I was once a patient diagnosed with Pancreatic Cancer. It was May 2016 when doctors told me I had months to live, but the worst thing was telling my children. My husband Dave, took part in a research project which involved a trip to South Africa to Dr Sims Gomez Herbs Clinic. He purchased the Herbal formula at ( drsimsgomezherbs. com ), Three months after taking the herbal herbs I went for a checkup and there were no signs of Pancreatic cancer. I also learned how much friends and family can be part of getting well. Our circle of friends and relatives was an incredible support. I would encourage anyone to seek second opinion especially if you've been told there’s no hope.
This article is two years old and nothing has changed?! My sister died a horrible death in 2017 from pancreatic cancer - less than a year after diagnosis. What still confuses me is the idiotic behavior of ALL her doctors (at Baylor in Dallas) who would tell us she was going to be fine - live a full life - oh, and we have this trial program for you to join. Our family had never dealt with anything like this. It was a roller coaster where we would believe them only to miss many opportunities to have had closure with my sister before she died.
3
You quote a John’s Hopkins article that says 5 mm can only be seen with a microscope. That’s just under 1/4 inch, easily visible to the naked eye. Please explain or correct the quote.
1
Clinicaltrials.gov has over 3000 pancreatic cancer entries.
My sister at age 62 was diagnosed with Stage IV Pancreatic Cancer in 2017.
She is in a trial at a research hospital in Dallas/Ft. Worth. She is doing remarkably well.
Diet and lifestyle contribute greatly to cancer.
The hospital dietician recommended minimal consumption of meat, fish, dairy and eggs.
I remarked that that was not true. She countered that complete protein is only achieved by eating animals. Again, I disagreed, but this time, politely accepted her beliefs.
After 45 years of being a vegetarian, I accepted the science and switched to veganism in 2015.
The science includes but is not limited to:
Literature:
1980: PETA
1985: Physicians Committee for Responsible Medicine (PCR)
2011: Forks over Knives (FOK)
2011: Nutritionfacts.org
Films:
2011: “Forks over Knives”
2014: “Cowspiracy”
2017: “What the Health”
2019: “The Game Changers”
2021: “Seaspiracy”
Rather than science, my sister believes corporations.
My heart breaks every time she eats animal protein.
“Possible symptoms include… pale odd-smelling feces that float”.
These last six words in this article are an important early-warning sign.
In his book “The Last Lecture”, Carnegie Mellon University professor Randy Pausch describes how he noticed that his feces would float. He learned that it was because the stricken pancreas was lowering its production of digestion enzymes, his body was not metabolizing fat (wight loss symptom). The fat was being excreted during bowel movements. The higher-than-normal fat content created the buoyancy and the pale color.
Your body can send signals when you should have things checked out. So pay attention to them.
2
Interesting information regarding 2 current blood tests.
https://www.pancan.org/news/new-early-detection-blood-tests-what-to-know/
All of these stories of pc coming back show the harsh reality of any kind of cancer. I was stage 4 prostate cancer (most aggressive score) that invaded my lymph nodes and bladder neck
After three rounds of chemo did no good (cancer spreading and PSA rising ), they switched me to immunotherapy. I now have fifteen straight months of undetectable PSA. I still have about six month of treatment left.
When I press my oncologist for an “optimistic long term prognosis”, he just says we don’t know what will happen when treatment stops. Also, I should keep my affairs in order.
2
The Statin my doctor prescribed ended up causing pancreatitis so severe after a period of years I thought I was dying. I had all the symptoms, plus. The four other doctors I was told to consult all misdiagnosed me. I had lost over 20 lbs. in six years with no change in diet and no expectation of losing weight. The final diagnosis became the addition of statins in my "allergies of patient" category. I found out I was one of over 10,000 other people who had this problem with a statin (FDA). I paid for a special cancer cell detection test to see if it had caused pancreatic cancer so far. It was okay. It has taken my pancreas over 18 months to heal itself; I am doing okay now.
2
@Crafty Fox Dear me- what a dreadful situation. Which statin was it?
1
Maybe a follow up could be done that looks at the effects of rapidly increasing radio frequency microwave radiation within inches of the pancreas, i.e., powerful cell phones in pockets, and purses, plus other sources like routers, 5G "small" cell antennas, 4G cell towers, blue toothed cars, etc. The FCC was recently sued for its outdated (since 1996) guidelines, so we can't count on them. But luckily there are sources that do keep up - including The Environmental Health Trust, Massachusetts for Safe Tech, Public Health Prof., Dir. of Family Health, Joel Moskowitz, PhD of UC Berkeley, and hundreds more.
Let me take this slightly malapropos opportunity to point ought that cancer statistics are a hoax. Ask (almost) anyone, and he or she will tell you that over the last, say, 25 years have gone down. And if you look at the standard sources, that's true. However, two things are important: First, the statistics are always AGE ADJUSTED. In fact, it is hard to find the pure numbers that don't include some tinkering. The fact is that the INCIDENCE of cancer continues to rise, year over year, and the NUMBER of deaths from cancer rises, too. So how come everyone thinks it is going DOWN? That's because the figures emphasize survival (or sometimes called mortality, paradoxically) rate. The easiest way to understand this is an illustration. Suppose that, no matter what, I am going to GET cancer when I am 70 and DIE from cancer when I am 76. Determinism and all. In the old days, I might not know I HAVE cancer until I am 74, so I have only two years to live. These days, I find out when I am 71, thus I survive five years. The survival rate has more than DOUBLED!! Hurrah! Although for me, no big whoop. These days there is more cancer and more death ... we just find out sooner that we are going to die. This is after -- by one account -- about $4-trillion spent on cancer research over the past 20 years, and five times that amount since 1950. So who exactly is winning this war?
6
@Kurt Freitag While there is a grain of truth in the "early detection paradox" here (breast cancers is one area this is a big effect), your argument is an exercise in statistical ignorance. Cancer is now recognized as not one disease, but hundreds of diseases. Some types of cancer have been essentially cured. Others have much better treatments available, and the traditional treatments (radiation/chemo) have in some cases been improved to have fewer side effects. Other treatments such as monoclonal antibodies have replaced chemo in some cases. But this article does show that the uneven distribution of research funding has favored some cancers and some approaches. The fact that there aren't good diagnostic procedures for pancreatic cancer is due to only one thing: lack of research funding in this area.
4
I was probably about 19-years old when I met my first pancreatic cancer patient. I was an intern at an NBC affiliate tv station. My major was broadcast journalism at the University of Missouri-Columbia.
My friend and I thought we were going to interview a group of people who had put together a fund raiser for a family whose father had pancreatic cancer.
Instead, we ended up trying to interview the man who was actually dying of pancreatic cancer. He was very thin, and was in a tremendous amount of He was injecting himself in the thigh with a pain killer that obviously was not working. His young family was gathered around him, watching in shock and horror.
