​Seniors Matter(s): Pancreatic cancer - silent and deadly

Pancreatic cancer occurs when malignant (cancerous) cells grow, divide, and spread in the pancreas, a six-inch-long, spongy, tube-shaped organ located in the back of the abdomen, behind the stomach.

The pancreas has two major jobs in the body: to make digestive juices (called enzymes) that help break down food, and to make hormones - including insulin - that control the body's use of sugars and starches.

Unfortunately, most people often don’t have symptoms in the early stages of this disease. But as the cancer grows and spreads, pain often develops in the upper abdomen and sometimes spreads to the back. The pain may worsen after you eat or lie down. Other symptoms may include jaundice, nausea, loss of appetite, weight loss, fatigue, weakness, and depression.

When a mutation begins in the cellular DNA of cells that form the pancreas, it impacts the way they grow, differentiate, multiply, and/or die.

There are two recognized forms of pancreatic cancer.

An exocrine tumour is the most common and happens when carcinogenesis takes place in the pancreatic cells responsible for producing digestive enzymes. 

Neuroendocrine tumours are rare and occur when carcinogenesis takes place in the pancreatic cells that are responsible for the production of hormones.

Symptoms of pancreatic cancer include nausea, stool changes, appetite loss, jaundice, weight loss, and abdominal pain.

Since pancreatic cancer in its early stages (when it’s easiest to treat), is difficult to diagnose, it’s one of the deadliest cancers. About nine per cent of people with pancreatic cancer live at least five years after diagnosis. But the five-year survival rate is much better – 34 per cent - if it hasn’t spread past the pancreas. Know that survival rates can’t predict what will happen to any single person and may not reflect newer types of treatment.

The exact cause of pancreatic cancer is unknown although certain gene mutations can cause it. Other risk factors include smoking, age (it’s usually diagnosed in people older than 45), diabetes, chronic pancreatitis due to a genetic mutation, liver cirrhosis, family history of the condition, gender (it’s more common in men than women), obesity, certain chemicals, and race. (Africans have a slightly higher risk than whites; experts don’t know why.)

Traditionally, radiation therapy uses high-powered radiation to kill cancer cells. For pancreatic cancer, you’d likely get it five days a week for several weeks. This schedule helps to protect normal tissue by spreading out the total dose of radiation. Radiation is also being studied as a way to kill cancer cells that stay in the area after surgery. Radiation therapy can help relieve pain or digestive problems caused by large tumours.

Further, chemotherapy uses drugs to destroy cancer cells and stop them from growing or multiplying. It may involve one drug or a combination of drugs. You may get it by mouth or by injection. The drugs enter the bloodstream and travel through the body, making chemotherapy a good choice for cancer that has spread. You may also get it after surgery to kill any cancer cells left behind.

These medications attack specific parts of the cancer cells. Targeted therapies seem to have fewer side effects than chemotherapy and are less harmful to normal cells. Doctors can use a targeted therapy called erlotinib (Tarceva) along with chemo to treat advanced pancreatic cancer. Side effects can include a rash, diarrhea, appetite loss, and fatigue.

This type of treatment uses your immune system to fight disease. For pancreatic cancer, doctors can use pembrolizumab (Keytruda) to block a protein called PD-1 so that the immune system can attack the cancer. Side effects can include fatigue, skin problems, joint pain, and gut problems (constipation, diarrhea, and nausea). More serious side effects can happen if the immune system starts to attack the body, itself.

However, things are changing, and this is where it gets exciting.

In the last decade, numerous exciting advances have been developed. For example, for a long time, a growth that is not isolated to the head of the pancreas may needed to undergo a distal or total pancreatectomy to have a chance at curing the malignancy. This procedure is only indicated when the tumour or lesion is isolated to the distal part of the organ. A total pancreatectomy is a surgical operation to remove the entire pancreas, part of the stomach, the spleen, gallbladder, and part of the small intestine.

A pancreaticoduodenectomy or Whipple procedure refers to treating some individuals who have cancer in the head of their pancreas. The Whipple procedure provides a method only to remove a certain part of the pancreas with the malignancy.

Next, is a procedure called laparoscopic surgery which refers to a technique where numerous small incisions are utilized to manipulate a camera and small instruments in the abdomen to perform the pancreas head removal. Robotic surgery is a common method used for the Whipple procedure, and it is minimally invasive and removes the challenge of the human hands being too large to manipulate the instruments properly.

Scientists have also developed a novel vaccine that attempts to help the body’s immune system identify and then fight cancer.

Dr. Zheng and a team of researchers are currently testing this pancreatic cancer vaccine in clinical trials. Johns Hopkins is at the forefront of development of this novel therapy, as researchers seek to learn more about how vaccine therapy could enhance pancreatic cancer treatment. While most vaccines are administered to prevent disease, this vaccine is used on patients already diagnosed with pancreatic cancer. The vaccine is made up of inactivated pancreatic cancer cells, meaning the cells are incapable of growing.

Scientists have altered these cells to release a certain molecule that attracts the immune cells to the cancer cells. This vaccine therapy essentially triggers the body to attack the cancer cells in the pancreas as well as anywhere else in the body where the cancer may have spread. The vaccine’s ability to treat metastatic disease (when cancer spreads from the pancreas to another organ) is key because few treatments, thus far, have proved effective in the long-term at treating systemic pancreatic cancer.

Researchers continue to investigate precisely how these therapies can best benefit patients. So far, this vaccine offers much potential in the fight against pancreatic cancer.

Palliative therapy is used to ease symptoms and manage pain in any stage of the disease. You can get it along with other medical treatments. The goal is to improve quality of life not just in the body, but in the mind and spirit. While palliative therapies are clearly appropriate at the very advanced stages of the disease, they also help when given along with other treatments that target the cancer.

As with many other areas of medicine, huge advances are happening almost daily.

I find it exciting and hope that we will continue to make these advancements.

Today is the oldest I’ve ever been!

‘Till next time.