DEAR DR. GOTT: My husband’s parents both died of pancreatic cancer. Is there any test my husband and his siblings could get during their regular checkups to screen for this cancer?
DEAR READER: Pancreatic cancer is a quiet, fast-spreading disease. According to the National Cancer Institute, in 2010, about 43,000 people will be diagnosed and just under 6,000 will survive. Often, symptoms are not present until very late, when it has spread to other areas and surgical removal is impossible. Those who are diagnosed early have about a 22.5 percent five-year survival rate compared to those with late-stage disease at the time of diagnosis who have a less than 2 percent five-year survival.
There are two types of pancreatic cancer. The first forms in the ducts of the pancreas. This type of tumor is known as adenocarcinoma or an exocrine tumor. Most cases of pancreatic cancer are of this sort. The second forms in the hormone-producing cells. This type is also known as endocrine cancer and is very rare.
Risk factors for developing pancreatic cancer include being overweight or obese, having pancreatitis (chronic inflammation of the pancreas), being a smoker, having a family history of pancreatic cancer, having diabetes and a family history of genetic syndromes that increase cancer risk and age, especially in those over age 60.
Symptoms can include loss of appetite, jaundice (yellowing of the skin and eyes), unexplained weight loss, blood clots, depression and upper abdominal pain that radiates to the back.
Treatment depends on the stage of cancer and which part of the pancreas is affected when first detected. In the early stages, surgical removal of part or all of the organ may be beneficial. As the disease spreads, this may not be an option. Chemotherapy and radiation therapy are often used before or after surgery or when surgery is not an option. In advanced cases, chemotherapy may be combined with targeted drug therapy.
There are clinical trials available for individuals with pancreatic cancer in order to study/test new therapies, but these trials are not a guarantee of cure. Clinical trials are simply studies to determine whether a new drug is effective and safe.
To date, there are no screening tests available to the general population. According to the Johns Hopkins website, researchers there are working on developing new tests to screen and detect pancreatic cancer in its earliest stages. It is hoped that these new tests will be effective, especially for those with increased risk, such as those with a strong family history.
Currently, the best available tumor marker for cancer of the pancreas is the CA19-9 test. Unfortunately, it is only 80 percent accurate in identifying patients with this type of cancer and cannot identify early disease.
Because both your husband’s parents had pancreatic cancer, he is at a higher risk for developing it as well. Sadly, I cannot offer you much hope about this disease other than the fact that the medical community now knows much more about it than in the past. Perhaps he should look into genetic testing or even contact the lab at Johns Hopkins that is developing these tests. They may need people to determine whether the tests are safe, effective and accurate. You can learn more about this at www.pathology.jhu.edu/pc/. You may wish to look into similar programs at other teaching hospitals, primarily those closest to your home.
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