ARTICLE ON PANCREATIC CANCER
Madhukar Kaw, M.D., Gastroenterologist
Board Certified in Internal Medicine and Gastroenterology
Gastrointestinal Care Consultants, P.A.
12121 Richmond Avenue, Suite 424, Houston, TX 77082
Silent but Deadly
What do Steve Jobs, Apple’s legendary founder and Patrick Swayze notable for his many award winning movies have in common? If you answered pancreatic cancer you would be correct. Although the deaths of these individuals has made public headlines, thousands of others around the world succumb to this silent killer annually. Undetected pancreatic cancer can spread rapidly to other organs and quickly become untreatable.
Some known risk factors for pancreatic cancer are: a history of smoking, diabetes, obesity and a family history of pancreatic cancer. Researchers are investigating possible associations between a diet high in fat (especially animal fat) or heavy drinking of alcoholic beverages and the increase in the risk of pancreatic cancer. Another area of study is focusing on the genetic predisposition to developing pancreatic cancer. Typical symptoms associated with pancreatic cancer include: Dark urine, pale stools, and yellow skin and eyes from jaundice, pain in the upper part of your belly, pain in the middle part of your back that doesn’t go away when you shift your position, nausea and vomiting or stools that float in the toilet. More advanced stages of pancreatic cancer present as weakness or feeling very tired, loss of appetite or feelings of fullness or weight loss for no apparent reason. While advanced stages of cancer have more generalized symptoms, any of the warnings listed must be relayed to a physician so a work-up can be initiated. Most individuals visit with a primary care doctor who may order blood or other lab tests and the results from these tests may necessitate a visit to a gastroenterologist. At the gastroenterologist’s office you can expect a physical examination of the abdomen to check for changes in the areas near the pancreas, liver, gallbladder and spleen. This initial examination allows the doctor to look for an abnormal build-up of fluid in the abdomen. The skin and eyes are also examine for signs of jaundice. Also, you may have one or more of the following tests. The gastroenterologist may recommend a CT scan of the abdomen with a contrast material (dye) so that the pancreas can be more easily visualized. Prior to the CT scan you may be asked to drink water in order for the stomach and duodenum to be more clearly visible. The CT scan is a powerful imaging tool on which a tumor present in the pancreas or elsewhere may be seen. Another tool for detecting pancreatic cancer is the ultrasound which is a device that uses sound waves that create a pattern of the organs as they sound waves bounce off the internal organs. The ultrasound image may show a tumor or blocked ducts. Alternately, the physician may order an endoscopic ultrasound which is a thin lighted tube that is passed down the throat into the stomach and the in the small intestine. As the probe is withdrawn from the patient, images are created of the pancreas and other organs. These images can show tumors as well as how deeply the cancer has invaded the blood vessels. Endoscopic Ultrasound guided needle biopsy can be used to make a diagnosis of cancer. Another procedure used is ERCP. In this procedure, an endoscope is passed through the mouth and stomach down into the first part of the small intestine and at this point the doctor slips a smaller tube through the endoscope into the bile and pancreatic ducts, and the doctor takes x-ray pictures of these ducts. After injecting dye through the smaller tube the doctor takes x-ray pictures. These x-ray images can show whether the ducts are narrowed or blocked by a tumor or other condition. Both ERCP and endoscopic ultrasound are done by only a select group of gastroenterologists who have spent additional time training during their fellowship to gain proficiency in these very skilled procedures.
Other methods for detecting pancreatic cancer utilize imaging either by MRI where computers linked to magnets provide detailed pictures of internal organs or PET scans which use radioactively labelled sugars that are more rapidly ingested by cancer cells resulting in brighter images of cancer cells when compared to their normal counterparts. Cancer cells because of their abnormal growth ingest greater amounts of sugars than the surrounding normal cells. Needle biopsies allow for tissue sampling that more accurately identifies and stages the cancer. EUS or CT may be used to guide the needle and a pathologist uses a microscope to look for cancer cells in the tissue. If cancer of the pancreas is diagnosed, your doctor needs to learn the extent (stage) of the disease to help you choose the best treatment. However, failure to initiate a visit to a physician early on, can lead to delayed diagnosis and a negative outcome. Depending on the stage that the cancer is detected, possible treatment paths include: surgery, radiation therapy, chemotherapy or targeted therapy which involves the combination of drug therapy and chemotherapy.