Pancreatic cancer

[Guest guest]

Name: Mark E. Armstrong

E-Mail: casca@...

Subject: Pancreatic cancer

Body of Message:

Pancreatic cancer is the fourth leading cause of cancer death in the United

States. Unfortunately, because of the location of the pancreas, deep in the body

just in front of the spine, most patients do not develop symptoms until the

disease is advanced. Some people may develop abdominal or back pain, unexplained

weight loss, or become jaundiced (yellow). Surgery is an option for treatment if

there is no evidence of metastases or tumor spread through the pancreas into the

adjacent organs. Some patients with confined small tumors may a combination

surgery, radiation and chemotherapy. Many patients can not have surgery because

their cancer has already spread beyond the pancreas. For these patients,

alternatives to surgery include chemotherapy and supportive care.

Because pancreatic cancer is difficult to treat, it is important to understand

risk factors, particularly ones that we can change--such as environmental

exposures (smoking, toxic chemicals). In addition, in families that appear to

inherit pancreatic cancer, it is now possible to screen this patients for the

development of pre-cancerous changes in the pancreas.

Risk Factors

Pancreatic cancer is usually a cancer of older people (average age of patients

is 71 years), however some patients can develop cancer at an early age, such as

40. Incidence varies by race, gender, and geography. The disease occurs more

often in African Americans than in whites and in men more than in women; global

incidence rates vary approximately 30-fold. African Americans have the highest

pancreatic cancer rate in the world. The reason for these risk factors is not

yet known.

There are four clear risk factors for pancreatic cancer: family history,

cigarette smoking, long-standing diabetes, and hereditary and chronic

pancreatitis.

Cigarette smoking. This risk factor is associated with approximately 25 percent

of pancreatic cancers. People who smoke for twenty years or more have double the

risk of those who have never smoked. Smoking has an even greater effect in

families that inherit pancreatic cancer---increasing the odds of developing

cancer by up to 7 fold and patients who smoke tend to develop cancer at an

earlier age. This cancerous effect of smoking is also seen in patients with

chronic pancreatitis or hereditary pancreatitis.

Family history. Pancreatic cancer runs in families, and people in affected

families have about a three-fold risk compared with the general population.

About five percent of patients with pancreatic cancer report a family history of

the disease. Hereditary syndromes would be seen in families that inherit

pancreatic cancer along with other additional cancers. Examples of these

additional cancers include: cancers of the colon, breast, lung, bladder,

uterine, and melanoma. In addition to the families that inherit cancer, some

families inherit chronic inflammation of the pancreas (hereditary pancreatitis);

these patients are prone to developing pancreatic cancer. Many families simply

inherit pancreatic cancer, with no other cancers in the family and no history of

pancreatitis.

Long-standing diabetes. There is about a two-fold increase in risk of pancreatic

cancer among people who were diagnosed with diabetes as adults. This observation

suggests that diabetes may be an independent risk factor for pancreatic cancer,

as well as a possible consequence of the disease. The mechanism involved,

however, is unclear.

Pancreatitis. Pancreatic cancer risk among individuals with hereditary

pancreatitis or nonhereditary chronic pancreatitis is about 50 times and 16 to

20 times higher, respectively, than those without pancreatitis.

Studies also have implicated a number of other factors, including diet and

nutrition, heavy alcohol consumption, other medical conditions, and certain

occupational exposures, but these findings have been inconsistent.

Diet and nutrition. Fruit and vegetable intake may have a protective effect

against pancreatic cancer. The effect appears to be stronger for vegetables,

particularly cruciferous vegetables. Folate is a nutrient is associated with a

lower risk of panreatic cancer. Folate can be found in leafy green vegetables.

Increased risk has been associated with high intake of meat, fat, and

carbohydrates and with elevated body mass index and caloric intake. A recent

study found an interaction between body mass index and caloric intake,

suggesting that caloric intake in excess of that required to maintain energy

balance (e.g. being overweight) may increase risk.

Alcohol. Alcohol consumption at the level typically consumed by the U.S.

population does not appear to increase risk; however, approximately 10 studies

have reported an increased risk associated with heavy alcohol consumption.

Occupational exposures. Organochlorine compounds (DDT, DDE, and PCBs) have been

associated with elevated risk in a small number of studies. Dry cleaning workers

have an increased risk of pancreatic cancer, possibly due to exposure to

chlorinated hydrocarbon solvents.

Prevention

Smoking cessation appears to reduce risk. A few recent studies suggest that risk

may revert to the level of nonsmokers after long-term cessation.

Treatment & Surgery

Options for management of pancreatic adenocarcinoma usually involve combinations

of surgery, chemotherapy, and radiation that must be customized for individual

patients, based on patient factors and the location and extent of the cancer. Of

these three types of treatment, only surgery offers the potential for cure and

then only in a carefully selected subset of patients. Patients who may be cured

with surgery (supported by other, adjunctive therapy) are those with localized

disease that can be completely removed to clear margins. Unfortunately for many

patients, by the time the cancer is detected it has escaped the local region of

the pancreas and spread into adjacent organs or regional lymph node beds, and/or

systemically to the liver, lungs, and beyond. In such patients, surgery may

still be considered to improve the quality of a patient's life by controlling

complications of the disease such as bleeding, bile duct, or intestinal

obstruction.

Link: http://www.uwgi.org/heal/pancreaticGenInfo.asp