I have never seen such suffering in a fellow human being before or since that terrible day.
We set up cameras, lights and the sound system. But we could not get more than two or three seconds of useable film because we couldn’t stop crying. I’m sure that this man did not live much longer after we saw him.
Several years later, a good friend was married. His brother served as best man. Shortly thereafter, the brother was diagnosed with pancreatic cancer. He died a month later.
I understand all the reasons why pancreatic cancer is so hard to detect.
But, to me, the biggest problem is the very quick and painful death that so often occurs shortly after diagnosis. Of all the cancers that exist, this is the one I fear the most.
8
This is great news about the blood tests!
I was a little confused when the denominator varied when comparing the incidence of different cancers. If you normalized all to per-100,000, the relative frequency would be discernible without mental math.
3
I wish we could take a step back and consider how 100,000 million years of human evolution are being reflected in our diet and lifestyle these days. It didn't include processed foods, drinking sugar and alcohol, slathering ourselves with chemicals, processing a world over which we have no control. Intelligence evolves with us, the pancreas is our command and control center in many ways.
1
A friend of mine died of pancreatic cancer despite having none of the usual risk factors and despite being diagnosed relatively early. She managed to survive and even thrive for a couple of years but then rapidly went downhill.
That kind of randomness is what makes the disease so frightening.
8
I'm always amazed how little discussion about cancer centers around the causes. Cures are wonderful when available but is there more we can do to eliminate the causes? So much of what we eat has insecticide or other poison residues...I will never believe any of that is actually safe for me. Glyphosate anyone?
13
@Kris King I read an article by an oncologist that suggested doing more research for the causes, because there are no actual cures. But he added that economically, this research can never happen. Not only will finding the causes have a negative impact on some businesses, but according to him, the cancer treatment industry is a powerful income and wealth generator that our culture doesn't want to tamper with.
8
@Kris King The cause is persistent low level pancreatitis. Anything that causes general inflammation, such as smoking or being overweight, being sedentary, will increase inflammation of the pancreas. Anything that increases the chances of getting type 2 diabetes will increases inflammation in the pancreas and consequently the risk of cancer.
8
@Kris King If you are worried about pesticides, I suggest that you avoid eating all vegetables, even "organically" grown vegetables. Since plants cannot run, their only defense against insect, and many animal, predators is chemical warfare. As such, all vegetables are loaded with toxic chemicals. Fortunately, we have a liver that can detoxify most toxins, included synthetic ones.
As to glyphosate, I love using the stuff due to its effectiveness. And, there is zero evidence that it is harmful to humans even though it has been so widely studied.
3
I kept in touch with an ex girlfriend. A few yrs. ago my best friend was hit with pancreatic cancer. My ex gf's brother had it at the same time.
I suggested a lunch where the two cancer sufferers could compare notes and I could talk to my ex.
After that lunch she developed a particular aggressive form of the disease and all three were dead within a year.
9
I’m sorry for your loss. Were environmental factors considered?
2
@Paul That is astonishingly sad and I am sorry for your loss.
Pancreatic cancer took Former President Jimmy Carter's father, brother and two sisters, and his mother's breast cancer spread to her pancreas. Heartrending.
5
@Paul That is astonishingly sad and I am sorry for your loss.
Pancreatic cancer took Former President Jimmy Carter's father, brother and two sisters, and his mother's breast cancer spread to her pancreas. Heartrending as well.
1
Any abnormal stools or urine is a sign that your body is in some sort of crisis.
The key is finding a doctor that will listen and be proactive. We can't take no for an answer, we have to keep fighting for answers.
18
Can someone right a summary about it
1
After reading this devastating article, I am glad I was not exposed to it earlier. I was diagnosed early November, 2018 because my stomach was still hurting and decided to see my generalist practitioner a second time in one month days before a long-planned trip to Japan, the kingdom of sushi and other fine foods.
A record-short three weeks of scans, endoscopies and second opinions preceded 4 1/2 months of rough chemo (Folfirinox) to reduce the stage 4 tumor solidly sitting on the head of the pancreas that had already invaded the superior mesenteric artery and vein, and, if this worked, determine if I would hopefully be a candidate for major surgery. My chosen surgeon in Strasbourg, France, gave the green light in February. May 14 I underwent an 11-hour operation which resulted in the removal of all of the tumor and detectable surrounding cancer cells! As a bonus, the impacted artery remained in place, as did the spleen, and diabetes has not set in! I lost the gall bladder, but there was no metastasis to the liver or elsewhere. Followed 1 1/2 months of « insurance » chemo with a scan and close exam by the surgeon.
Now I am recovering, losing more weight, but confident that I will recover from this weak state.
I feel like the camel making it through the eye of the needle, so far anyway.
The damning statistics seem a little less so to right now.
Perhaps the author or any reader could inform me on how many cases like mine she has seen.
42
@Pierre Heisbourg
I hope you continue to thrive. I was diagnosed in March of 2020 after eight years of troubling symptoms, nearly all of which have evaporated after my Whipple surgery. I am doing very well although some doctors refused to fix my incisional hernia stating I have zero chance of living 5 years! Keep hopeful and listen to your gut, literally and figuratively! Be strong, brave and don’t give up the fight! Cheers to all of us pancreatic survivors. Best, Laura Metzger, currently being treated at UCLA
27
@Pierre Heisbourg
Thank you for sharing this harrowing story.
Of course, you will recover fully with your proactive behavior, exceptional medical care, and positive attitude.
My French grandmother lived to almost a hundred years old fortifying her blood and nourishing her vital organs with a beef broth made by simmering natural cow marrow bones (no chemicals, pesticides in feed or injected hormones) and a simple mirepoix.
A delicious, warming tonic to help a body restore. The marrow is full of life-affirming nutrients and delicious (it's one bite) too.
Bonne sante, mon ami!
4
@Pierre Heisbourg Those numbers/statistics are for populations and what you are referring to (your survival) is an individual statistic. Thus, while a population may be at XX% risk for something, an individual will have a 0 or 1 probability (presence/absence). There are many cases where patients live longer than predicted. Just natural variation in how our bodies work.
2
My grandmother died of pancreatic cancer in 1954 and a close friend met the same fate three years ago. The diagnosis and treatment protocols were identical for both. Sad that almost no progress has been made on this.
22
@Newport Iggy
We must fight for updated diagnostic protocols, review retrospectively bloodwork of all pancreatic cancer patients to identify bio-markers. I had an elevated CA125 four times in 2014 during the start of my symptoms which was thought to be ovarian cancer by a number of gastroenterologists, a gynecologist and my GP. Too bad they never sent me to a pancreatic surgeon or an oncologist at that moment in time. It took six more years before it was discovered at the UCLA emergency room in 2020, at the start of the Covid pandemic and 3000 miles away from my east coast roots! By that time my symptoms increased with late stage jaundice with urine color changes, vague stomach pain and itching. Shame on the medical profession for missing so much of the details in my medical records, including the fact that my pancreas was obscured by gas on three ultra sounds and on the fourth one it was said that it was obscured by an incomplete sonographic window. I am so lucky to be alive and now in the best medical hands here in California!
