Pancreatic cancer, a silent killer?

Seven years ago today, Matt Wilson went to the emergency room. He had stomach pains, which he supposed to be a kidney stone. That was not it. His CT scan showed an abnormal spot, later diagnosed as early pancreatic cancer. This fortuitous discovery may have saved his life. Pancreatic cancer usually develops silently, without symptoms, and successful treatment is rare.

Thursday is pancreatic cancer awareness day, in the hope that awareness of the disease can help save lives.

What is pancreatic cancer?

The pancreas, organ of the abdomen, is responsible for the secretion of digestive enzymes and hormones regulating the metabolism. Pancreatic cancer is the third leading cause of cancer death in the United States – it could even exceed lung cancer and colorectal cancer by 2020. The risk of developing this cancer over the course of life is 1 in 63 for men and from 1 to 65 for women; the risk increases with age. Nearly 90% of people diagnosed are over 55 years old. Other risk factors include family history of cancer, obesity, smoking, diabetes, and a diet rich in red and processed meats. A diet with lots of fruits and vegetables can help reduce risk.

Why is it so deadly?

Most people diagnosed, including Matt Wilson, initially have only vague symptoms: abdominal or lumbar pain, unintentional weight loss, fatigue, recent diagnosis of diabetes or jaundice (yellowing of the skin and eyes). Because these symptoms apply to many diseases, cancer is often diagnosed too late for effective treatment. A scary survival rate of 9% 5 years after diagnosis. This year alone, 55,440 people will be diagnosed and 44,330 will die.

Are there different types?

There are two main types of pancreatic cancer: endocrine and exocrine tumors.

The most common and aggressive form is the exocrine tumor. It is an adenocarcinoma that starts in the pancreatic ducts and gland cells, which produce enzymes. These cells have a thick coat to protect them from the digestive enzymes that they produce. But this thick layer also reduces the effects of chemotherapy.

Some cases of pancreatic cancer – about 1% – are endocrine tumors. They affect the cells that produce insulin and glucagon, the hormones that manage our blood sugar. The survival rate of these cancers has increased considerably 5 years after diagnosis, between 50 and 80% approximately.

Treatment options

The preferred treatment option is a surgical procedure known as Whipple. Dr. Allen Whipple invented this technique in 1935 at the Columbia-Presbyterian Hospital in New York. Doctors take many digestive organs: gallbladder, bile duct, part of the stomach and pancreatic head. Unfortunately, this procedure is only possible in about 20% of patients; it can not work with patients diagnosed with cancer at a later stage. Other treatment options include chemotherapy, a multitude of drugs designed to kill cancer cells. This can be done after the Whipple or with irradiation for those who are not eligible for surgery. Treatment is difficult because it is so difficult to diagnose pancreatic cancer when the tumor is small. When it grows and obstructs the pancreatic ducts or produces abnormal levels of hormones, it is often too late for surgery.

Pancreatic transplants, another treatment option, have also made their way recently. That's what Steve Jobs used, in part, to fight his illness. However, doctors warn that measures taken to prevent the body from rejecting the new pancreas may allow the remaining cancer cells to grow, which implies a high risk of recurrence of cancer.

"An oncologist will likely need to use both the science and the art of medicine to help a patient determine the best treatment for them," said Lynn Matrisian, Ph.D., Scientific Manager. from the Pancreatic Cancer Action Network, said ABC News.

Can not we screen for pancreatic cancer as we do for breast cancer?

The International Pancreatic Cancer Screening Consortium recommends that people with hereditary pancreatitis, first-degree relatives diagnosed or BRCA1 / 2 mutations be examined more closely by doctors when they enter the office with a wave pain in the stomach. Unfortunately, no other specific directive exists.

What's on the horizon?

Matt, the patient under emergency, underwent surgery that removed part of his pancreas, spleen and more than 20 lymph nodes. A difficult recovery and the discovery of a new cause mean that Matt is now separating from his position as a university professor and advocating for people with the same diagnosis. It is now part of the Action Network Against Pancreatic Cancer.

Organizations such as the Pancreatic Cancer Action Network are continually striving to leverage additional funds to determine what might work against this aggressive cancer. They are also looking for biomarkers for a blood test that could help diagnose it early. At this stage, the tests are still unreliable, but new research may open new doors. Pharmacotherapy targeting specific mutations of DNA can help create drugs that penetrate better into tumor cells. Unfortunately, these screening tools will take years to develop.

Dr. Sumir Shah, MD is an emergency physician at New York-Presbyterian Medical Center Queens / Weill Cornell in New York and a member of ABC News Medical Unit.