Pancreatic adenocarcinoma

The new electronic health record is live at the hospital and the Jet’s 7th/8th grade football season is over. If anyone is wondering we finished 4-3 on the season.  We had a great group of boys! I can now spend a little more time doing other things such as continuing this blog…..

We have made tremendous advances in most cancers when it comes to improving overall survival, however, pancreatic cancer is not one of them. This cancer is a “non-relenting” beast among beasts.

There will be approximately 54,000 cases of pancreatic cancer diagnosed this year and approximately 43,000 people will die from it.  Pancreatic cancer is the 4th most common cause of cancer related death in males and females. The incidence is about the same between the sexes.  Per the NCCN (National Comprehensive Cancer Network) the incidence of pancreatic cancer actually increased from 1999-2008. It is thought that possible contributing factors include the obesity epidemic, the aging population and others.  As stated above, the mortality rate of pancreatic cancer has not changed throughout the years which is a very unfortunate thing.

Risk factors associated with pancreatic cancer include: obesity, smoking, certain chemical (benzene, asbestos, pesticides and others,) heavy alcohol use, chronic pancreatitis and diabetes. There are also genetic causes of pancreatic cancer. Familial malignant melanoma syndrome (FAMM) is a syndrome associated with melanoma’s and pancreatic cancer.  Many people are now familiar with BRCA gene because of Angelina Jolie, however, did you know that this gene also increases your risk for pancreatic cancer? The BRCA 2 gene has a better association with pancreatic cancer than does the BRCA 1 gene.

Unfortunately, pancreatic cancer is usually detected late in its course. Potential warning signs include but are not limited to: weight loss, jaundice, abdominal pain, new onset diabetes, and others. There are however, no early warning signs for this devastating disease.

When physician’s think about pancreatic cancer we think of this cancer in clinical terms. What I mean by that is we break this cancer into one that is resectable, borderline resectable or unresectable. This will determine how we approach it and whether or not it is potentially curable. When one is diagnosed with pancreatic adenocarcinoma without surgery it can’t be cured. There are many imaging modalities used to assess this cancer including CT scans, MRI’s, endoscopic ultrasounds and PET scans.

The treatment of pancreatic cancer can include one or any combination of the following modalities: surgery, radiation and chemotherapy. There are many ways to approach pancreatic cancer if not already metastasized (spread) to other areas of the body. We can give neo-adjuvant (meaning prior to surgery) chemotherapy +/- radiation therapy or surgery can be performed first followed by chemotherapy. There are guidelines physician’s can follow, however, places all around this Country approach pancreatic cancer differently. I would encourage anyone diagnosed with pancreatic cancer to seek out clinical trials if at all possible.

In the end, pancreatic cancer remains a very tough disease to treat. Hopefully, over time there will be new advances that allow us to detect this cancer earlier in the hopes of improving the bleak overall survival associated with this disease.  I remain hopeful that better systemic therapies will come to the forefront to fight this beast. For all out there struggling with pancreatic cancer do not lose hope and know that there are many people out there fighting to make this disease a thing of the past.