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@Laura Metzger
You are on the path to recovery!
5
Well, everyone dies eventually so what we are really talking about is the preamble. I think cancer is a good way to die. Gives you time to say goodbye and here in Washington we can take the cure - if the pain and stress on loved ones becomes overwhelming.
Living kills people - every single one of us. I tell my kids I'm old enough to die and there will be no interventions. A real problem is is attitudes towards death. We can spend our short time trying to prevent an imagined future, sign on to various torturous and ultimately futile treatments or simply allow these bodies live out their natural existence.
Medicine can use up massive amounts of resources and energy trying to add a few years or months. Investing those resources in children will give a much greater return than in the elderly. One might say It's a cold heart that would let grandpa die, but you may not appreciate what we do to grandpas in hospitals and nursing homes.
Another side to concerns about cause and effects is that we may come to withhold experiences ( I'm thinking of my rocket motorcycle in the garage) for potential life saving effect. But why try to live longer to have more experience if we limit our experiencing now
17
Everyone must die, but Pancreatic is an especially painful way to die. Having had 2 relatives die of it and seeing how much they suffered it’s not a fate I would wish on anyone.
63
Another way of minimizing one's chances of getting pancreatic cancer: avoiding heavy alcohol use:
https://www.cancer.org/cancer/pancreatic-cancer/causes-risks-prevention/risk-factors.html
11
This is hardly a panacea. The doctor notes that it may help extend survival in some people if they recognize symptoms of pancreatic cancer and act on them without delay.
Possible symptoms include loss of appetite, abdominal pain that radiates to the back, new-onset diabetes in someone over 50, jaundice, itchy skin, a change in how alcohol tastes, and pale odd-smelling feces that float.
As an over 50 male who has pale odd-smelling feces that float, am I at risk? If I am, I daresay that there are tens of millions of other Americans who are also! FOOEY!
2
@DWAC Expert These symptoms, like the author mentioned, can be found in other, less nefarious ailments. These can be found with cholecystitis (gallbladder inflammation), cholelithiasis (gallstones), biliary obstruction, pancreatitis, and liver failure.
10
@DWAC Expert Yep, those symptoms are common and usually from other things. But the point is to get it checked out because it could be something worse.
3
@DWAC Expert Why is your first instinct to write a comment here instead of seeing a doctor? No one here will answer your questions with any authority.
There are, of course, people who are perfectly healthy and get pancreatic cancer.
But people who smoke, are obese, or have Type II diabetes are at greater risk, as the article says.
I know many commenters are enjoying piling on the doc who recommended a plant-based diet. But such a diet lowers the risk of obesity and Type II diabetes. (Smoking is another story!)
To each their own. Body positivity. I love Lizzo as much as anyone.
But risk-taking is not something I’m known for!
6
My father survived 3 weeks after his diagnosis of stage 4 pancreatic cancer via CT scan. He was 78 and hadn’t felt well for about a year, he had extreme weight lost, fatigue and stomach pain. 2 months before his diagnosis he was diagnosed with uncontrolled diabetes. He was previously a 14 year prostrate cancer survivor (with recurrence/radiation) and also Basal cell carcinoma of the skin. He was genetically tested before his death for free using Invitae Labs. He tested positive for CHEK2 mutation and also was found to have an atypical variance for BRCA 1. My sibling and I were also tested for free. I was told that the CHEK2 mutation does not explain his pancreatic cancer, this mutation puts one at higher risk for colon and beast cancers. His parents died from metastatic cancers as well as a grandparent on each side of his family.
My father was a laborer most of his life, pretty physically fit for an old guy, actually was still working at time of pancreatic cancer diagnosis. As a bachelor most of his meals were eaten at a restaurant, he didn’t consume alcohol or artificial sweeteners but chewed tobacco which he swallowed rather than spit. I had read in a British medical journal that doctors should investigate the pancreas immediately in anyone in their 70’s with a new diagnosis of diabetes with weight loss. Diabetes due to a damaged pancreas is actually referred to as type 3c and share some of the same symptoms of pancreatic cancer.
13
It's not true that CT or PET would fail to detect a 5mm tumor. In fact the spatial resolution for each imaging technique is about 2mm. The statement that screening is impossible is misleading. In fact, if one combines CA19-9 with about 20 other biomarkers the accuracy is about 92%. However, if one looks at this percentage in the opposite light, this might indicate a false negative (judged clean but not truly) or a false positive (judged as disease but not truly) to the tune of several percent. Erroneous judgement would be costly ($$) or fatal if screening were done on large scale. However, if the patient has risk factors, such as close relative(s) with pancreatic ... or lung or colon cancer. Why mention lung and colon cancer? The genetic mutations at the root of pancreatic care also found in half the lung cancers and half the colon cancers. There are research programs to correlate genetics with sequencing, especially Dr Petersen at Mayo.
11
It was a surprise to not see listed among known causes of pancreatic cancer the BRCA 1 and 2 mutations that are commonly associated with breast cancer and ovarian cancer, but are also "the most common causes of familial pancreatic cancer," especially BRCA 1.
A dear friend of mine diagnosed about a year ago with pancreatic cancer told me that she had been checked for pancreatic cancer every six months following the removal of her breasts, ovaries and uterus due to having the BRCA marker. Her last check up prior to diagnosis had been in April 2018. She experienced severe back pain in the early fall, first dismissed as some form of musculo-skeletally generated pain, until finally she received the diagnosis she feared--pancreatic cancer.
She told no one about the higher risk for pancreatic cancer nor her biannual screenings, not wanting to alarm her friends or daughters about the possibility of contracting what everyone recognizes to be mostly a terminal illness. You might want to report on this more fully.
18
My fiancé died from pancreatic cancer less than 4 months after being diagnosed with the disease. He had not been seriously sick prior to that, and he was always active with many different sports and other interests. It was devastating to suddenly be sick and weak. He died at 43, too young, too soon. I hope that more research will be done on this, that will hopefully pave the way for early detection and prevention.
47
My mother was diagnosed with colon cancer when she 78 years old. This could have been prevented. Her doctor never referred her for a colonoscopy until she asked for one. Twelve inches of her colon and her duodenum were removed.
Four years later she was diagnosed with pancreatic cancer, in December, 2008. She died on April 1, 2009, less than four months after diagnosis. Both her oncologist and her gastroenterologist stated that these were separate cancers. Perhaps because she had chronic back pain due to osteoporosis, further back pain did not lead to investigation, nor did late-onset diabetes at age 80.
