Pancreatic Cancer

Pancreatic Cancer also known as Pancreatic carcinoma, is a disease that afflicts about 44,000 Americans each year. It's the 4th most common cause of cancer-related deaths in the United States. Since the majority of cases aren't caught in the early stages, when the tumor is most treatable, only about 6 percent of patients live at least five years after diagnosis. In affected patients, malignant cancer cells are found in the tissues of the pancreas, a large organ located behind the stomach that is mainly responsible for helping your body absorb and break down foods. In about 95% of cases, pancreatic cancer begins in the pancreatic juice ducts - referred to as exocrine pancreatic cancer. However, it can also start in the cells that make hormones - referred to as endocrine pancreatic cancer or islet cell cancer.

Risk Factors for Pancreatic Cancer

One of the most natural questions to ask when you’ve been diagnosed with Pancreatic Cancer is, “Why me?”

Although the exact cause of Pancreatic Cancer is unknown, there are certain risk factors that may contribute to the development of the disease. These include:

Smoking – The most important risk factor is smoking tobacco. If you are a smoker you are more likely than nonsmokers to develop this disease.
History of Diabetes – If you have been diagnosed with diabetes, you have a higher likelihood of developing pancreatic cancer than those who haven’t.
Weight Problems – If you are overweight or obese, there is a slightly higher risk of developing pancreatic cancer.
Family history of Pancreatic Cancer – An immediate family member (mother, father, sister, or brother) being diagnosed with pancreatic cancer increases your risk of developing the disease.
Inflammation of the pancreas – Long-term suffering from Pancreatitis, which is an inflammation of the pancreas, may increase your risk of Pancreatic Cancer.

It should be noted that many people who have one or more risk factors may never develop the disease and many who have been diagnosed don’t have any risk factors.

Symptoms of Pancreatic Cancer

Since the pancreas is positioned deep within the belly, pancreatic cancer often advances quietly for months before it is discovered. The early stages of pancreatic cancer often go undiagnosed because there are little or no symptoms. As the cancer progresses, you may notice any one of the following common symptoms:

Upper abdominal pain (typically radiating from the back)
Dark urine
Pale colored stool or stool that floats
Yellow cast skin and eyes
Nausea, vomiting or loss of appetite
Drastic weight loss
Elevated levels of blood sugar

If you are experiencing any of the above symptoms, they should be discussed with your doctor immediately.

Diagnosis of Pancreatic Cancer

In most cases of Pancreatic Cancer, patients will complain to their doctors about nonspecific symptoms. This conversation will usually trigger the doctor to recommend tests to identify the source of the problems. Some of the most common tests include:

Physical exam – With a physical exam, your doctor will likely feel your abdomen to identify changes in areas near the pancreas, liver, gallbladder, and spleen, including a buildup of fluid in the abdominal area. In addition to a feel test, your skin and eyes may be checked for signs of jaundice (a common Symptom of Pancreatic Cancer (link)).
Ultrasound – This may be the first test suggested to you if you’re suffering from jaundice or abdominal pain. Your doctor will place an ultrasound device on your abdomen and move it around to look for gallstones, a common condition that has similar symptoms to Pancreatic Cancer, or other abnormalities. If a pancreatic tumor is seen on ultrasound, a CT scan is still necessary to obtain more information.
CT scan – With this test, an x-ray machine takes a series of pictures of your pancreas and nearby organs and blood vessels. It tends to be the preferred test to diagnose Pancreatic Cancer, as it can pick up small tumors that are often overlooked by an ultrasound. Also, a CT scan can show whether the mass has spread beyond the pancreas, information that is critical prior to surgery.
EUS (Endoscopic Ultrasound) – While you are heavily sedated, a gastroenterologist will insert a thin, flexible tube (endoscope) with a camera at the tip down your throat, through the stomach, and into the duodenum in the small intestine. From there, a needle biopsy (see below) can be performed, with guidance from an ultrasound, at the tip of the endoscope.

