Cancer Of The Pancreas
CANCER OF THE PANCREAS
Pancreatic cancer is on the rise, with a tripling of its incidence over the past 40 years. The normal functions of the pancreas are outlined in the section on pancreatitis, but in summary it provides various enzymes necessary for digestion of fats, and also is the site of insulin production. The location of the pancreas is deep in the abdomen, behind the stomach; this is such that even large cancers can form before being detected. In part this accounts for the grim prognosis.
This cancer affects three to four males for each female, and usually strikes in the middle or older years. It is the fourth or fifth most common cancer. The cause of pancreatic cancer is not known. Several years ago, some research suggested a connection with excessive coffee intake. This research was subsequently brought into question, and is not currently accepted by most authorities. Cigarette smoking and chronic diabetes may be risk factors for some cases.
SYMPTOMS
Loss of appetite, weight loss and nausea are common presenting complaints. It has long been observed that severe depression can also be associated with pancreatic cancer, and may be the only symptom at first. A dull constant upper abdominal or mid-back pain is common. If the tumor is near the liver and gall bladder, blockage of bile drainage may occur, and is a common cause of yellow jaundice, often with no pain at all. Other patients develop diabetes from the destruction of the insulin producing cells.
DIAGNOSIS
Once the above symptoms raise the possibility of the diagnosis, confirmation is not always easy. In some cases, a simple stomach x-ray may show the bulging mass as it pushes into the stomach, but this is far from a universal finding. Ultrasound tests will show the tumor in over 80% of cases. CAT scan x-rays of the pancreas will usually show a tumor, but sometimes simple swelling of an inflamed pancreas without tumor will appear misleadingly as a cancer.
More invasive techniques include needle biopsies of the pancreas, and passing of a tube from the intestine (swallowed by the patient) into the ducts of the pancreas, and taking x-rays after injecting dye. Ancillary tests of the blood and digestive function can enhance one’s diagnostic confidence, but do not of themselves confirm the diagnosis.
TREATMENT and PROGNOSIS
Surgery is almost never curative, but when a tumor is apparently well-localized may offer the only chance for cure, however remote. It is a radical procedure, and has its own risks and side effects. Surgery can also provide temporary relief of liver or intestinal blockage, and improvement in the pain if a mechanical cause is present.
Various types of radiation therapy have been investigated, and some temporary improvements have been noted. Unfortunately, uninvolved organs must necessarily receive high doses as well, and side effects may be severe, involving the stomach and spinal cord among other organs. Thus the role of radiation is currently quite limited.
Chemotherapy can provide temporary improvement in about 20% of treated patients, and may prolong survival slightly at the expense of side-effects.
As may be deduced from the above, the prognosis of this disease is grim with or without treatment. Within one year of the diagnosis, 90% of patients are dead. The five year cure rate is probably around 5%. Little hope for improvement in these figures can be expected until research shows more about the causes and means of early detection for this most dismal cancer.