November is Pancreatic Cancer Awareness month

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phylp

Trad climber

Millbrae, CA

Topic Author's Original Post - Nov 17, 2010 - 06:59pm PT

Dear Supertopo members,

November is Pancreatic Cancer Awareness month, so I thought it would be worth posting this write-up of the current information (as I understand it), about early diagnosis and prevention of pancreatic cancer. Hopefully, this info will help you make decisions about whether or not you want to be proactive about talking to a health professional about this disease. I will not address at all, in this post, the implications and treatment of a diagnosis of later stage disease (Stage II-IV).

My background is in molecular and cellular biology (many years doing research in the pharma industry). I am not a physician or medical expert in this disease, so there may be inaccuracies in this write-up. I do have two family members who died of this disease, my mother at age 63 and my brother at age 53, so I have done a fair amount of technical reading in this area.

I’ll go into more detail below but here is the bottom line:

1. If you have family members who have died from this disease, or if you are a heavy smoker, the info in this post should be of particular interest to you.
2. If you are in a “higher risk” category to develop this disease, because of a family history, and choose to get annual or bi-annual EUS (see below), there is a very good possibility that lesions will be caught in the precancerous or very small tumor stage, and that surgery could cure you.
3. If you find out you have pancreatic cancer because of symptoms that develop, the odds are very high that you will die of the disease.

Are you at higher risk for pancreatic cancer?

The pancreas is only the 10th most common site for cancers to develop, but pancreatic cancer (adenocarcinoma of the pancreas) is the 4th most common cause of DEATH from cancer in the US. This is because, unlike breast, prostate and colon, it is not routinely screened for, and by the time symptoms appear, metastasis has often occurred.

Over a lifetime, an individual has a 1.4% chance of developing pancreatic cancer. The overall incidence of pancreatic cancer is 8-10 cases per 100,000 people per year for all ages. If you look at age of diagnosis, the incidence is higher if you are older (this is true for most cancers, since most develop in a “step-wise” progression from normal to precancerous to cancerous to metastatic as the cell accumulates further mutations over time). The average age at diagnosis is 72. In people with a genetic predisposition, age of diagnosis is usually lower.

There are a number of “life style” factors that contribute to an increased incidence of developing pancreatic cancer:

1. Smoking! Up to 30% of the incidence is thought to be attributable to smoking. Get a clue, people.
2. Obesity and a sedentary lifestyle
3. A diet high in red meat
4. Nitrosamines in foods (found in nitrate preserved cold cuts, hot dogs, fried or char-grilled meats)

There are also genetic factors:

If you have had one relative with pancreatic cancer, it is thought that your risk is increased 4-5 times.
With 2 relatives, your risk is increased 6-7 times.
With 3 relatives, your risk is increased 32 times.

Here is an online risk calculator if you are interested:
http://www.yourdiseaserisk.wustl.edu/hccpquiz.pl?lang=english&func=show&page=estimating

Bottom line: if you are not at increased genetic risk to develop pancreatic cancer, and you don’t smoke, it’s probably not worth any particular proactive measures, as the general incidence is pretty low.

Why is early diagnosis important?

For those at higher risk to develop this cancer, early diagnosis is important because the likelihood that you will die of this cancer increases dramatically depending on when it is found:
“Pancreatic carcinoma is unfortunately usually a fatal disease. The collective median survival time of all patients is 4-6 months. Most patients eventually succumb to the consequences of local invasion and metastatic cancer, and true long-term cures are rare. In patients able to undergo a successful curative resection (only about 20% of patients), median survival time ranges from 12-19 months, and the overall 5-year survival rate is 15-20%. The best predictors of long-term survival after surgery are a tumor diameter of less than 3 cm, no nodal involvement, negative resection margins, and diploid tumor DNA content.”

Stage 1a is less than 2 cm. It is very rare to detect a tumor at this stage unless you do specific testing for early diagnosis. Because it is so rare to even find pancreatic tumors this small, there are not many statistics on survival. However, once recent study found that resection of tumors of less than 1 cm (about the size of a cube of sugar) is associated with nearly 100% 5 year survival. (Compare this to 5% chance of 1 year survival of Stage IV.)

Again, because early testing is such a new phenomenon, there are very few statistics about treatment of precancerous lesions. However, as with the treatment of precancerous lesions of the colon, it is thought that surgical removal at this stage could be a cure.

Early diagnosis

The state of the art for early detection of lesions of the pancreas is via endoscopic ultrasound (EUS). In this procedure you are put under light sedation and an ultrasound scope is fed down your throat to the area near the pancreas. Very good images are obtained. If anything looks unusual, a fine needle biopsy is taken for analysis.

I had this procedure as part of the CAPS-3 clinical trial at UCLA, comparing various imaging techniques for the detection of pancreatic cancer in its early stages. It is not pleasant (you may experience a little throat irritation) but not particularly difficult. The only prep that is required is fasting after midnight. As with all procedures, there are some minor risks involved. If you have a family history, it is probable that your health insurance will agree to cover the cost of the procedure, even if you are not currently experiencing any symptoms.

CA19-9 blood assay is not an early screening method. If you have elevated CA19-9, you probably already have advanced disease.