In addition to some of the more common ways to diagnose Pancreatic Cancer above, your doctor may also recommend the following tests:

ERCP (Endoscopic retrograde cholangiopancreatography) – While you are heavily sedated, your doctor will insert a thin, flexible tube (endoscope) down your throat, through the stomach, and into the duodenum in the small intestine. They will then slip a smaller tube, which will be injected with dye, through the endoscope into the bile ducts and pancreatic ducts so the doctor can take x-ray pictures. The x-rays can show whether the ducts are narrowed or blocked by a tumor or other condition.

MRI (Magnetic resonance imaging) – A machine with a strong magnet linked to a computer is used to take detailed pictures of areas inside your body.

PET (Positron emission tomography) scan – With this test, your doctor will inject you with a small amount of radioactive sugar, which gives off signals that the PET scanner picks up. The sugar goes into those parts of the body that use glucose for energy and the PET scanner makes a picture of the places in your body where the sugar is being taken up. Cancer cells use glucose differently than normal tissue, so they show up brighter in the picture. A PET scan may identify a tumor in the pancreas and can also show cancer that has spread to other parts of the body.

Needle biopsy – Your doctor will use a thin needle to remove a small sample of tissue from the pancreas. An EUS or CT test may be used to help guide the needle.

Pancreatic Cancer Diagnosis Statistics

According to the National Cancer Institute’s Surveillance Epidemiology and End Results program (SEER Incidence data from 2005 – 2009), the median age of diagnosis for pancreatic cancer was age 71 with the distribution based on age detailed as follows:

0.1% < age 20

0.4% between 20 – 34

2.2% between 35 – 44

9.7% between 45 – 54

20.7% between 55 – 64

25.8% between 65 – 74

27.8% between 75 – 84

13.3% over age 85

The stage of pancreatic cancer at diagnosis (National Cancer Institute 5-Year Survival Relative Trends from 2002-2008) is distributed as follows:

8% are diagnosed with cancer of the pancreas confined to the primary site (localized)

27% are diagnosed when cancer of the pancreas has spread to the regional lymphnodes

53% are diagnosed after pancreatic cancer has metastasized

12% are diagnosed as unstaged or unknown

Stages of Pancreatic Cancer

Once a patient has been diagnosed, the next step will be to determine the stage of Pancreatic Cancer so that treatment options can be identified and discussed. Pancreatic cancer is broken into four stages with Stage 1 being the earliest stage and Stage 4 being the most advanced (also known as metastatic disease).

Stage 1 Pancreatic Cancer – The tumor is only found in the pancreas.
Stage 2 Pancreatic Cancer – The tumor has invaded nearby tissue but not nearby blood vessels. In this stage, the cancer may have spread to the lymph nodes.
Stage 3 Pancreatic Cancer – The tumor has invaded nearby blood vessels.
Stage 4 Pancreatic Cancer– The cancer has spread to a distant organ, such as the liver or lungs.

If Pancreatic Cancer is in Stage I or Stage II and found either in the pancreas or in nearby tissue, surgery, which is the only curative treatment for the disease, may be recommended by your doctor. After your recovery from the Pancreatic Cancer procedure, “adjuvant therapy” may be recommended to reduce the risk of the disease recurring. This would typically include six months of chemotherapy, often in combination with radiation therapy.

Pancreatic Cancer Prognosis

Below is life expectancy data for pancreatic cancer based on the stage of progression at diagnosis and the corresponding 5-Year Relative Survival Trends from 2002-2008 from the National Cancer Institute.

Stage at Pancreatic Cancer Diagnosis (All Races, Both Sexes)	Stage Distribution (%)	5-year Relative Survival (%)
Localized (confined to primary site)	8%	23.3%
Regional (spread to regional lymph nodes)	27%	8.9%
Distant (cancer has metastasized)	53%	1.8%
Unknown (unstaged)	12%	3.9%

What does this mean? Based on data derived from SEER (above), 8% of individuals diagnosed with pancreatic cancer were diagnosed in Stage I, of those diagnosed with localized pancreatic cancer, 23.3% were alive 5 years later. 27% of pancreatic cancer patients were diagnosed in Stage II and 8.9 % of those patients survived 5 years. The majority of patients, 53%, were diagnosed in Stage IV when the cancer had already metastasized, while only 1.8% survived beyond 5 years. 12% of patients were diagnosed with no stage detailed and 3.9% survived 5 years or longer. Without active treatment, metastatic pancreatic cancer patients have a median survival of 3–5 months.

