Pancreatic cancer: Difficult to diagnose, treat

The Detroit News
Oakland County Executive L. Brooks Patterson has been diagnosed with pancreatic cancer, a disease that is expected to afflict more than 56,000 other Americans this year.

Oakland County Executive L. Brooks Patterson announced Tuesday he has been diagnosed with stage 4 pancreatic cancer, a disease that is difficult to treat and that kills tens of thousands of people each year in the U.S.

Pancreatic cancer accounts for about 3 percent of all cancers in the United States and about 7 percent of all cancer deaths. The American Cancer Society estimates about 56,770 people will be diagnosed with pancreatic cancer this year in the U.S., and 45,750 people will die of the disease.

The five-year survival rate for patients with stage 4 pancreatic cancer is 3 percent, according to the cancer society.

The pancreas is a large glandular organ located behind the stomach and next to the small intestine. About six to eight inches long and a couple of inches wide, it secretes enzymes that help break down food and produces insulin the body needs to regulate sugar and glucose levels.

Pancreatic cancer is rarely diagnosed at an early stage, according to Dr. Otis Brawley, chief medical officer for the American Cancer Society and a medical oncologist and epidemiologist at Emory University in Atlanta.

The pancreas hides deep inside the body, so it's hard to see. And pancreatic cancer can grow secretively with few if any symptoms.

The pancreas has a unique anatomical feature that allows cancer to spread rapidly to other parts of the body.

"It does not have a fibrous outer covering the way the liver, the kidney, the colon and the uterus have," Brawley said. "Other organs have this capsule, and the capsule can help keep the cancer confined for a time. 

"With pancreatic cancer we rarely find it localized. As soon as the tumor develops it’s starting to spread because the organ itself doesn’t have an outer capsule." 

Pancreatic cancers — like some lung cancers, brain cancers and colorectal cancers — are harder to treat than many others because they're caused by a mutation in a RAS gene.

These are from a family of genes that make proteins involved in cell-signaling pathways that control cell growth and cell death — and they don't respond to chemotherapy. Scientists are looking for ways to stop RAS-derived cancers, but progress has been slow, Brawley said. 

Most patients who are diagnosed with pancreatic cancer are 45 or older, and the risk of developing the disease rises with age. According to the cancer society, about two-thirds of patients are at least 65.

Pancreatic cancer is slightly more prevalent among men and African-Americans, and family history also can increase a person's risk of developing the disease. Other risk factors include obesity, smoking, a history of pancreatitis and type 2 diabetes.

While pancreatic cancer is difficult to detect early, symptoms include jaundice, light-colored or greasy stools, dark urine, belly or back pain, unintentional weight loss, nausea and gallbladder or liver enlargement, according to the cancer society. 

Treatment options include radiation, chemotherapy and immunotherapy. Surgery can be performed in early-stage patients whose cancer has not spread outside the pancreas.