Navigating Our Health: 5 Things to Know About Pancreatic Cancer

November is National Pancreatic Cancer Awareness month. This topic is very close to heart, as I lost my father-in-law to pancreatic cancer in July of this year. He was 61 years old. 

His diagnosis was sudden and unexpected. It turned our world upside down. I will never forget my husband waking me up and telling me they had found “lesions” on his father’s pancreas on a CT scan in the ER the night before. The next few weeks were a whirlwind of appointments and procedures.

He had a biopsy completed that confirmed the diagnosis of adenocarcinoma of the pancreas. We were in shock. How could this be happening? 

We saw multiple healthcare providers to discuss the treatment plan and received multiple “second opinions.” They all had the same recommendation and explanation…. The tumor was too large and complex to remove with surgery, so chemotherapy would be the treatment. 

And, so it began….

The chemotherapy combination was aggressive and brutal. It required hours of infusion that meant he was connected to a continuous infusion for multiple days at a time. There are no words to describe how difficult it is to watch someone you love go through cancer treatment. The treatment itself is ruthless. The chemotherapy destroys the immune system. Their bodies are working so hard killing the cancer cells that they are beyond fatigued. They can’t eat. They have vomiting and diarrhea. They lose weight. They lose their hair.  

Sometimes you ask yourself, “what is worse…the cancer or the treatment?” As a family, we had multiple discussions regarding this. My father-in-law was so strong and wanted to fight. He had so much he wanted to live for. The chemotherapy medications had to be changed over time and the doses tweaked as the cancer cells began to “outsmart’ the treatment. Eventually it stopped working all together and the decision was made to stop the chemotherapy.

He passed away July 4, 2019, 13 ½ months after being diagnosed. We were lucky to have one more year of memories with him, but it all happened so fast.

What I Want You to Know about Pancreatic Cancer

My goal of writing this is to bring awareness to this disease.  We need more research to develop better treatments, screening tools, and improve survival rates. 

Here are the 5 things you should know about Pancreatic Cancer:

1. The job of the pancreas is to control digestion and blood sugar regulation.  It is located in the abdomen and sits between the stomach and the spine.  Pancreatic tumors can be exocrine or neuroendocrine, depending on what type of cell they start in.  93% of pancreatic cancers are exocrine and the most common is adenocarcinoma.  Only 7% are neuroendocrine and these often grow slower than exocrine.
2. We don’t know what causes pancreatic cancer: Only 5-10% of pancreatic cancers are familial, or “inherited from your parents”.  Most happen and we have no idea why.  We do know some of the risk factors associated with pancreatic cancer.

• Two or more 1st degree relatives who have had pancreatic cancer
• A first degree relative who developed pancreatic cancer before the age of 50
• An inherited genetic syndrome associated with pancreatic cancer
• Diabetes
• Chronic and hereditary Pancreatitis
• Race (ethnicity): African American or Ashkenazi Jew
• Age: over 60
• Gender: Males have slightly higher risk
• Diets high in red and processed meats
• Obesity
   

3. The signs and symptoms are often vague.  These include:

• Pain, usually in the abdomen or back
• Weight loss
• Jaundice (yellowing of the skin, eyes, or both)
• Itching
• Nausea
• Loss of appetite
• Changes in stool
• Pancreatitis
• Recent onset of diabetes
• Fatigue and weakness
• Depression
• Fluid in Abdomen (advanced disease)
• Blood clots (advanced disease)
   

4. Pancreatic cancer is difficult to diagnose.  Because of the location of the pancreas, the tumor typically cannot be felt on a clinical exam or seen or imaging studies until it becomes very large.  If your provider suspects pancreatic cancer, it is likely they will order an imaging study such as a CT scan.  If a mass is seen on the exam, an Endoscopic Ultrasound may be needed.  This test is similar to a regular endoscopy, but includes an ultrasound probe to visualize the pancreas, take pictures, and even perform a biopsy of the tumor.  This is the test my father-in-law had completed to confirm the diagnosis of adenocarcinoma of the pancreas.  A blood test known as Carbohydrate antigen 19-9 (CA 19-9) will also likely be ordered.  This is a nonspecific test that is used to determine if the cancer is progressing.  Not all pancreatic tumors release this enzyme, and it can sometimes be released by other cancers, so this test cannot be used to diagnosis pancreatic cancer, but rather to track progression.  Unfortunately, most pancreatic cancers have progressed to stage 3 or 4 by the time they are found.  According to the American Cancer Society, the 5 year survival rate for pancreatic cancer in 2019 is 9%. The survival rate significantly declines to 3% if the cancer is considered Stage 4.  Currently, there is no screening test for pancreatic cancer which would allow us to diagnosis this cancer earlier and likely improve the chance of survival. 
    
5. Treatment for pancreatic cancer depends on the individual’s health and staging of the cancer.  Some treatments may not be recommended depending on the stage.  Staging is based on the primary tumor’s size and location, if the cancer has spread to nearby lymph nodes and blood vessels and if the cancer has spread to other parts of the body.  For earlier stages of cancer, the best option is surgery to remove the tumor.  This increases a patient’s survival rate.  Other options include chemotherapy, radiation, and clinical trials.  The Pancreatic Cancer Action Network (PanCan) recommends for all stages the following treatments:

• Clinical trials at diagnosis and during every treatment decision
• Molecular profiling of your tumor to help determine the best treatment options
• Symptom management and supportive (palliative) care, provided early in your diagnosis as well as during and after treatment

Pancreatic cancer is on the rise.  The American Cancer Society’s estimates for pancreatic cancer in the United States for 2019 are:

• About 56,770 people (29,940 men and 26,830 women) will be diagnosed with pancreatic cancer.
• About 45,750 people (23,800 men and 21,950 women) will die of pancreatic cancer.

Pancreatic cancer is estimated to be the 3rd leading cause of cancer deaths in 2019.  The hope is with multiple new clinical trials being examined, we will come up with more effective treatment options.  There is also research being conducted to develop earlier screening tests.  Pancreatic cancer has affected my family and so many other families out there.  Let’s work to bring awareness to this horrific cancer so we can improve outcomes for patients and families in the future. 

I just want to give a personal thank-you to all people who were involved in the healthcare team of my father-in-law.  From initial diagnosis in the Beebe ED, to receiving the Endoscopic US performed by Dr. Wiggins, the Beebe Surgical team including preop and PACU, the staff at Tunnel Cancer Center including Dr. Murukutla, Dr. Katie Johnson with Beebe Palliative Care, and everyone from Seasons Hospice….. Thank-you for the wonderful, compassionate care you provided.

Additional Resources:

PanCan: https://www.pancan.org/

American Cancer Society: https://www.cancer.org/cancer/pancreatic-cancer.html

Beebe Tunnel Cancer: https://www.beebehealthcare.org/tunnell-cancer-center

Beebe Palliative Care: https://www.beebehealthcare.org/palliative-care