Why Is Pancreatic Cancer So Deadly?
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October 19, 2011, last updated January 6, 2015
By Alison Turner, Contributing Columnist

What do Dizzy Gillespie, Luciano Pavarotti and Patrick Swayze
have in common?  Unfortunately, in addition to grabbing the
hearts of fans from all over the world, they are also all victims
of pancreatic cancer (dying in the years 1993, 2007 and 2008,
respectively) – and this year, as well all know, another popular
and respected name joins this list: Steve Jobs, October 5, 2011.

The National Cancer Institute estimates that over 37 thousand
other Americans died from pancreatic cancer this year alone,
and over 44 thousand new cases were diagnosed.   Even more
concerning is that prevalence is increasing: rates of pancreatic
cancer have gone up in both men and women since 1998, so
that currently the lifetime risk of developing pancreatic cancer
is about 1 in 71.

Cancer for beginners: Most of us hear about cancer every day
but few of us understand what actually happens with the
disease.  When all is healthy and happy, the body’s cells grow,
divide for growth and repair, and die.  Cancer, a situation that
is neither healthy nor happy, occurs when cells grow too
quickly, continuously forming new, abnormal cells and
sometimes invading other tissues (which does not follow the
behavior of normal cells).  The American Cancer Society
summarizes that “growing out of control and invading other
tissues are what makes a cell a cancer cell.”

A healthy pancreas, the basics:  The pancreas is a digestive
gland that sits behind the stomach, horizontally across the
abdomen. Of crucial relevance to pancreatic cancer, the
pancreas uses two types of cells for two different functions:
exocrine cells (exo meaning outwards) and endocrine cells
(endo meaning within).  

As their names suggest, exocrine cells work on what will exit
the body -- food and waste -- by producing and releasing
enzymes, proteins that break down food into nutrition.  A piece
of meat, for example, is cut into protein, then to amino acids.   
While these exocrine cells are busy at work, the pancreatic
endocrine cells produce and secrete insulin (among other
hormones), a hormone that stays within the body, running
ahead in the blood stream to advise cells that nutrients are
coming which helps to maintain proper levels of blood sugar.
Cancer of the pancreas can occur in the exocrine or the
endocrine cells (see below).

How Does Cancer Happen?  

Cancer in general comes from damaged DNA. This damage can
be inherited, but most of it is made by “mistake” during normal
cell reproduction or by something in the environment.  

In cancer cells, damaged DNA is not repaired as it is in healthy
cells, but instead goes on making new cells that the body does
not need – all of which have the same, damaged DNA as the
original cell.  

Usually these infected cells form a tumor, though not always –
leukemia, for example, involves the blood and circulates
through other tissues. (Note: some tumors are benign, which
means that they do not invade into other tissues or spread to
other parts of the body -- though they can grow large enough
to press upon other organs, possibly causing problems). No
matter where a cancer spreads (or doesn’t spread), it is named
for its place of origin – if a cancer begins in the pancreas but
spreads to the kidneys, it will always be pancreatic cancer.  

Pancreatic cancer can occur in the exocrine or the endocrine
cells (see above), producing different diagnoses.  Endocrine
cancer, the source of about 5% of pancreatic cancers, comes in
several types, all of which fall under the label of pancreatic
neuroendocrine tumors (NETs) or islet cell tumors.  

These tumors start in types of hormone-making cells, and are
named according to that location: insulinomas begins in cells
that make insulin, for example, and glucagonomas arises in cells
that make glucagon.  The American Cancer Society finds that
nearly half of NETs are ¨functioning,¨ meaning that despite the
tumor the cells continue to make hormones that are released
into the blood.  NETs can be benign or malignant, though the
outlook is ¨generally better than that of pancreatic exocrine

Exocrine Pancreatic Cancer

The American Cancer Society reports that cancer of pancreatic
exocrine cells is: “by far the most common type of pancreas
cancer. When someone says that they have pancreatic cancer,
they usually mean an exocrine pancreatic cancer.”   Symptoms
of exocrine pancreatic cancer often do not appear until it has
grown quite large, at which point patients experience dark
urine, yellow skin and eyes, pain in the belly and middle of the
back, nausea and floating stools.   

While tumors can be benign in exocrine cells, most are
malignant (will spread), and most of them (about 95%) are
"adenocarcinomas".  Adenocarcinoma is cancer that begins in
gland cells, and in the case of the pancreas usually begin in
ducts or sometimes in cells that make enzymes.  Treatment for
pancreatic exocrine cancer depends on the stage of cancer,
meaning how large the tumor has become and how far it has

Can this be prevented?  The information above is daunting --
pancreatic cancer is something we wouldn´t wish on our worst
enemies.  The National Cancer Institute suggests that while the
causes of pancreatic cancer cannot be entirely explained,
research does show certain risk factors that ¨may increase the
chance”  of pancreatic cancer.  Both the National Cancer
Institute and the American Cancer Society list risk factors for
pancreatic cancer, some of which are lifestyle choices, some of
which are seemingly unavoidable:

Lifestyle choices that could decrease your odds of pancreatic
cancer: Smoking, diabetes, and obesity are three of the more
preventable (in some cases) conditions that studies show to be
risk factors for pancreatic cancers. The risk of pancreatic
cancer is 2 to 3 times higher in smokers, so that up to “30% of
exocrine pancreatic cancers are thought to be caused by
cigarette smoking.¨   This may be because of the cancerous
chemicals in cigarette smoke that enter the blood, possibly
damaging the pancreas.

