 percent – are endocrine tumors. They affect the cells that produce insulin and glucagon, the hormones that regulate our blood sugar. This cancer has a survival rate that increases significantly 5 years after a diagnosis of around 50 to 80 percent.
The gold standard treatment option is a surgical procedure known as Whipple. This technique was created by Dr. Allen Whipple in 1935 at Columbia-Presbyterian Hospital in New York City. Doctors dispose of many digestive organs: gallbladder, bile duct, stomach, and pancreatic head. Unfortunately, the procedure is only possible in about 20 percent of patients; it cannot work with patients diagnosed with cancer at a later stage. Other treatment options include chemotherapy, a number of drugs designed to kill cancer cells. This can be done after Whipple or together with radiation for those who do not qualify for surgery. Treatment is difficult because it is very difficult to diagnose pancreatic cancer when the tumor is small. When enlarging and blocking the pancreatic duct or producing abnormal hormone levels, it is often too late for surgery.
Pancreatic transplantation, another treatment option, was also recently caught. That's what Steve Jobs used, in part, to fight his illness. However, doctors warn that steps taken to stop the body from rejecting the new pancreas can allow the remaining cancer cells to grow, and that means a high risk of cancer returning.
"An oncologist may have to rely on science and the art of treatment to help patients determine which care is the best choice for them," Lynn Matrisian Ph.D., chief science officer for the Pancreatic Cancer Action Network, told ABC News.
Can't we filter pancreatic cancer like we do for breast cancer?
The International Pancreatic Cancer Screening Consortium recommends that people with hereditary pancreatitis, those with first-degree relatives who have been diagnosed, or those with BRCA1 / 2 mutations should be examined by a doctor more closely when they come to the office with vague abdominal pain. Unfortunately, there are no other specific guidelines.
What's on the horizon?
Matt, an ER patient, underwent surgery that removed part of the pancreas, spleen, and more than 20 lymph nodes. Challenging recovery and discovering new causes means that Matt now divides his time as a university professor and advocates for others with the same diagnosis. He is now part of the Pancreatic Cancer Action Network.
Organizations such as the Pancreatic Cancer Action Network continue to work to urge further funding to find out what can successfully fight this aggressive cancer. They also examined biomarkers for blood tests that can help diagnose them early. At this point the test remains unreliable, but maybe further research can open new doors. Drug therapies that target certain DNA mutations can help create drugs that better penetrate tumor cells. But unfortunately, the screening tool will take years to develop.
Dr. Sumir Shah, M.D. is an emergency medicine doctor at the New York-Presbyterian Health Center in Queens / Weill Cornell in New York City, and a member of the ABC News Medical Unit.