Pancreatic Cancer

at the doctor's office

Alexander Raths

In 2009, Patrick Swayze, the actor known for his roles in Dirty Dancing and Ghost, died of pancreatic cancer. The disease was again in the news recently when Apple founder Steve Jobs died on Oct. 5.

Both men were in their late 50s, but that’s about where the comparisons end. While each battled pancreatic cancer, Jobs’ disease was a rare form that accounts for only about 5 percent of the cases diagnosed each year. Jobs’ pancreatic neuroendocrine tumor offered a better prognosis than Swayze’s adenocarcinoma, a more common form of the disease that has a five-year survival rate of only about 2 percent.

“There are two major reasons the prognosis is so poor,” says Dr. David Linehan, chief of hepatobiliarypancreatic and gastrointestinal surgery with Washington University Physicians. “One is that we don’t really have a good detection test, so often it’s already spread and the horse is out of the barn before it’s diagnosed. And it’s a relatively rare cancer, with only about 40,000 cases per year in the U.S., so there’s no good test.”

Compounding these problems, pancreatic cancer generally has no symptoms or only vague symptoms that could point to a variety of health concerns. Unexplained weight loss, upper abdominal and midback pain, jaundice and new onset diabetes are among the nonspecific symptoms patients report, explains Dr. Somasekhar Bandi, an oncologist with Mercy Clinic St. Louis Cancer and Breast Institute.

As for risk factors, there are few, and those that have been identified cannot typically be modified by the patient. For instance, risk is higher for people who have chronic pancreatitis, but along with family history and age, patients can’t alter this factor. Smoking and obesity also have been linked to increased risk, but these lifestyle-related factors put people at risk for a wide array of more common diseases and health conditions.

While the prognosis is relatively grim for most patients with pancreatic cancer, “if you can operate on an early-stage cancer, it is very beneficial,” says Dr. Banke Agarwal, an associate professor of internal medicine at Saint Louis University and SLUCare gastroenterologist. “But about 90 percent of the tumors, when they are diagnosed, are not resectable (surgically treatable), so they cannot be taken out.”

Researchers have been studying new combinations of chemotherapy drugs, and initial results are promising, Linehan notes. The challenge is “balancing the toxicity and side effects of the drugs with the extension of life,” he says. “There’s lots of clinical research going on, and in fact we have several clinical trials open looking at combinations of chemotherapy and medicines that modulate the immune system. We’re trying to elicit an immune response to the cancer.”

Linehan feels strongly that anyone diagnosed with pancreatic cancer should enter a clinical trial. “When you look at a cancer where the long-term survival rate is 2 percent, we’re not going to get better at treating this disease unless we test novel therapies for it.”

Linehan notes that Jobs was an example of a person living with cancer, as opposed to dying from cancer. “He was still so incredibly productive,” he says. “Regardless of what kind of cancer you have, I think you can live with the disease.”

Agarwal agrees. “There are a lot of adjunctive treatments to improve the quality of life. All is not lost,” he says.