Looking for Early Warning Signs of Pancreatic Cancer ~ Scientists are exploring whether the onset of diabetes may in some cases herald the existence of one of the most deadly of all cancers.
By: Jane Brody/Health Columnist
Pancreatic cancer is a nasty, stubborn killer that has thus far defied medicine’s best efforts at early diagnosis and curative treatment. In November, it claimed the life of my friend Peter L. Zimroth, a 78-year-old New York City attorney who was devoted to public service and who most recently oversaw the decline in the police department’s stop-and-frisk strategy.
Mr. Zimroth had been on my “most admired” list even before he married the esteemed actress Estelle Parsons, who was 16 years his senior. Even during his yearlong, albeit losing, fight against cancer during the pandemic, Mr. Zimroth remained devoted to the public good, designing a brightly colored T-shirt and cap bearing an urgent plea, “Smash the Virus! Get the Shot,” and raising more than $73,000 to support research at Memorial Sloan Kettering Cancer Center, where doctors tried valiantly to buy him more time.
Mr. Zimroth was fit and active and in otherwise good health before symptoms developed — in his case, stomach pains and constipation. By that time, the cancer had spread and it was too late to operate. His death follows that of several other well-known people who have succumbed to the same disease: Supreme Court Justice Ruth Bader Ginsburg, Representative John Lewis, the “Jeopardy!” host Alex Trebek and the Apple co-founder Steve Jobs.
Although pancreatic cancer is a relatively rare cancer, it is so deadly it is now on track to become the country’s second leading cause of cancer-related deaths by 2040. Currently it accounts for about 3 percent of all cancers and 7 percent of cancer deaths.
Overall, only one person in 10 diagnosed with pancreatic cancer survives five years. A cure is almost always a lucky accident, when the cancer is detected at an early, symptom-free stage during an unrelated abdominal scan or surgery and the tumor can be surgically removed.
Dr. Brian M. Wolpin, director of the gastrointestinal cancer center at the Dana-Farber Cancer Institute in Boston, told me that this is such a hard cancer to find early because “it’s relatively uncommon in the population and the symptoms it causes, like weight loss, fatigue and abdominal discomfort, are nonspecific and more likely due to other conditions.” As a result, he said, “when 80 percent of patients walk through my door for the first time, I know that we are highly unlikely to cure their cancer.”
Risk factors for pancreatic cancer
Still, there are several major risk factors for developing pancreatic cancer.
Smoking doubles the risk and accounts for about a quarter of all cases. Being obese, gaining excess weight as an adult and carrying extra weight around the waist, even if not otherwise very overweight, also increase one’s risk.
That may be why Type 2 diabetes, which is most often related to being overweight, is an important risk factor as well. Other risks include chronic pancreatitis, a persistent inflammation of the pancreas often linked to heavy alcohol consumption and smoking, and workplace exposure to certain chemicals, like those used in dry cleaning and metal work industries.
Older age is also a risk factor — some two-thirds of cases occur in those 65 and older. And family history may also play a role, including inherited genetic conditions like mutations in the BRCA1 or BRCA2 genes that are most often associated with breast and ovarian cancers.
Diabetes as an early warning sign:
It’s long been known that the best chance of surviving most cancers results from early detection, when the malignancy is totally confined to the organ or tissue in which it originates. (Blood cancers present different issues.)
The pancreas is a rather small, carrot-shaped organ, about six inches long and less than two inches wide, that lies well hidden between the ribs and the stomach.
An early cancer in the pancreas doesn’t produce a lesion that can be felt, and it rarely causes symptoms that might prompt a definitive medical work-up until it has escaped the confines of the pancreas and spread elsewhere.
But scientists are studying one possible early warning sign: a link between pancreatic cancer and newly developed Type 2 diabetes. Diabetes, too, arises in the pancreas, which contains specialized cells that produce the hormone insulin that regulates blood sugar levels. And while it’s not yet known which comes first, diabetes or cancer, some research suggests that the recent development of Type 2 diabetes may herald the existence of cancer hidden in this organ.
An early study from 2005 of 2,122 residents of Rochester, Minn., by Dr. Suresh T. Chari, now a gastroenterologist at The University of Texas MD Anderson Cancer Center, found that within three years of receiving a diagnosis of diabetes, people were six to eight times more likely than the general population to have pancreatic cancer. He, along with colleagues at the Mayo Clinic, also identified a gene called UCP-1 that may predict the development of this cancer in people with diabetes.
