Dr. Michael Wallace, a gastroenterologist at the Mayo Clinic who treats patients with pancreatic cancer, and has a family history of it, shares the warning signs he looks for in his own body.
The disease caused the death of D’Angelo, the Grammy-winning R&B musician who passed away recently at 51.
Other high-profile patients who died include “Jeopardy!” host Alex Trebek and actor Patrick Swayze.
The cancer is hard to find because doctors can’t see or feel the pancreas, a 6-inch-long gland that lies between the stomach and the spine, and is hidden by the small intestine, liver and other organs, the National Cancer Institute notes.
So there’s no lump to find or visual checks to make.
“It’s not a place you can feel with any sort of physical examination,” explains Dr. Wallace.
He adds, “So the only way to really know something’s wrong there is either to wait until you get overt symptoms or to screen with imaging tests.”
People at higher risk — who have a strong family history or an abnormal gene — can be screened with MRIs or specialized endoscopic ultrasounds, he notes.
But there’s no routine screening for the general population to catch it early, so pancreatic cancer is usually found late, when the tumor has already spread outside the pancreas and grown large enough to press on another organ, causing symptoms.
“It’s also deadly because a “wall of scar tissue” forms around the cancer, blocking chemotherapy or radiation from getting into the tumor, Dr. Wallace explains.
“It’s kind of a double whammy. It’s detected late, and even when it’s detected not so late, it’s very difficult to treat,” he says.
As Dr. Wallace takes care of patients with pancreatic cancer, he thinks about it affecting him personally. His aunt had pancreatic cancer, and it was found late, as in most cases.
Given what Dr. Wallace knows about the disease, here are the pancreatic cancer symptoms the doctor pays close attention to in his own body:
New Onset Diabetes with Weight Loss
This is the most common warning sign and perhaps the best opportunity to find pancreatic cancer early, Dr. Wallace says.
If you’re newly diagnosed with high blood sugars and you’re losing weight — especially after the age of 50 or if you have a family history — he recommends asking your doctor, “Could this be a sign of pancreatic cancer? Should I get a scan?”
In general, the answer is yes and yes, he adds.
Diabetes associated with pancreatic cancer is known as Type 3c diabetes. It’s different than the run-of-the-mill Type 2 diabetes with weight gain.
“It’s the one symptom that happens at an early stage,” Dr. Wallace notes, adding it can show up years before the other warning signs.
“It’s an important red flag.”
This symptom applies to the vast majority of pancreatic cancers that start in the exocrine cells.
Pancreatic neuroendocrine tumors, a rare type of the disease, are not typically associated with new onset diabetes, he says. But there’s some overlap with the other symptoms.
Unexplained Weight Loss
People will unintentionally lose a couple of pounds one week, a couple more the next and that pattern continues, the doctor explains.
“I dropped about 20 pounds in the blink of an eye,” Swayze said in an interview.
The weight loss is persistent, progressive and unexplained — it’s not happening because of diet changes or GLP-1 drugs.
Abdominal Pain
“This is a very characteristic dull ache in the upper abdomen, usually midway between the breastbone and the belly button,” Dr. Wallace says.
“It’s a persistent pain. It doesn’t come and go. It kind of builds over weeks, where it’s there one week, it’s worse the next, it’s worse the next,” he notes.
“It typically radiates through to the back — people often say they thought it was a back pain.”
When Swayze revealed his symptoms, he said his indigestion issues “got gigantic and constant.” Trebek also experienced persistent stomach pain.
Jaundice
This is when the skin and the whites of the eyes turn yellow. It’s the first symptom Alex Trebek’s wife, Jean, noticed before his cancer diagnosis.
“The condition is often first seen in the urine, which becomes darker yellow and eventually takes on the color of tea or cola,” Dr. Wallace says.
“It happens when a tumor starts to press on the bile duct, which runs through the middle of the pancreas. The body’s normal method of clearing bile through the gut becomes obstructed, so the bile backs up into the skin and the pigments spill over into the urine,” he notes.
Stools may become pale colored because the bile isn’t being passed through the gut.
Bloating, Nausea and Vomiting
This set of symptoms depends on the location of the tumor. The pancreas has three parts: the head, the body and the tail.