Everyone needs to have colonoscopy at the prescribed age and again as directed. Everyone needs to learn to recognize the symptoms of these two diseases. Don't wait for your doctor to recommend tests. Ask for them.
15
.
@Barbara,.
theyr often asymptomatic, esp P
.
1
Ovarian cancer is another cancer that is most often diagnosed long after it has spread widely. It has a marginally better 5 year survival rate, but 5 years of cancer treatments is arduous.
10
It's my understanding that people are living longer with cancers because they're being screened earlier, not because the treatments are working. The best way to treat cancer is to clean up the environment.
10
People are surviving cancer due to both early detection and more successful treatment. Jimmy Carter survived melanoma that had spread to his brain because he was treated with immunotherapy, not because it was detected early. I’m old enough to remember when a diagnosis of lung cancer was usually a death sentence, but my mother was cured of lung cancer in 2008-2009 with conventional American medical treatment. My brother was cured of a very rare cancer in the 1970s when he was a teenager, again with conventional medical treatment. More people are being diagnosed with cancer because we are living longer and not dying of things like heart disease and smallpox.
6
.
@JGSD,
.
Many cancers are self-induced via an unhealthy life style :
random diet, lack of exercise, lack of regular exams
.
1
Sorry, Susan, I know that some respond to conventional treatment. It's called the placebo effect. I also know that the medical profession is a profit-making endeavor.
2
Excellent column. I would like to see Ms. Brody follow-up with a piece on promising treatments in various stages of clinical trials, involving photodynamic therapy, sometimes in combination with other treatments. A good place to start would be the Wellman Center at Massachusetts General Hospital.
6
This piece is not only a public service — in that it tells us a great deal of what we need to know not only for ourselves but for others — it’s also a reminder of how indispensable Jane Brody is.
13
We are making progress though: https://www.skymedicine.com/2019/08/31/nonsense-mutation-in-rabl3-associated-with-increased-risk-for-pancreatic-ductal-adenocarcinoma/
It is important to note that neuroendocrine tumors of the pancreas, that which killed Steve Jobs, are more treatable than pancreatic adenocarcinoma, even when discovered at a more advanced stage.
In certain cases, head of the pancreas adenocarcinoma may be discovered early, a successfully treated, such as in the case of RGB.
It is important to note, however, that pancreatic cancer is not unique in its late stage presentation and poor control -- renal cell carcinoma and ovarian cancer both tend to present in later stages due to a lower likelihood of symptoms during early stages. Glioblastomas portend an awful prognosis regardless of the when diagnosed (causative of John McCain and Ted Kennedy's deaths). However, as above, progress will be made in the treatment of each of these cancers.
8
The first "warning" my husband and I had was when it became uncomfortable for him to walk on the sand beach at Cabo. The second came when I noticed that his ankles had swelled. When he complained of "not catching my breath", the doc at Estes determined it was a problem from coming from low altitude climate to lower oxygen availability.
We learned, later, that the pancreatic cancer had moved to his lungs.
A "flag" we finally recognized was when he lost his "taste"; foods he'd always sought "just don't taste right". Weird?
This is a stealth killer.
9
My sister died at age 60 in 1996, 3 months after her diagnosis. My brother had surgery in 2014 and for 4+ years was cancer free. Now he has a recurrence and is in hospice care. I get screened annually at MSKCC and know that I have pancreatic cysts. Also joined the pancreatic cancer tumor registry at Johns Hopkins and a research study at MSKCC.
20
Most often there is no pain & any clinician knows that painless jaundice is cancer unless proved otherwise.
What about the link with melanoma?
14
Isn't there a proven connection with alcohol consumption?
10
@Edith Barles-Frawley
I don't think so, though smoking can be a factor. Sometimes alcoholics develop pancreatitis, but that's an inflammation of the pancreas, not cancer. Pancreatitis can also kill, however.
5
@Edith Barles-Frawley
Absolutely!
Risk factors for pancreatic cancer are diabetes and chronic pancreatitis, and one of the most well-known RF for chronic pancreatitis is alcoholism.
1
@Edith Barles-Frawley
NASH- non-alcohol fatty liver is also, a risk factor. I had my first pancreatitis episode after consuming 3 glasses of red wine, a high carb dish of pasta with bacon bits. My NASH caused this to be my tipping point in 2011. My cancer was not detected until 2020. But after I experienced a deathly ill episode of pancreatitis, I developed a myriad of other symptoms as my pancreas was deregulating my entire metabolic system!
2
I have long suspected that CF carriage, which affects 1 in 20-25 people of European ancestry, might be a risk factor. The disease was originally called cystic fibrosis of the pancreas, after all. CF carriage may also account for why only some alcoholics progress to cirrhosis and only some smokers develop emphisema. Both liver and lungs rely heavily on the cloride-bicarbonate co-transporter which is only half there in recessive carriage, reducing each respective organ's functional reserve proportionately.
3
My father died a rapid, but painful, death from PC at an early age over a decade ago. The cause, I’m now sure, was his lifelong addiction to smoking and stubborn adherence to the standard American diet (SAD) consisting of large portions of meat, dairy and processed foods.
As indicated in the accompanying research to the article in PubMed: “However, during 2012-2014 there was a statistically significant decrease in PAC incidence-based mortality”. It seems highly logical and apparent to me, at least, that the per capita decrease in US meat consumption preceding that decrease and general smoking trends would be among the causes for improvement. The fact that Type II diabetes, largely a chronic disease caused by poor diet, is another PC risk factor, means adopting a healthy whole food plant-based lifestyle could save more lives from PC and other chronic diseases than any medicine known or ever will be known to man.
15
Once upon a time, medicine was focused on the patient. Now Medicine has become A Great Medical Monopoly War. The patients are the casualties.
There is evidence that Dr William Donald Kelley and Dr Nicholas Gonzalez had the best treatment in history for pancreatic cancer.
11
@ManOfScience
I agree, having been misdiagnosed for 8 years. My pancreatic cancer was involved with pancreatitis and that was never diagnosed!
2
Really sad... No medical progress in this insidious disease. Lost my mother in 2000 after just 9 months from diagnosis. Others I have known have gone even quicker. I hope there is significant progress with pancreatic cancer in my lifetime.
17
@Mary I feel the same way I lost my beloved mum to this dreadful disease on 9.23 thirty five years ago. She was 48 when diagnosed and the suffering was/is beyond words. The research for this particular disease hasn't had much progress in the last 35 years and yet I refuse to lose hope.