Age can also be a factor for the life expectancy prognosis for pancreatic cancer patients. Younger aged patients have better odds of an extended life expectancy.

Relative Survival By Survival Time (All Races, Both Sexes 1988-2008)
Survival Interval (Years)	Ages < 50	Ages < 65	Ages 50-64	Ages 65+	Ages 65-74
0	100.0%	100.0%	100.0%	100.0%	100.0%
1	38.8%	31.8%	29.9%	18.6%	22.7%
2	23.3%	15.9%	13.9%	7.9%	9.6%
3	17.8%	11.2%	9.3%	5.0%	6.0%
4	15.1%	9.1%	7.4%	3.9%	4.6%
5	14.0%	8.0%	6.3%	3.4%	4.0%
6	13.3%	7.3%	5.6%	3.1%	3.7%
7	12.2%	6.7%	5.2%	2.8%	3.3%
8	11.2%	6.2%	4.8%	2.6%	3.1%
9	10.9%	6.0%	4.5%	2.4%	3.0%
10	10.0%	5.6%	4.3%	2.3%	2.9%
- Cancer sites include invasive cases only unless otherwise noted. - Survival source: SEER 9 areas (San Francisco, CT, Detroit, HI, IA, NM, Seattle, UT, and Atlanta). - The annual survival estimates are calculated using monthly intervals.

According to the SEER mortality data 2005 – 2009, the median age at death caused by pancreatic cancer was age 73, the breakdown of age-based mortality is below:

0.0% < age 20
0.2% between 20 – 34
1.5% between 35 – 44
8.2% between 45 – 54
19.1% between 55 – 64
25.6% between 65 – 74
30.0% between 75 – 84
15.5% over age 85

Pancreatic Cancer Treatments

Pancreatic Cancer treatments can be a challenge. Once the disease has advanced beyond a certain stage, it can become quite difficult to manage and is often resistant to care. Although there’s no cure for advanced pancreatic cancer, recent developments in research are helping patients live longer with the disease and maintain a relatively good quality of life.

The treatment options that will be discussed with you by your doctor are dependent on the extent of the cancer in your body, which can be divided into 3 categories:

Localized – The cancer is completely confined within the pancreas.
Locally advanced – The cancer has extended from the pancreas to nearby blood vessels or organs.
Metastatic – The cancer has spread to other parts of the body.

The most common Pancreatic Cancer treatment options are:

Surgery – Surgery can be used in either of the following two scenarios:
1. When it is possible to remove all of the cancer, which would mean removing all or part of the pancreas and possibly nearby tissues like the duodenum, gallbladder, common bial duct and/or a part of the stomach;
2. Even if the tumor is too widespread to be completely removed, but surgery can be used to relieve symptoms and prevent certain complications.
Chemotherapy – Chemotherapy drugs are used to kill cancerous cells. Most people with pancreatic cancer will undergo chemotherapy. For early pancreatic cancer, chemotherapy is typically given after surgery, but in some cases, it’s given before surgery. For advanced cancer, chemotherapy is used alone, with targeted therapy, or with radiation therapy.
Radiation therapy – Radiation therapy uses high-energy radiation to kill cancer cells and shrink tumors. In a painless procedure, a machine aims beams of radiation at the cancer in the abdomen. Side effects can include fatigue, nausea, vomiting, or diarrhea.
Targeted therapy – Chemotherapy and radiation therapy cannot distinguish the difference between cancer cells and healthy cells, so they often end up harming healthy cells. Targeted therapy is designed to treat only the cancer cells and minimize damage to normal cells. It also helps prevent cancer cells from spreading.