“The head of the pancreas happens to be sort of nestled in with the upper intestinal tract, so if a tumor grows, it can press on and eventually block off that upper intestinal tract called the duodenum,” Dr. Wallace says.
“When that happens, the food can’t go downstream. So it backs up and you feel nauseous and throw up.”
Itching All Over
Bile pigments cause a lot of itching, leading to this unusual warning sign that’s worrisome if it’s accompanied by jaundice.
Sudden itching all over the body was a Virginia woman’s main symptom of pancreatic cancer, she previously told TODAY.com.
“It’s actually a very difficult symptom to manage because the normal anti-itch things like an antihistamine or antihistamine creams or cortisone creams don’t work at all,” Dr. Wallace says.
What Are the Risk Factors for Pancreatic Cancer?
Most patients are over 45, and men have a slightly higher risk of developing the disease than women.
The American Cancer Society says the risk factors include:
Tobacco use: About 25% of pancreatic cancers are linked to cigarette smoking.
Excess weight: People with obesity are about 20% more likely to develop pancreatic cancer.
Diabetes: Most of the risk is found in people with Type 2 diabetes.
Cyst in the pancreas: Known as a cystic neoplasm, “it’s a little bit like a mole on your skin. They’re common. Most of them will not turn malignant, but they do have a definite potential to turn malignant,” Wallace says. The cyst can be found when people get a CT scan for another reason. Doctors now have very good tools to monitor these, he adds.
Diagnosing Pancreatic Cancer
“If you have new-onset diabetes with weight loss, it’s important to self-advocate and tell your doctor you’re concerned about pancreatic cancer,” Dr. Wallace advises.
“This “big red flag” is still not widely recognized as an early symptom of pancreatic cancer,” he warns.
“It often gets managed as just a routine type of diabetes. And it’s often a bit tragic when we see somebody who’s had this for two or three years and then we find their tumor when it’s too late,” Dr. Wallace says.
CyberKnife Radiation Therapy for Pancreatic Cancer
CyberKnife therapy has been used successfully to treat pancreatic cancer in patients who are poor surgical candidates, those who refuse surgery, and in patients for whom surgery or other treatments have failed.
Treating tumors in and near the pancreas with radiation is challenging because the stomach, bowel, kidneys, and liver are in close proximity to the pancreas, making it difficult to target them safely with radiation. As a result, with traditional radiation therapy, the tumor may not receive enough radiation to destroy it, and healthy tissue near the tumor may be damaged
CyberKnife’s missile guidance technology and respiratory tracking system eliminates that problem. It enables the radiation beam to track tumor movement in real time as patients breathe normally, always staying on target, delivering the highest dose of radiation possible, and destroying the tumor without harming healthy surrounding tissue.
Another bonus: CyberKnife only requires one to five treatments compared to over 25 to 35 with standard radiation.
The treatment is completely pain free. You feel nothing as the computer-controlled robot moves around the body delivering radiation. Patients dress comfortably in their own clothes and can bring music to listen to during treatment.
Nothing will be required of the patient during treatment, except to relax and lie as still as possible.
Once treatment is complete, most patients quickly return to their daily routines with little interruption to their normal activities.
Early results indicate that patients tolerate the CyberKnife procedure well.
Doctors will discuss all possible side effects prior to treatment. In addition, doctors may prescribe medication to control any side effects, should they occur.
After treatment, the patient will follow-up with their doctor and will have CT or PET/CT scan prior to your follow-up appointment.
The patient should be aware that his or her tumor will not suddenly disappear. Response to treatment varies from patient to patient. It could take several weeks or longer to determine the effectiveness of the CyberKnife treatment.
The types of treatment for pancreatic cancer will depend on the stage of the disease.
CyberKnife radiotherapy is also often combined with chemotherapy.
Studies show the growth of pancreatic tumors in patients with advanced disease has been controlled by CyberKnife radiosurgery without damaging normal tissues including bowels, kidneys, and liver.
If you have pancreatic cancer, it’s critical to understand your treatment options. To find out if you’re a candidate for life-saving CyberKnife radiosurgery, call the CyberKnife Center of Miami at (800) 204-0455.
November is Pancreatic Cancer Awareness Month.