3
@Mary
I am happy to find this foundation which is focused on early detection. That is something I can work with having had so many early signs just swept under the rug by so many doctors. I am just lucky to be alive and that my trip to the UCLA emergency room in 2020 finally led to my “aha” moment. I knew something was very wrong for eight years - suffering from so many symptoms. I will follow up soon with this foundation as a PC research doctor will formally make an introduction for me. I have solutions they are waiting for!
I had pancreatic cancer in 2006 and treatment early in 2007 at Memorial Sloan Kettering. It was caught early—the symptom was obstructive jaundice—and after surgery (a Whipple Procedure) and 5 months of chemo, I've been cancer free ever since. My 12 year follow-up visit is due next month.
As to why I got the disease, I have absolutely no idea. I think there were way too many variables to point to one cause.
I continue to be happy that I'm alive, and posting comments on The Times.
172
When looking at the gall bladder for pain and stones, doctors should routinely check the pancreas for any issues.
14
@Lynn Sheehan
Usually gallbladder disease is diagnosed with ultrasound. Ultrasound is not sensitive enough to find most pancreatic tumors on account of them being so small in the early stages.
5
@Lynn Sheehan 8 months before my mother's death from PC - she had issues and drs deemed it to be gallstones and removed gallbladder. She went to an excellent hospital - but only imaging that was done was ultrasound, no CT or MRI. I only learned this after obtaining her records as executor. 20 days from my mom's diagnosis to her death from PC
2
The article answers its own question, pancreatic cancer is now only detected at the stage where little can be done to stop it, it is silent until then. There are few ways to detect it in its early stages and even then it is relatively uncommon, not worth the effort. It is only about as common as endometrial or thyroid cancer and few have even heard of them.
Medicine could give everyone who has a headache an MRI for a brain tumor but that is silly, unlikely so it not worth it. If a simple blood test is created for any of these rarer cancers then maybe it is worth the trouble to screen for it, but that has not occurred yet.
10
My father died of pancreatic cancer in 1988. I'm surprised Jane Brody missed an NIH study that found that a baby aspirin a day could reduce risk by 50%. I started doing that as soon as I read this study:
https://www.ncbi.nlm.nih.gov/pubmed/27999143
CONCLUSIONS:
Regular use of aspirin thus appears to reduce risk of pancreatic cancer by almost half.
Also, Ruth Bader Ginsburg is not "cured" of pancreatic cancer. She recently received additional treatment. Lucky for her, she has exemplary medical care. The rest of us do not.
37
The risk of getting it is already very small. Does baby aspirin make it detectable sooner? There are risks to baby aspirin that are far more probable than pancreatic cancer, i.e. strokes and bleeding and reducing the effectiveness of other medications.Its benefit for colon cancer has been questioned recently and it does not replace a periodic colonoscopy.
4
A couple of important points. People can donate to, or become active with, the Pancreatic Cancer Action Network, which (among other things) raises money for pancan research and lobbies Congress to fund research at the NIH, etc. That's a way of leveraging your money donations to the cause. People can also donate money to the Lustgarten Foundation, where 100% of your donation goes to research (not admin overhead). There is a lot of great work being done in the field. We have to make sure researchers receive adequate funding!
29
Lost my mother just 3 weeks after her PC diagnosis. My healthy, vibrant mom, who had no risk factors and no family history. By the time she became jaundiced and itchy, she was already stage 3/4. She gave physicians an opportunity for early detection 9 months before her death, but it was missed. Physicians blamed the gallbladder due to a single stone and removed it. Obviously the abdominal pain returned. Unfortunately, even when symptoms are there, doctors seemingly fail to keep PC on the radar, opting for other diagnoses and ordering tests to confirm those other diagnoses. The gallbladder seems to be a common scapegoat. Had my mom had a CT scan, nine months before her death, maybe, just maybe we would have had more time; something I would have done absolutely anything for.
35
@Ali I'm sorry. I lost my mother too, though she lived 1.5 years from diagnosis (though her quality of life wasn't great for most of it). Early diagnosis, unfortunately, doesn't always mean much more time.
10
Really feel for you. I had a similar experience. My mother left us in four weeks after the diagnosis. She too had been told a year before that a stone from gallbladder caused jaundice and itchiness. The gallbladder was removed and on one paid attention to pancreas.
10
@Ali
Sorry about your loss but I did want to let you know that anyone can get a CT scan done. Insurance companies won't pay for it of course unless it's prescribed by an MD but you can pay a few hundred dollars to have one done. It's called a total body scan. I had one done years ago because someone in my family died at a young age from uterine cancer which has vague symptoms initially and then once the diagnosis was made, it was too late. Unfortunately that is an all too familiar story for me a nurse for over 25 years. Long story short: that total body scan cost me 700 dollars but it saved my life. Sometimes we spend more than that on auto repairs.
38
The most common genetic mutation is KRAS G12D for Pancreatic Cancer and there is progress being made against this mutation. Tumor Infiltrating Leukocytes at NCI is an example. KRAS has been tough to battle for many decades but we are just starting to design processes for attacking it via the body's own immune system.
14
My father, 77 years old, is currently undergoing chemotherapy at NY Columbia- Presbyterian hospital. His pancreatic cancer was detected at a treatable phase, the tumor being less than an inch in diameter. It was cancerous and removed within a month.
The symptoms which led him to a gastroenterologist were the following (this is a bit graphic): oily and mushy, unformed stool, and extreme weight loss. The gastroenterologist ran the typical battery of tests and found nothing alarming. No cancer markers in my father's blood, no evidence of a tumor in other tests.
But the doctor perisisted and had my father do an MRI.
A small mass was discovered in his pancreas. He is currently undergoing chemo as a precaution, but is cancer free; but will be tested for cancer every few months into the foreesable future.
So please, as with breast cancer, get to know your body well enough to spot changes. If you notice something unsual in your body go to your doctor immeditaely and make sure she, or he, runs every test imagineable until an answer is found.
49
@Elissa Goldman unfortunately, I think survival depends upon the tenacity of your treating physician. My mom gave physicians an opportunity just months before her death, but it was missed. She did not have any of those signs your father had, but for abdominal pain, that was wrongly attributed to the gallbladder (I later learned a common misdiagnosis). Wishing your father well today and his continued good health.
24
.
@Ali,
.
The tenacity of the docs can be enhanced by patients questioning their diagnoses. In Ms Goldman's case, "Are there any other causes of abdom pain like mine other that gallbladder?"
.
2
3 years ago, I had a rapidly-growing pancreatic cyst. I consulted with a doctor at a major cancer research center. He was alarmed, and urged me to have an endoscopy procedure to find out if the cyst was cancerous.
I did not want this procedure because it was invasive.
So I went to another major cancer center. That doctor said the cyst gave all signs of developing into cancer. She insisted on the endoscopy.
I gave it one final shot at yet another major cancer center. This doctor also urged me to have the endoscopy.