More recently, Dr. Maxim S. Petrov, a professor of pancreatology at the University of Auckland School of Medicine, led a September 2020 study in New Zealand of nearly 140,000 people with Type 2 diabetes or pancreatitis, or both, who were followed for up to 18 years. The findings revealed that those who developed diabetes after an attack of pancreatitis were seven times more likely to get pancreatic cancer than others with Type 2 diabetes.
In 2018, the National Cancer Institute launched a study that is in the process of enrolling 10,000 people aged 50 to 85 with newly diagnosed diabetes or elevated blood sugar levels. Participants will donate blood and tissue samples, and researchers will follow them in the hopes of identifying clues to early detection among those who develop pancreatic cancer.
Another effort begun last summer by the Pancreatic Cancer Action Network, called the Early Detection Initiative for Pancreatic Cancer, will enroll more than 12,000 participants with elevated blood sugar levels and new-onset diabetes.
Half will have periodic blood tests and undergo abdominal imaging based on their age, body weight and blood glucose levels to look for evidence of early pancreatic cancer, while the others will serve as controls.
The goal of such studies is to identify biological markers, like certain genes or proteins excreted by the tumor, that could be used in screening tests to indicate the presence of cancer when it could still potentially benefit from surgery. Alas, the results are not likely to be known before 2030, if then.
Meanwhile, Dr. Wolpin said that doctors should consider “a checklist” of warning signs that might alert them to the presence of an early, curable cancer.
Among things to consider, he said, are whether a patient’s glucose level is rising rapidly and is difficult to control with diabetes medication; whether patients with diabetes are losing weight with no explanation like a change in diet or exercise; or if patients have been fine for years and then suddenly in their early 70s get diabetes and it’s not clear why.
Another Study Found Two More New Symptoms That Could Point to Pancreatic Cancer
By: Robert Preidt/HealthDay Reporter
Researchers have identified two previously unrecognized symptoms of pancreatic cancer — a discovery that might help with earlier detection and improve extremely low survival numbers, they say.
“When pancreatic cancer is diagnosed earlier, patients have a higher chance of survival. It is possible to diagnose patients when they visit their GP, but both patients and GPs need to be aware of the symptoms associated with pancreatic cancer,” said study author Weiqi Liao, a data scientist at Britain’s University of Oxford.
Along with confirming 21 previously identified signs of pancreatic cancer, the new study pinpoints two new symptoms — feeling thirsty and having dark urine — associated with the deadly disease.
It also shows that patients often have some symptoms of the disease up to a year before their diagnosis, and other significant symptoms three months before diagnosis.
The study included more than 24,000 patients who were diagnosed with pancreatic cancer in England between 2000 and 2017.
Yellowing of the skin (jaundice) and bleeding in the stomach or intestine were the two serious symptoms most associated with pancreatic ductal adenocarcinoma (PDAC), the most common type of pancreatic cancer, and pancreatic neuroendocrine neoplasms (PNEN), a rarer form of pancreatic cancer.
The two newly identified symptoms — thirst and dark urine — were associated with PDAC, according to the study presented at a U.K. National Cancer Research Institute meeting.
Other symptoms linked with PDAC include: problems swallowing, diarrhea, change in bowel habits, vomiting, indigestion, abdominal mass, abdominal pain, weight loss, constipation, fat in stool, abdominal swelling, nausea, flatulence, heartburn, fever, tiredness, appetite loss, itching and back pain.
Other symptoms associated with PNEN include: diarrhea, change in bowel habits, vomiting, indigestion, abdominal mass, abdominal pain and weight loss.
“These new findings enable us to conduct further work on understanding symptoms that could suggest pancreatic cancer. This will help GPs to make decisions about who to refer for urgent tests, especially when patients have several seemingly non-specific symptoms,” Liao said in an institute news release.
Share this new information with your doctor should you have any of these symptoms.
Giving Patients Hope: Pancreatic Cancer Treatment at CyberKnife Miami:
At the CyberKnife Center of Miami we have good success treating 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 radio-surgery without damaging normal tissues including bowels, kidneys, and liver.
To find out if you’re a candidate for life-saving CyberKnife Radiosurgery, call the CyberKnife Center of Miami at (800) 204-0455.