Pancreatic Cancer Linked to Your Diet

There are also links between pancreatic cancer and diet.  
People who are obese and who get low levels of physical
activity are shown to be more likely to develop pancreatic
cancer, as are those who have diabetes (particularly
Type 2
adult on-set diabetes), which is also “often related to being
overweight or obese.”   

Diets that are high in fat and full of red meat, pork, sausage
and bacon often correlate with high risk of pancreatic cancer,
whereas a diet high in fruits and vegetables seems to decrease
the risk.  

In fact, a new 2012 study from Sweden found a very strong
link between  eating processed meat and pancreatic cancer.

The study, conducted by the Karolinska Institute in Sweden
and led by Professor Susanna Larsson, looked at 6,643 people
with pancreatic cancer and their eating patterns.

The researchers found that eating just 50 grams of processed
meat a day -- about 1 small sausage -- increases your risk of
pancreatic cancer by 19%.  Your risk increases as you eat more
processed meat. Eating 100g of processed meat daily would
increase the risk by 38% eating 150 grams a day increases
your risk by 57%.

However, the American Cancer Society warns, ¨not all studies
have found such links, and the exact role of diet in relation to
pancreatic cancer is still under study” -- but with something
like pancreatic cancer at stake, it might be worth it to make all
the changes that you can.

Similarly, while there has been no direct link discovered
between alcohol and pancreatic cancer, there are possible
indirect connections.  Heavy alcohol consumption increases the
risk of diabetes, and other diseases (such as cirrhosis of the
liver) which are risk factors for pancreatic cancer -- again, it
might be worth it to weigh the options and what may be at

The less-avoidable risk factors:  While some of us might be able
to decrease our odds for pancreatic cancer by following the
lifestyle choices as stated above, there are, unfortunately,
several other conditions that may put us at risk which we
cannot control at all.  First of all, the average age of diagnosis
for pancreatic cancer is 72, and almost all patients are above
the age of 45, so that age seems to have something to do with
the disease.  The American Cancer Society also finds that
¨pancreatic cancer seems to run in some families¨either
because of an inherited syndrome or because of a mysterious
gene that is currently unknown.  

Additionally, inherited gene mutations (abnormal copies of
certain genes that can be passed from parent to child) may
cause up to 10 percent of panceratic cancers.  There is a long
list of these mutations, some of the most common being
hereditary breast and ovarian cancer syndorome, Peutz-
Jueghers Syndrome, and familial pancreatitis.   

While the above information may seem defeating -- we cannot
pick our age or our family -- the bottom line is that we do not
yet have control over who does or does not get pancreatic
cancer. In the words of The National Cancer Institute, “Many
people who get pancreatic cancer have none of these risk
factors, and many people who have known risk factors don’t
develop the disease.”

What if you or a loved one does get pancreatic cancer? The
National Cancer Institute explains that treatment for pancreatic
cancer depends entirely on the stage of cancer, meaning the
size of the tumor, whether or not it has spread to other tissues,
whether or not the cancer is recurring (has come back from a
previous cancer) and the patient´s general health.  Pancreatic
cancer can be controlled through surgery if it is found before it
has spread -- but if it has spread already, usually treatment is
palliative only, working to soften symptoms and improve the
quality of life of the patient.

What is in the future for pancreatic cancer?  

The silver lining in this growing dark cloud of depressing
statistics and question marks, is that researchers, doctors and
experts from all over the world are working at full capacity to
solve this riddle.  To give just a few examples, Drs Gloria
Petersen and William Bamlet from the Department of Health
Sciences Research, College of Medicine in Minnesota, along with
a large team of doctors in Maryland, Massachusettes, Canada,
the Netherlands, and several other locations, published findings
from 2009  that have “identified common susceptibility loci for
pancreatic cancer¨(i.e. have more specifically located the
mutation within the genes) which will better focus the field for
further researchers.  And because of recent findings that
“inappropriate activation” of the reninangiotensin system
(RAS), which maintains blood pressure and other function in
the pancreas and other organs, seems to be related to
pancreatic cancer, Drs S.T. Lau and S. Leung with the School of
Biomedical Sciences Faculty of Medicine at The Chinese
University of Hong Kong  published in May of 2011  a hopeful
prospect for drugs that target the RAS system.  They suggest
that “pharmacological RAS blockage could have therapeutic
potential in the management of pancreatic cancer.”  

So while pancreatic cancer is an alarming and mysterious
condition, it is not one that is neglected.  And perhaps most
hopefully, because of its increasing attention from researchers,
experts and the public, more people might begin to make the
most important first step towards a cure: early detection.  

Dr. Michael Goggins with The Sol Goldman Pancreatic Cancer
Research Center at The Johns Hopkins Medical Institutions  
maintains that “early detection of pancreatic cancer is the best
way to cure this disease,” and while scientists search for a cure
they also look for methods for earlier diagnosis.  

If you or a loved one is at risk for pancreatic cancer, it never
hurts to get it checked out –--- early detection always helps,
and, in the case of pancreatic cancer, the earlier the detection
the better.  


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Steve Jobs, CEO of Apple, died from
pancreatic cancer on October 5, 2011.