November is Pancreatic Cancer Awareness Month
This November, the American Society for Gastrointestinal Endoscopy (ASGE) is raising awareness about pancreatic cancer and encouraging patients and their families to become educated about the disease, to ask their doctor about treatments and to reach out for support. Pancreatic cancer is the fourth leading cause of cancer deaths in the United States.
In 2012, an estimated 43,920 Americans will be diagnosed with pancreatic cancer and 37,390 will die from the disease. According to a report this year from the Pancreatic Cancer Action Network, pancreatic cancer is anticipated to move from fourth to the second leading cause of cancer death in the U.S. by 2020. Since 2004, the incidence rates of pancreatic cancer have been increasing by 1.5 percent per year. During 2004 to 2008, the death rate from pancreatic cancer increased by 0.4 percent per year. The 1- and 5-year survival rates are 26 percent and 6 percent, respectively. Unfortunately, it is one of the few cancers for which survival has not improved substantially over the past 25 years. Men are 20 percent more likely to get pancreatic cancer than women and the majority of cases occur in people over the age of 65. The incidence rate among African Americans is 40 percent to 50 percent higher than other ethnic groups.
"The statistics on pancreatic cancer are sobering, but it is important for patients to know that treatment does exist for pancreatic cancer. Clinical trials can provide important treatment options beyond what is currently available," said Thomas M. Deas Jr., MD, MMM, FASGE, president, American Society for Gastrointestinal Endoscopy. "Advanced technologies are allowing for the diagnosis of pancreatic cancer at earlier, more treatable stages. Screening for pancreatic cancer in relatives of affected people is not usually recommended in the United States, however, families with many cases of pancreatic cancer or close relatives of people who developed pancreatic cancer at an early age should seek the advice of a specialist such as a gastroenterologist or oncologist, as there are specific genetic syndromes that may increase susceptibility for pancreatic cancer."
About Pancreatic Cancer
The pancreas is a gland deep in the abdomen, behind the stomach, that is part of the digestive and endocrine systems. The pancreas makes juices that help with digestion (enzymes) as well as important hormones such as insulin that control the level of sugar in the bloodstream. Pancreatic cancer is difficult to diagnose early, as the symptoms are often minor or nonexistent until the tumor has extended outside the pancreas. Once outside the pancreas, the tumor invades a number of adjacent organs and is usually not amenable to surgical resection. There are no effective screening tests for pancreatic cancer.
Advances from scientific research about pancreatic cancer continue to be an important goal. Pancreatic cancer risk factors need to be identified and verified before research about prevention methods can begin. Research studies indicate that approximately 10 percent of pancreatic cancer cases are familial and another 30 percent are thought to result from cigarette smoking. Some other risk factors scientists are currently studying include: diabetes, chronic and hereditary pancreatitis (inflammation of the pancreas), and obesity.
Symptoms and Detection
Since the pancreas is near the drainage tubes for bile and digestive enzymes, a mass in the pancreas can block the flow of these substances into the small intestine. This can cause the skin and eyes to turn yellow (jaundice) and the stool to turn pale. It can also cause pain, weight loss, nausea, vomiting and itchy skin. The symptoms of pancreatic cancer can be confused with those of benign diseases such as arthritis (back pain), gallstones (jaundice) or chronic pancreatitis (pain, diarrhea, weight loss). Unfortunately, by the time most patients develop symptoms, the cancer is usually advanced and difficult to treat.
A variety of tests are used to detect and understand the extent or stage of the disease. It is important to detect pancreatic cancer at its earliest and most treatable stage. Precise staging helps determine what treatment course is best and what alternatives (such as participation in a clinical trial) might be appropriate.
After a physical examination and some basic blood tests, most patients get scanned with a computed tomography (CT) scan. CT scans and MRI (magnetic resonance imaging) provide a detailed view of the pancreas and neighboring organs. A very important test, usually performed after a CT or MRI scan, is endoscopic ultrasound (EUS). EUS allows specially trained doctors known as endoscopists to obtain highly detailed pictures of the pancreas and to get a biopsy of any abnormalities seen. This type of biopsy is known as fine needle aspiration, or FNA. EUS uses a thin, flexible camera (combined with a tiny ultrasound device) that is passed gently through the mouth and into the stomach.
EUS and EUS-FNA have become valuable tools in the diagnostic evaluation of patients with suspected pancreatic cancer. Another test that may be required is known as endoscopic retrograde cholangiopancreatography (ERCP). During this test a small camera (scope) is used to allow injection of a dye into the ducts that drain bile and the pancreatic juices. It also allows doctors to insert a small tube (stent) if needed to relieve a blockage.
Treatments are generally recommended based on the stage of the cancer. Currently, surgery offers the only potential for a cure. It is estimated that only 15 percent of pancreatic cancer cases are caught early enough for surgery. Most patients will have a recurrence within two years.
The most commonly used surgical procedure to remove tumors in this stage is called the Whipple procedure, named after the doctor who developed the technique in 1935. A Whipple procedure treats cancer of the head of the pancreas (the widest part) and generally involves removing most of the pancreas and part of the small intestine, bile duct and stomach. Surgery may be followed by chemotherapy or a combination of chemotherapy and radiation. If the tumor has spread into surrounding tissue or organs and cannot be removed by surgery, then the treatment becomes medical and is focused on control of the disease, optimal symptom relief, and a chance for increased survival.
An estimated 52 percent of pancreatic cancer patients are diagnosed with late stage pancreatic cancer that has spread to distant organs or sites. Chemotherapy alone, without surgery or radiation, is the recommended treatment for patients at this stage. The goal of treatment in this case is palliative care – optimal relief of symptoms and improvement in quality of life. Unfortunately, only two percent of pancreatic cancer patients who are diagnosed at this stage will survive for more than five years.
The Pancreatic Cancer Action Network offers a number of resources for pancreatic cancer patients and their families through the Patient and Liaison Services (PALS) program. Patients and their families can call PALS toll-free at 877-272-6226 to talk with trained staff members and receive free educational literature. PALS also offers patient education booklets for physicians to keep in their clinics. To request free booklets, call PALS at 877-272-6226 or visit www.pancan.org.
For more information on endoscopic procedures for pancreatic cancer and to find a physician in your area, log on to www.asge.org.
About the American Society for Gastrointestinal Endoscopy
Since its founding in 1941, the American Society for Gastrointestinal Endoscopy (ASGE) has been dedicated to advancing patient care and digestive health by promoting excellence and innovation in gastrointestinal endoscopy. ASGE, with more than 12,000 members worldwide, promotes the highest standards for endoscopic training and practice, fosters endoscopic research, recognizes distinguished contributions to endoscopy, and is the foremost resource for endoscopic education. Visit www.asge.organd www.screen4coloncancer.org for more information and to find a qualified doctor in your area.
Endoscopy is performed by specially-trained physicians called endoscopists using the most current technology to diagnose and treat diseases of the gastrointestinal tract. Using flexible, thin tubes called endoscopes, endoscopists are able to access the human digestive tract without incisions via natural orifices. Endoscopes are designed with high-intensity lighting and fitted with precision devices that allow viewing and treatment of the gastrointestinal system.