When I resisted, he, unlike the others, struck a deal: Come back in 6months. If the cyst stopped growing I was off the hook. Otherwise, I must have the procedure.
At that point, I totally altered my diet & lifestyle.
6 months later, to my great relief, the the cyst had stopped growing.
I expected the center to want to hear what I had done.
But to my surprise, there was little interest, so I let it go.
I guess if it doesn't involve expensive medicines and expensive procedures, it doesn't count.
I can see first hand why there is little headway in cancer treatment.
32
@delores
Really, the lack of interest has more to do with how science is conducted. Clinical research science is based on studying large numbers of people who differ in one or two ways, and trying to determine whether those differences improve their life expectancy or the course of their disease.
When scientists speak of an “n of one”, what they mean is that the number is too small to make sense of using the scientific method. This is also called an anecdote, or a personal story.
I think the lack of interest in what you had done is based in the above. Also, as a retired clinician, I can tell you that advocating lifestyle change is one of the most difficult things for clinicians, as people's lifestyles are very difficult to change.
31
@delores Why on earth would you consult three physicians about this issue, and then dismiss their advice? You just happen to be one of the lucky people who didn't show continued enlargement of the area, and who likely doesn't have pancreatic cancer. When a patient refuses recommended testing, often a physician will recommend the next best alternative, rechecking in an another time interval. We can't force you to do anything. This happens all the time in my practice. Small lung nodule? Could be cancer, could be something benign. Don't want further testing (after being fully informed of the options and risks of delay in diagnosis)? Let's check it again in 3-6 months. Always nice to see stable findings in the interval testing. But stable findings don't mean whatever hocus locus "remedy" or diet/lifestyle changes happened made a bit of difference.
79
@Diane
So plodding along with old ineffectual methods are the only way to go?
I am not advocating "homespun" treatment over science.
I am simply wondering a success story is of zero interest to a top cancer treatment center.
And it seems to me there is DIRE need for new methodology in cancer research.
11
I beg to differ. Ruth Bader Ginsberg, amazing superwoman that she is, is not 'cured' of pancreatic cancer. Neither am I, although I am a twelve year survivor of this terrible cancer. Like Justice Ginsberg, I had surgery when the cancer was first diagnosed but I then had intense chemotherapy when it recurred eight years later rather than radiation. I will never be 'cured' but I am currently NED (no evidence of disease) and hope to remain in that condition for a long time. It is my most fervent hope that Justice Ginsberg remains NED for a long, long time as well.
101
Worried about risk for pancreatic cancer? Know your genes.
Pancreatic cancer is associated with inherited mutations of BRCA1/2, Lynch syndrome genes, and other less well-known genes (ATM, CDKN2A, PALB2). Asymptomatic individuals with inherited mutations may qualify for screening by imaging. Chemotherapy may be tailored for affected individuals with certain mutations.
The National Comprehensive Cancer Network Genetic recommends genetic testing for testing for anyone with pancreatic cancer, or for unaffected close relatives. If insurance won't cover the cost of testing: there are self-pay options (about $250) at several reputable labs. At least one lab offers sponsored (no cost) testing for individuals with pancreatic adenocarcinoma or neuroendocrine tumors.
21
@Jackalope Can you please provide the name of the lab which provides sponsored genetic testing for neuroendocrine tumors?
5
@Suzy Google search " 'sponsored genetic testing' pancreatic cancer".
After an initial ad, the first 5 or 6 hits should be from the lab with this offer. Testing requires a physician's order.
5
My husband passed away in March 2013 after a valiant fight against pancreatic cancer for almost 4 years. Initially he was given four months to live and it took us quite a while to find an oncologist who was willing to treat him. With much research we finally found a Doctor and the results were almost miraculous. Within a few months he was in remission. Unfortunately, the chemo therapy was so strong he was in and out of the hospital 6 times over the next 4 years, each time we were told he would die right there in the emergency room. By the third time he was given the nickname, ‘the cat’ because he survived those close encounters with mortality.
After he died I became aware that a young 15-year-old genius name Jack Andraka had won the grand prize at the 2012 Intel international science and engineering fair. He presented a method for detecting the early stages of pancreatic and other cancers that was fast, simple and inexpensive. Jack worked with doctors at Johns Hopkins Hospital in Baltimore to develop this inexpensive screening test that can detect the biomarkers for pancreatic cancer at the very earliest stages thereby potentially saving millions of lives. The fact that this test has not come to market is unknowable to me. The stated reason is has not been published. Look up Jack, on Wikipedia and in the press. In my opinion, pressure should be brought to make a test like this available to the public since early detection is key.
62
Just to shed more light, Jack Andraka's experiment was conducted on mice, detecting a protein that appears in late-stage pancreatic cancer. A practical test would have to detect early pancreatic cancer (different proteins, still being identified) and be proven to work in humans. It is very common for treatments that work on mice not to work on humans.
13
@Kathryn Gurfein
Apparently, the test was a bit hyped. I do not think we are talking Neo-Theranos here but there does seem to be issues with the claims.
(https://www.forbes.com/sites/matthewherper/2014/01/08/why-biotech-whiz-kid-jack-andraka-is-not-on-the-forbes-30-under-30-list/#5df5019a6f88)
4
@Kathryn Gurfein Having worked for 25 years as a research scientist in PHARMA, I always get a smile out of a comment of a colleague: "We can cure any cancer there is. In mice".
2
Something is wrong with the following paragraph in the article – it states that pancreatic cancer is much more common then colon cancer:
“Among 100,000 people of average risk, pancreatic cancer develops in only 13. By contrast, more than four in 100 people will develop colon cancer, and one woman in eight who lives to age 80 will develop breast cancer.”
@Erik No, that is not what she says there. Four in 100 (for colon cancer) is the same as 4,000 in 100,000. Colon cancer incidence is about 308 times as likely as pancreatic cancer. One in 8 for breast cancer is the same as 12,500 in 100,000 for women who live to be 80. Both cancers are far more prevalent than pancreatic cancer.
12
@Erik
Know your percentages. Nothing is wrong with the paragraph.
4% people will develop colon cancer and only 0.013% will develop pancreatic cancer. The author likely used 13/100,000 instead of 0.013% to keep humans whole as opposed to a mathematical statistical fraction..
3
@Erik I think you need to check your math. 13/100,000 is definitely not more than 4/100.
3
I would add .... in my experience with the specialty of oncology...,
As a surgical oncology nurse in early 1970’s the practice then was tumor removal and then deadly dosing with drug therapy.
My dear sister was started on Cisplatin first and the surgeon at Mass. General refused to do the debulking surgery for four months while the ovarian cancer cells had a chance to ruminate and resist the chemo. By year five she had exhausted every chemo option and all the incredible side effects of this heinous cancer and was told she was Cisplatin resistant.
I am suspect of the rational for chemo first then surgery. Happened w my father in law too.
