An Expert Explains the Risk Factors and Treatments for Pancreatic Cancer
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Reviewed By Louise Chang, MD
March 6, 2008—Patrick Swayze, who starred in such blockbuster films as Dirty Dancing and Ghost, has been diagnosed with pancreatic cancer, according to media reports. While little has been reported about the 55-year-old actor's condition, the news casts a spotlight on this often fatal form of cancer.
The pancreas is a long, flat gland that lies in the abdomen behind the stomach and produces both enzymes that aid digestion and certain hormones that help maintain the proper level of sugar in the blood.
The American Cancer Society estimates that 37,680 Americans (18,770 men and 18,910 women) will be diagnosed with pancreatic cancer in 2008. About 34,290 Americans (17,500 men and 16,790 women) will die of pancreatic cancer in 2008, making it the fourth deadliest cancer.
In a statement published in People magazine, Swayze's doctor, George Fisher, MD, an oncologist at Stanford Cancer Center in Palo Alto, Calif., said, "Patrick has a very limited amount of disease and he appears to be responding well to treatment thus far. All of the reports stating the time frame of his prognosis and his physical side effects are absolutely untrue. We are considerably more optimistic."
Swayze's diagnosis was initially reported by the National Enquirer and New York Post, which both suggested that the cancer is more severe.
To find out more about this form of cancer, WebMD spoke to Gagandeep Singh, MD, director of hepatobiliary and pancreatic surgery at the John Wayne Cancer Institute at Saint John's Health Center in Santa Monica, Calif., and a spokesman for the Pancreatic Cancer Action Network (PanCan), based in El Segundo, Calif.
Is Patrick Swayze a poster child for this disease in any way?
"No. It is almost equal in its incidence in men and women, so sex is not a factor. It occurs most often in patients about the age of 60 through 65, so at age 55, Patrick Swayze is young. The youngest patient I have ever treated was 21 and the oldest was 86, so there is a spectrum."
Why is this form of cancer so often considered a death sentence?
"There are usually no symptoms until the cancer has started to spread. It is relatively silent. Patients only get pain after it has spread and starts involving the nerves. In addition, there is no routine screening test for pancreatic cancer. By the time it's found in about 50% of cases, the cancer has already spread to other organs."
Why are there usually no symptoms?
"The pancreas is really deep set near the spine, so there is nothing for it to obstruct or press on to cause pain or other symptoms. If the tumor is in the head of the pancreas, it may cause jaundice, so these tumors are easier to find early. In these cases, the jaundice is characterized by dark urine and yellow eyes. The skin may also have an orangeish hue."
What is the survival rate for pancreatic cancer?
"It depends. If it's just in the pancreas and the neighboring glands and we take it out, and give chemotherapy [to kill errant cancer cells throughout the body], there is still good survival at five years. If it has already spread beyond the pancreas and starts going into the glands and the liver, the survival rate goes down. Once it has spread to other organs, the outcome is fairly dismal. It's less than 1% at five years."
How is pancreatic cancer treated?
"A surgeon will start by removing the tumor [if operable], but the buck doesn't stop with taking out the cancer. We need to add chemotherapy and/or radiation to improve long-term survival."
What should a newly diagnosed person like Swayze do?
"The first thing to do is assess the stage of the cancer. The next step is to go for a second opinion even if the first doctor said the tumor was inoperable. Seek out a specialist in pancreatic cancer and get a second opinion."
Are there any risk factors for pancreatic cancer?
"We really don't know the exact cause of pancreatic cancer. There are multiple risk factors that are all loosely associated with the cancer including the use of tobacco, poor diet, obesity, and diabetes. But 60% to 70% is really just bad luck."
Does pancreatic cancer run in families?
"Yes. About 10% to 15% of these cancers do have a genetic or familial predisposition. In fact, former U.S. president Jimmy Carter was the only person in his family who did not have pancreatic cancer. His mother, father, and all of his siblings had pancreatic cancer. We do know that there are certain genes that may be linked to pancreatic cancer."
Is there anything the average person can do to lower their risk of pancreatic cancer?
"Leading a healthy lifestyle is key and definitely makes a difference. This includes quitting smoking, consuming a healthy diet, and maintaining a normal body weight."
If there are no symptoms, what can a person do to catch this cancer before it spreads?
"Go for a yearly physical exam and evaluate anything that is out of the ordinary. Tell your doctor if you have unexplained pain in your abdomen, jaundice, or darkening of the urine. Also tell your doctor if pancreatic cancer runs in your family."
(Medical Editor's Note: According to the American Cancer Society, tests for detecting early pancreatic cancer may help people with a strong family history of pancreatic cancer. However, such tests would not be used to screen the general population.)
Is there anything more aggressive that a person who is at risk can do?
"Yes. Tell your doctor if your mom, dad, or other first-degree relatives have had pancreatic cancer, so that you can be scanned every year with a computed tomography (CT) scan [which uses X-rays to make detailed pictures of the pancreas]. The downside is that insurance doesn't pay for these scans.
Any other times you would recommend this CT scan?
"Yes. There is a marker in the blood called cancer antigen 19-9 (CA 19-9) that tends to increase in people with pancreatic cancer, but it is not specific to pancreatic cancer. If a person has jaundice, is in their 60s, and has elevated levels of this marker, I would strongly think they had pancreatic cancer and order a CT scan of the abdomen."
Often when a celebrity is diagnosed with a disease, it raises awareness of the condition. In that sense, what would you like to see happen in the wake of Swayze's diagnosis?
"Clearly there has to be research into pancreatic cancer. We need new blood markers to identify pancreatic cancer earlier and we need new agents to treat pancreatic cancer after surgery to get rid of microscopic floating cancer cells that we are not aware of and can add a survival advantage."
SOURCES: Gagandeep Singh, MD, director of hepatobiliary and pancreatic surgery, John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, Calif. American Cancer Society web site: "What are the key statistics about cancer of the pancreas?" People magazine web site: "Doctor optimistic about Patrick Swayze's cancer." American Cancer Society web site: "Can Cancer of the Pancreas Be Found Early?"
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