Diagnosis and Treatment of Pancreatic Cancer
In October 2011, Apple founder Steve Jobs died at age 56 after a seven-year battle with pancreatic cancer, and as a result, patients are asking me about this disease. Jobs announced he had pancreatic cancer in 2004, battled the disease for years, and resigned as CEO of Apple in August 2011. Actor Patrick Swayze died from pancreatic cancer in September 2009. While pancreatic cancer is not one of the most common forms of cancer, it can be considered one of the most deadly because it is aggressive, spreads rapidly and thus often not diagnosed until it is in later stages, and few treatment options exist.
Pancreatic cancer is the fourth leading cause of cancer death overall, according to the American Cancer Society. About 44,000 Americans will be diagnosed with cancer of the pancreas during 2011, and 37,000 will die from the disease.
One of my first patients as an intern following my graduation from medical school was a 64-year-old man diagnosed with late-stage pancreatic cancer. He was admitted to the hospital suffering from weakness and dehydration and was unable to hold down solid foods or liquids.
He had been diagnosed with pancreatic cancer about six months earlier. His doctors at the time recommended surgery to remove the malignant tumor in his pancreas. This surgery is known as a Whipple procedure (pancreatoduodenectomy); this is still the most common procedure for surgically treating pancreatic cancer. This is a radical surgical procedure which involves removing the malignant part of the pancreas and rerouting the stomach and the bile ducts from the liver to the small intestine. Recovery time for this procedure is several weeks, and there can be multiple complications. Because of the risks, the patient elected not to have the surgery.
Instead, the patient opted for chemotherapy with fluorouracil (5-FU), the most commonly used chemotherapy agent at the time. His side effects included nausea and vomiting, and he developed a bacterial infection in his blood. When I saw him, it was clear his body was losing the battle with the disease. He had lost a significant amount of weight, his skin and eyes had a yellow coloring (jaundice), and he was exhausted from his multiple hospitalizations.
His oncologist determined he was in the terminal stages of the disease, and the patient decided with the support of his family that it was time to go home under hospice care. I felt sad and frustrated that there was nothing that medicine could do to help this man. Pancreatic cancer remains one of the most difficult to treat.
The good news is that medical science is beginning to make inroads against this deadly form of cancer. There are advances in diagnosis and treatment, including newer chemotherapy regimens. Better technology, including CAT scans and MRIs, helps to diagnose the disease at earlier stages. Multiple areas of research including gene therapy and even vaccines offer additional hope.
Last Editorial Review: 10/6/2011