The silent killer: pancreatic cancer

Every November, we celebrate a rich tradition of thanking everyone who has touched our lives in some way with the annual holiday of Thanksgiving. What one may not realize, however, is that November is also the month when we honor the survivors and remember the victims of pancreatic cancer.

The goal of this article is to more closely examine pancreatic cancer's frequency and prevalence in our population, risk factors, signs and symptoms, as well as discuss the tools that are at the forefront of medicine and easily accessible in our community to help combat this disease.

The pancreas is an organ that measures approximately six to seven inches long in the body, sits largely behind the stomach and is involved in secretion of hormones and enzymes that help regulate metabolism and levels of different chemicals such as glucose.

It is divided into three parts: the head, body and tail.

The American Cancer Society estimates that in the United States 53,670 people will develop pancreatic cancer annually, and of those people 43,090 will succumb to the disease. In South Carolina alone, that translates to roughly 1,000 new cases this year.

Most cases of pancreatic cancer occur after the age of 60, and rarely does it occur before the age of 40.

The largest risk factors for pancreatic cancer are smoking and a history of chronic pancreatitis, which increase the risk by three times and six times, respectively.

In South Carolina, smoking rates are some of the highest in the nation, as is the use of alcohol, which can lead to chronic pancreatitis. As a consequence of these two factors, pancreatic cancer is a condition that we all should be aware of and watch for warning signs and symptoms.

Early signs of pancreatic cancer are vague and nonspecific, and that makes early diagnosis difficult.

Symptoms of pancreatic cancer might include abdominal pain or back pain, unexplained weight loss, nausea, fatigue, yellowing of the skin and eyes and loss of appetite.

Research also suggests that a new diagnosis of diabetes after the age of 50 could be an early sign of pancreatic cancer. Unfortunately, because of these vague symptoms, pancreatic cancer often is diagnosed in later stages, when the cancer has spread to other organs.

As medicine continues to evolve, we are learning more about how pancreatic cancer originates. One risk factor that has emerged is pancreatic cysts. Interestingly, we have found that cysts within the pancreas can give rise to growths, which can eventually lead to cancer.

Pancreatic cysts are exceedingly common, and approximately 10 percent of adults over age 70 will develop cysts within the pancreas. It is important to note that not all pancreas cysts are precancerous, but some cysts can be, and this is the reason that certain cysts need to be looked at further with either a CT, MRI scan or a procedure called an endoscopic ultrasound (EUS). Your family physician or gastroenterologist can discuss your options and which test would be best.

Screening is not recommended at this time for pancreatic cancer, but given that 5 to 10 percent of pancreatic cancers have an inherited genetic component, there is consensus that patients with a family history (parent, sibling, children) need to be screened.

There is some debate as to which other patients should undergo screening, and this is a constantly evolving topic among physicians and medical researchers. Best practice is always to discuss your options with your doctor.

Endoscopic ultrasound, MRI and CT scans have emerged as the primary modalities to assess the pancreas. EUS is an innovative tool that has emerged as the ideal way to assess the pancreas, primarily because of the endoscope's location being in the stomach or small intestine from where the pancreas can be easily assessed.

Although the EUS procedure is extremely safe, it is a procedure and carries risks of anesthesia among other things. To limit those risks, the EUS technique is combined with a CT/MRI to closely evaluate and assess pancreatic cysts and other diseases of the pancreas.

So this month, let's all take a moment to remember those who have been afflicted by pancreatic cancer and come together to make a promise to our families, friends and ourselves to stay aware of our own health and not ignore the warning signs of this silent killer.