Malignant esophageal tumor stage 3 allowed to exist and grow as he was radiated and given chemo first. By the time these therapies are done cancer patients are too compromised for surgical intervention of the least invasive nature.
The theory of cancer cell shrinking or migrating has been studied but has it been a proven correlation for better outcomes doing it like this in treatment.
Those hearing a cancer diagnosis go into shock and allow themselves to be paternalistically controlled by the “ Cancer Industry” Look at all the TV commercials. Ridiculous promises. False hope and extreme suffering from oncological intervention . That was our family experience
I was a skeptical nurse and in retirement and with my family perishing from cancers I wonder why our scientist haven’t devised early diagnostic tests for these deadly cell changes.
16
@nursejacki Testing seems to apply to each specific cancer. For example Prostate Specific-Antigen (PSA) has a common blood test. But it only is helpful for that one cancer.
1
Research is the answer. The Lustgarten Foundation supports research on the diagnosis and treatment of Pancreatic Cancer. They have a 100% rating by Charity Navigator and have created four research laboratories dedicated to the diagnosis and treatment of pancreatic cancer research including research labs at Johns Hopkins, Cold Spring Harbor Laboratory, Dana-Farber Cancer Institute, and Massachusetts Institute of Technology.
18
I am a 56 year old female. I was healthy ( good BMI, regular exerciser, healthy eater) 1 1/2 month ago. I had a blood clot in my leg which then spiraled to a verbal stroke and landed me to the emergency room and 5 days hospitalized. In that time my 4 stage non-operable pancreatic cancer was found along with metastasis to my liver.
My life is now upside down with very limited time ahead of me.
I appreciate this article which explains why this is not easy to detect.
The medical field must put strong effort in how to make this a routine check for all.
I would have appreciated the runway ( like RBG) to fight this for years ahead...I am in a different place than she was when first found.
81
@Claire Miller Thank you for sharing with us. Your story and courage are heartbreaking. I re-read your account several times, as it pains me to hear how you accidentally "stumbled" on this terrible diagnosis. I survived prostate cancer, but I was fortunate, there are many tests and exams available for this cancer type. I wish you well and much prayer.
33
@Claire Miller
Thank you for being open with others, describing an illness which strikes terror in most of us.
I ended up wondering whether pancreatic cancer may have wrought changes on your body that set the stage for the clot and stroke. Someday, far ahead, we may understand and be able to recognize this hidden scourge.
18
@Claire Miller Thank you for sharing your story, Claire. You have summed up both the reach and the limitations of modern medicine in your comment.
I am so sorry this has happened to you.
25
My brother was diagnosed with an inoperable 3cm adenocarcinoma at the head of the pancreas in Sept ‘17. That summer he was rapidly losing weight but it was the yellowing of his eyes (jaundice) which finally led him to go to the ER. The diagnosis was devastating for him and our family. After combing through the research, it was clear that the odds of even short term survival were not good. We buried ourselves in research and began an extensive regimen of supplements... at this point we had nothing to lose since his doctors said he could not even begin chemo treatments until his bilirubin #s came down. His weight had dropped from 250lbs to 151lbs in only 4 months. After weeks of starting our supplement program, he began gaining weight again. His energy levels improved as did his overall feeling of wellness and by Christmas he was back up to 190lbs. By the end of 2017 he began a 6 month course of chemo treatments. He was feeling stronger and was even able to get in a few rounds of golf the following spring. After the 6 months of chemo he was was given daily doses of concentrated radiation treatments for 2 weeks. It was at this time that things changed dramatically for him as he experienced complications which began a very rapid decline. I lost my brother to this terrible disease in Oct ‘18, a little over 1 year from diagnosis. I’m hopeful that within my children’s lifetime, science (with both public and private support) will find a cure for this and other devastating cancers.
29
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@T.B.,
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could you post more ab his complications ?
.
Since Pancreatic cancer is linked to obesity and type 2 diabetes after 50 wouldn't diet be considered a cause. Heart disease, Type 2 diabetes and obesity have been reversed by a whole food plant based no oil diet. The microbiome is directly related to diet. A meat centered diet produces an unhealthy gut producing toxic compounds such as TMAO linked to cancer.
6
Sorry, I've known very thin, fit people with pancreatic cancer.
23
@John Raffaele
You have made a giant leap in assumptions --including thinking that type 2 diabetes is a precursor of pancreatic cancer - - and not either a result, or part of related changes in body chemistry.
And anecdote isn't science, but the relatives I've known who died from pancreatic cancer were thin, active, nonsmoking people who - prior to the diagnosis - were the picture of fitness.
14
@cheryl But what do they eat? Thinness and even fitness don't neccesarily mean people are eating what many people would call "healthy" foods.
1
The author compares Annual incidence of pancreatic cancer to Lifetime rates of colon and breast cancer. Lifetime rates of pancreatic cancer are indeed lower - but the comparison is off by a factor of about 80, due to comparing different measures of disease incidence.
6
@K. B. Mastin Good point. A quick perusal of google throws up these, more comparable, figures of lifetime risk:
Pancreatic cancer: 1.6%
Breast cancer: 12% (in women)
Colorectal cancer: 4.2%
Brain cancer <1.%
Research is very active in trying to understand the central importance of the gut, the gut microbiome, and their direct connections to our health. The gut and its microbiome may be a key factor in pancreatic cancer. The microbiome is heavily influenced by diet and lifestyle. Stay tuned.
11
Why is the incidence rising? Are their other factors contributing? I know someone whose father and several of his father’s co workers got PC (and died). Environmental? Any research in this are it are we convinced we know all the risk factors?
10
@SC
Diet. The more processed, chemically enhanced food one consumes, the moer likely the body will retain and not eliminate all of the foreign chemicals ingested.
Natural foods, uncontaminated with pesticides or preservational agents, should supply the majority of one's diet, even in the affluent Western world.
3
Pancreatic cancer is awful but so is glioblastoma and ovarian cancer to name a few other dreadful cancers.
So how long did Steve Jobs live with his pancreatic cancer, and Justice Ginsburg is alive and well years after having had pancreatic cancer.
Perhaps the well connected receive blood test that the average person would never be given, nor would it be approved by insurance companies.
Preventative care is still limited to the well connected.
12
@JRS -- Like the article says, Justice Ginsburg's early cancer was found by accident. Steve Jobs had an endocrine cancer in the pancreas that was loosely referred to as pancreatic cancer but wasnt really malignancy of the pancreatic cells. Like the article says -- theres no prevention for pancreatic cancer. Not even for the well connected.
22
Didn't Jobs also elect for non-traditional holistic treatments for some period of time? Sometimes going to the doctor, having the surgery and chemo are the answer. Cancer is a disease where time is an enemy. Jobs gave up time for what it would seem are non-effective treatments.