What happens if something is seen?

In the case of a finding of precancerous lesions or a very small lesion (stage I) with the EUS, the recomendation would be for a surgical treatment. The surgical intervention would be a either a resection (removal of a small portion of the pancreas), a Whipple procedure (a more extensive resection), or a complete pancreatectomy (performed in rare cases where the expert thinks that the whole pancreas looks funky). The issue is that all of these surgeries have some real chance of complications and mortality. If you choose to go this route, it is imperative that you have it done at a hospital with a high success rate and a low complication rate.

A complete pancreatectomy will of course have life-changing consequence. You will be an insulin dependant diabetic and will need to take oral enzymes to aid digestion for the rest of your life. However, in the one study that I could find on elective pancreatectomy outcomes “none of the patients who were caught early went on to develop cancer” (over the 5 years of the study).

I sincerely hope that none of you who read through this have a family history of pancreatic cancer. But if even one of you has, and this helps you in any way, it was worth posting.

donini

Trad climber

Ouray, Colorado

Nov 17, 2010 - 07:02pm PT

If you are 50 or older and haven't had your colon checked, this is the time to do it. It's one of the cancers most amenable to treatment if caught in time. Oh, and guys, don't forget those fun annual prostate checks.

Ezra Ellis

Trad climber

WA, & NC & Idaho

Nov 17, 2010 - 09:18pm PT

Unfortunately I diagnose several dozen cancers a week.

The 4 biggies are
1. colon - highly preventable like doninni said, colonoscopy at 50, or at ten years before your first degree relative (mom, dad borother or sis gets colon cancer)

2. Breast- women -mamograms should start at 40 (in my opinion), never miss one year

3. Prostate- annual PSA and prostate exam starting at age 50

4. Lung- NEVER SMOKE, DUH

skin cancer- rarely fatal unless melanoma, but those with lots of sun exposure should prolly get checked yearly, especially with a family history of melanoma!

I hate to be negative but pancreatic cancer is rarely curable and highly agressive, and rarely with specific symptoms!

Take care Y'all!
-e

Nohea

Trad climber

Sunny Aiea,Hi

Nov 17, 2010 - 11:00pm PT

Thanks..good post. My moms brother went fast once diagnosed. That some mean sheet.

Ezra Ellis

Trad climber

WA, & NC & Idaho

Nov 17, 2010 - 11:02pm PT

Forgot to mention the importance of yearly pap smears for women, cervical cancer USED to be a top killer prior to pap smears.

Tfish

Trad climber

La Crescenta, CA

Nov 17, 2010 - 11:16pm PT

MOvember!

HighDesertDJ

Trad climber

Swimming in LEB tears.

Nov 17, 2010 - 11:18pm PT

Wait is my pancreas in my colon or my pap I'm confused.

rottingjohnny

Sport climber

mammoth lakes ca

Nov 17, 2010 - 11:36pm PT

I believe Zappa died from pancreatic cancer? Supposedly a heavy smoker?

Dr.Sprock

Boulder climber

I'm James Brown, Bi-atch!

Nov 18, 2010 - 12:14am PT

phylp, that name is dangerously close to polyp,

can i buy a vowell?

what about BM's?

does a 3 week wait after a loaf of wonder bread put me at risk?

Elvis had an enlarged colon, probably from the Col? diladad??

should i get another mamogram?

kaiser did not cover my last mamogram because i am a guy.

can you believe the health care in this country?

next thing ya know they will reject my claim for the pap smear.

have you done the mail in sh#t stick contest?

i was gonna join the us postal service til i sent my own sh#t thru the mail,

go-B

climber

Matthew 25:40

Nov 18, 2010 - 12:30am PT

My mom died from Pancreatic Cancer, just skin and bones,

Zappa died from Prostate Cancer.

rottingjohnny

Sport climber

mammoth lakes ca

Nov 18, 2010 - 12:31am PT

Zappa died from prostate...i stand corrected

Dr.Sprock

Boulder climber

I'm James Brown, Bi-atch!

Nov 18, 2010 - 12:31am PT

my grandmother died from prostate cancer, happy holidays,

rottingjohnny

Sport climber

mammoth lakes ca

Nov 18, 2010 - 12:32am PT

Sorry about your mom go-B....

rottingjohnny

Sport climber

mammoth lakes ca

Nov 18, 2010 - 12:35am PT

Dr. Sprock.....have you done any self-exams on your breasts?

go-B

climber

Matthew 25:40

Nov 18, 2010 - 12:41am PT

Thanks Johnny,
It was a long time ago, she was only 48, when I was just out of High School, she tried to keep it from us kids, she was a champ!

Mighty Hiker

climber

Vancouver, B.C.

Nov 18, 2010 - 12:46am PT

The last major thread on colonoscopies, prostate exams, and other important and quite fun stuff. Rather related.
http://www.supertopo.com/climbers-forum/524239/Over-50-Stop-stalling-and-get-that-colonoscopy

Just for the record, brave manly climbers should have an annual physical and prostate exam from 40 on. And a screening colonoscopy every ten years from 50 on. Plus whatever else is indicated by family history, lifestyle, and so on.

Girly (male) climbers are those who aren't man enough for a physical.