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phylp
Trad climber
Millbrae, CA
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Topic Author's Original Post - Nov 17, 2010 - 06:59pm PT
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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.
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donini
Trad climber
Ouray, Colorado
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Nov 17, 2010 - 07:02pm PT
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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.
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Ezra Ellis
Trad climber
WA, & NC & Idaho
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Nov 17, 2010 - 09:18pm PT
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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
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Nohea
Trad climber
Sunny Aiea,Hi
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Nov 17, 2010 - 11:00pm PT
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Thanks..good post. My moms brother went fast once diagnosed. That some mean sheet.
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Ezra Ellis
Trad climber
WA, & NC & Idaho
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Nov 17, 2010 - 11:02pm PT
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Forgot to mention the importance of yearly pap smears for women, cervical cancer USED to be a top killer prior to pap smears.
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Tfish
Trad climber
La Crescenta, CA
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Nov 17, 2010 - 11:16pm PT
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MOvember!
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HighDesertDJ
Trad climber
Swimming in LEB tears.
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Nov 17, 2010 - 11:18pm PT
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Wait is my pancreas in my colon or my pap I'm confused.
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rottingjohnny
Sport climber
mammoth lakes ca
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Nov 17, 2010 - 11:36pm PT
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I believe Zappa died from pancreatic cancer? Supposedly a heavy smoker?
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Dr.Sprock
Boulder climber
I'm James Brown, Bi-atch!
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Nov 18, 2010 - 12:14am PT
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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,
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go-B
climber
Matthew 25:40
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Nov 18, 2010 - 12:30am PT
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My mom died from Pancreatic Cancer, just skin and bones,
Zappa died from Prostate Cancer.
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rottingjohnny
Sport climber
mammoth lakes ca
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Nov 18, 2010 - 12:31am PT
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Zappa died from prostate...i stand corrected
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Dr.Sprock
Boulder climber
I'm James Brown, Bi-atch!
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Nov 18, 2010 - 12:31am PT
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my grandmother died from prostate cancer, happy holidays,
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rottingjohnny
Sport climber
mammoth lakes ca
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Nov 18, 2010 - 12:32am PT
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Sorry about your mom go-B....
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rottingjohnny
Sport climber
mammoth lakes ca
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Nov 18, 2010 - 12:35am PT
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Dr. Sprock.....have you done any self-exams on your breasts?
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go-B
climber
Matthew 25:40
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Nov 18, 2010 - 12:41am PT
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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!
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Mighty Hiker
climber
Vancouver, B.C.
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Nov 18, 2010 - 12:46am PT
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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.
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go-B
climber
Matthew 25:40
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Nov 18, 2010 - 12:48am PT
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Dr.Sprock,
Sorry about you Grandmother!
Mine almost raised me, she lived next door!
When I think of her, all I can do is smile and thank God for Her!
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Dr.Sprock
Boulder climber
I'm James Brown, Bi-atch!
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Nov 18, 2010 - 12:53am PT
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umm,
ok.
can somebody with a brief history of mediacal knowledge please help the above poster?
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go-B
climber
Matthew 25:40
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Nov 18, 2010 - 12:59am PT
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Got me!
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Jaybro
Social climber
Wolf City, Wyoming
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Nov 18, 2010 - 05:19am PT
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my father died of Pancreatic C back in '79. a Robust, athletic 56yr old with lower back pain at xams, he was gone by late august.
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phylp
Trad climber
Millbrae, CA
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Topic Author's Reply - Nov 18, 2010 - 11:45am PT
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Yeah, Jay - That's the way it usually goes. By the time you have symptoms it's really too late. That is why my focus was specifically on awareness of family history and the current desire by the medical community to understand if early screening for a special high risk group will make a difference for outcome. I'd be happy to expand on this offline with you sometime if you're interested. PM me or get my number from Daph.
"I hate to be negative but pancreatic cancer is rarely curable and highly agressive, and rarely with specific symptoms!"
Ezra, you are not being negative, that is a statement of current reality. But 50 yrs ago, I don't think mammograms or colonoscopies even existed. People just died. 200 years ago, no vaccines or antibiotics existed. People just died. Before they invented how to stitch people up, if you got a bad slice - you just died.
For better or worse, our Western society has evolved to value each life and solve these medical challenges through research and invention. That is what is happening now with pancreatic cancer research - it is in it's early stages. Whether the research should even be done is a point for debate. But it probably will get done, because scientists love a puzzle. That's what drives research - it's playtime for scientists.
I don't want to speak for him, but I think the point Dr. Sprock is making with his jolly jibes is that as a society we have become too focused on personal longevity. It's a great point. The monetary cost to society is enormous. But where do we draw the line and who draws it? 80% of health care dollars are spent in the patient's last year of life. That is why we have a health care crisis in this country, not dollars spent on prevention.
Phyl P. (aka polyp)
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Ezra Ellis
Trad climber
WA, & NC & Idaho
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Nov 18, 2010 - 11:57am PT
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Phylip,
Thanks for raising awareness of an important issue. You are dead on about our need to focus on PREVENTION, which is why I wrote my post.
Thank you for your research contributions to medicine!
best
-e
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#310
Social climber
Telluride, CO
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Nov 18, 2010 - 11:22pm PT
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Thank you for raising awareness about Pancreatic Cancer. I lost my husband, Chuck Kroger, to pancreatic cancer almost 3 years ago. He was 61 years old. There is no history of any cancer in his family, he was thin and very fit and never smoked tobacco, always ate healthy foods. Chuck lived 5 months after his diagnosis. He ran 28 miles on the Hardrock 100 trail run a week before his diagnosis and surprisingly dropped out - too tired to finish. I hope that some day soon both prevention and effective treatment will be possible.
It is a horrible disease.
Kathy
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Jaybro
Social climber
Wolf City, Wyoming
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Nov 19, 2010 - 12:08am PT
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Bump, just came back to read this, thanks Phyl.
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neebee
Social climber
calif/texas
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Nov 19, 2010 - 12:53am PT
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hey there say, phylp.... thanks for the awareness post...
right now, my friend in calif, has a friend of hers that is dying
from panceatic cancer.. and another friend of mine, her mom died from it...
i had never heard of it connected to folks i knew, until their stories...
though i had read of it...
also, say, time is flying by:
i will bump my november seizure awareness post, soon, again...
god bless, thanks for the share...
:)
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Daphne
Trad climber
Mill Valley, CA
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Nov 19, 2010 - 01:55am PT
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Damn, Phyl! Signing yourself off polyp (above) made me spray mouthwash all over my mac screen (I was multi-tasking).
Thanks for getting the word out on this scary cancer. I hope your thread is read by all and the information provided gets to those who need it.
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