Determining the ideal treatment plan for you will depend on the following:

Where the tumor is located in your pancreas;
Whether the disease has spread and where it has spread; and
What your age and general health is

Pancreatic Cancer Medications

There are a number of Pancreatic Cancer drugs that have been approved by the Food and Drug Administration (FDA) for the treatment and maintenance of the disease, including brand names as well as generics. Following is a list of Pancreatic Cancer medications:

Adrucil (Fluorouracil)

Efudex (Fluorouracil)

Erlotinib Hydrochloride

Fluoroplex (Fluorouracil)

Fluorouracil

Gemcitabine Hydrochloride

Gemzar (Gemcitabine Hydrochloride)

Mitomycin C

Mitozytrex (Mitomycin C)

Mutamycin (Mitomycin C)

Tarceva (Erlotinib Hydrochloride)

There may be drugs used in the treatment of pancreatic cancer that are not listed here.

Projected Annual Cost of Patient Care for Pancreatic Cancer

In January 2011, the National Cancer Institute completed a study to estimate the Average Annual Projected Costs of Cancer Care by cancer type (per patient) in the United States. Below are the results of this study, specific to pancreatic cancer patients, which shows the projected annual costs of care, based on sex and phases of care (estimates are adjusted for patient deductibles and coinsurance expenses):

Phase of Pancreatic Cancer Care	Male	Female
Initial Year of Diagnosis	$94,092	$93,462
Continuing Care	$11,697	$8,672
Last Year of Life – Cancer as Cause of Death	$113,115	$109,941
Last Year of Life – Other Cause of Death	$47,565	$40,538
* Phases of care: Initial year after diagnosis, Last year of life, and the period between (Continuing). Months of survival are first applied to last year of life, any remaining to initial phase, then to continuing.

Financial Assistance for Pancreatic Cancer

Learning that you’ve been diagnosed with Pancreatic Cancer can be stressful enough, but trying to find financial assistance to pay for not only your treatments but your mounting cost of living bills can seem insurmountable. What many people don’t realize is that there are financial resources for Pancreatic Cancer available, including:

Welcome Funds – For the past decade, Welcome Funds has been assisting people battling cancer to achieve financial freedom by converting life insurance policies into cash. Rather than use your home as loan collateral or applying for a reverse mortgage, both of which might financially burden your family in the future, you may be able to access the future value of a life insurance policy to get the financial relief you seek.
Cancer Financial Assistance Coalition – The Cancer Financial Assistance coalition (CFAC) is comprised of several organizations that have joined forces to help patient experience better health and well-being by reducing financial challenges. CFAC facilitates communication among member organizations, educates patients and providers about resources and links to advocates on behalf of cancer patients who bear financial burdens associated with the costs of cancer treatment and care.
Patient Access Foundation – The Patient Access Network (PAN) Foundation is an independent national nonprofit organization founded to help the underinsured get financial assistance and access to the health care they need to continue living a relatively normal and productive lifestyle.
Cancer Survivors’ Fund – Cancer Survivors' Fund is a non-profit organization that provides college scholarships and prosthetics for the benefit of persons diagnosed with cancer, receiving treatment for cancer or in remission to give them a new purpose and meaning in life.
Rofeh Cholim Cancer Society – RCCS provides an array of services for cancer-stricken patients in need - primary among them is the subsidizing of health insurance premiums, enabling pateients to obtain the best possible medical care.

Pancreatic Cancer Resources

If you’re looking for Pancreatic Cancer resources, look no further. When dealing with your disease, the most important elements to your maintenance and recovery are information, advocacy and a sense of community. The following are resources for patients suffering from Pancreatic Cancer:

Pancreatic Cancer Network – The Pancreatic Cancer Action Network is a nationwide network of people dedicated to working together to advance research, support patients and create hope for those affected by pancreatic cancer.
Pancreatica – Cancer Patients Alliance is led by a Medical Director and a five-member scientific board of highly regarded specialists in oncology from around the world. The mission of the Foundation is to promote awareness, increase education, and further pancreatic cancer research.
National Coalition for Cancer Survivorship – NCCS’s mission is to advocate for quality cancer care for all people touched by cancer.
Disability Rights Legal Center: Cancer Legal Resource Center – The Cancer Legal Resource Center (CLRC) is a national, joint program of the Disability Rights Legal Center and Loyola Law School Los Angeles. The CLRC provides free information and resources on cancer-related legal issues to cancer survivors, caregivers, healthcare professionals, employers, and others coping with cancer.

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