BTW- I was treated at Sloan Kettering for a very rare type of cancer of the appendix, and a neuro-endocrine tumor of my colon, a cousin to what Jobs had. Found when I had surgery for diverticulitis. That was nine years ago. My mom was at the end of the road at the same time from colon cancer and her experiences were a valuable lesson for me. Nine years now and doing well.
21
@Beckett Congratulations on your good health. I also was treated at Sloan Kettering 16 years ago for Non-Hodgkin’s Lymphoma. A friend of mine was insistent that I first try holistic medicine. I told her that if chemo didn’t work then I would try her shaman. So far I’m in remission from the first cancer and in what is call “watch and wait” phase of another type of lymphoma. I receive IVIG ( immunoglobulin) treatment for my compromised immune system. However, I’m doing well in every other respect.
11
The Pancreatic Cancer Action Network (PanCAN) provides extensive information about pancreatic cancer.
https://www.pancan.org
Founded in 1999, PanCAN is fighting against this cancer through its clinical research, advocacy, and patient services. Its staff can immediately assist pancreatic cancer patients and their families. Its Know Your Tumor program will help a pancreatic cancer patient find out the molecular profile of a tumor in order to determine the best treatment options. This is so important. It's through Know Your Tumor that my sister, who has Stage IV pancreatic cancer, found that her tumor might respond to immunotherapy—a treatment she is following. She is now 2-1/2 years post diagnosis.
https://www.pancan.org/facing-pancreatic-cancer/patient-services/know-your-tumor/
If you have symptoms mentioned in this article that could point to pancreatic cancer, be your own advocate. This cancer often is not on a doctor's radar.
30
In light of Justice Ginsberg - thank you for this education.
I also learned a great deal from comments below.
Thanks to all.
My question : Is Justice Ginsberg complete recovery along the same lines of President Wilson and his stroke ??
Is this more for public consumption or playing politics ?
I say this because your stats make her complete recovery - a really false hope or a cruel joke on others.
4
After 45 years of On/Gyn practice, I have yet to see ovarian cancer in early stage. When detected, they are always in stage 3 or 4. Ovarian cancer is more common than pancreatic cancer. Both are lethal.
57
@dlessani
I tested positive for BRCA2 and had my ovaries and fallopian tubes removed. The patholgy report revealed very early stage (0/1) ovarian cancer - serous tubal interepithelial carcinoma -- caught very early! Apparently, my situation was very rare. Further testing after the surgery revealed the cancer had not spread elsewhere. I am grateful for the genetic test!
24
I did the same.
6
@Honeybee -- ovarian cysts are very common and have nothing to do with cancer. I hope your gyn educates you so you can stop worrying.
4
This one and ovarian cancer are two deadly diseases. Sometimes I feel as if the 2 ovaries and the pancreas are like ticking time bombs in there. Yes, there are some genetic risk factors for ovarian cancer, but as is true with most cancers, such risks are not present in all who develop the disease.
17
@Anne-Marie Hislop my maternal Uncle and my paternal Grandfather both died young of pancreatic cancer, and my sister died too young of ovarian cancer. Breast cancer gets so much of the attention and funds; we need more $ for early detection with these two diseases.
10
@Honeybee Yikes! Before you tell someone to have her pancreas removed, you might want to read up on the issue a little...
4
Agree with Rick! Surgery to remove part or all of the pancreas is no small thing. My mother had the Whipple at age 70 and, while I’m grateful that she’s still alive, I feel pretty sure that I will make different choices if I receive the same diagnosis at a similar age. Three years of Whipple complications have been almost unbearable for her. I dearly hope that she is out of the woods now — time will tell.
Yeah, of all the terminal diseases this is the one that worries me the most as chronic hyperlipidemia and pancreatitis are common in my family. Given how the Cancer industry makes money hand over fist there's zero reason for not having adequate testing for this. Probably because most of the money goes to breast cancer because of politics.
9
@Sparky -- uh, more money goes to breast cancer because more people get it. Each one who gets it has family and friends who raise more money. Its not politics, its math. And not all cancers are alike; nor all are equally able to be detected, which is the very detailed point of the whole article.
8
Sparky, we all have some scary health issues to worry about; my family’s health issue is malignant or difficult to control hypertension; just as scary as any cancer.
Best of health to you and your family.
4
Just a heads up. Judge Gingsberg is far from cured, in fact she is dying from it. That's why she is presently receiving radiation as a palliative treatment. The main reason its so deadly as you pointed out its because of delayed diagnosis and the fact that its in an area that makes difficult to resect thoroughly. Furthermore up to now its unusually resilient to cytotoxic therapy. Until better therapeutic agents are found, results will continue to be disappointing.
23
@Ed
Thak you for your honesty.
The downside of treating cancer as a game opponent, as something to be fought and survived, is that we overinflate the "victories". The "cures" cost the body too. No pink shirts or shaved heads will change that. Better to "fight" to stay healthy before you get sick.
6
Spreading misinformation, are we? Unless you’re involved with her medical care you can’t know this.
It has been years since she was treated
5
@A The SC announced last month that she was treated with radiation over the summer.
7
Best written article I have seen in laymen terms on PC. I have to add that 5-10% have the slower growing one like Steve Jobs and Arethra Franklin that live up to a decade. But even they succumbed. Like the research in Alzheimer's and HIV they are searching for some DNA or RNA that makes one resistant to it. You stated that the risk rises with family history. What is that magic DNA for populations that don't get it?
6
@Nadine
Scientists in 2015 have found that 2 mammals have cancer surpression. Elephants have an abundance of TP53 compared to humans. For their cells amount they have much less percentage of cancer. In survival adaptation, this allows aging moms to rear their young.
Also mole rats have an abundance of the polymer hyaluronan and never get cancer.
3
@Nadine
The gene TP-53 in humans and elephants produces a protein P53 which is a cancer supressor. Mutated TP-53 is found in 1/2 of cancer tumors. Wouldnt it be great if a simple screening for P53 shortage in the blood would predict the presence of cancer rather than simple inflammatory proteins? Elephants pound per pound have a higher percentage of gene TP-53 and get much less cancer.
4
@Nadine
This gene mutation is used by Genentech, the company that developed AZT for aids, to fight cancer with immunotherapy.
1
Regarding early diagnosis, why not employ periodic imaging with abdominal ultrasound? Expectant mothers have it done multiple times during each and every pregnancy. There's no radiation and the test is inexpensive relative to CT or MRI scanning. Compared to colonoscopy to screen the colon, the test is much easier for the patient, much quicker, much safer, and requires minimal physician time. Plus, it could screen for other abdominal cancers at the same time.
18
@Frank
Because routine imaging causes more harm than good. Routine imaging leads to a lot of diagnostic interventions for benign problems. Even with cancers that are much more common such as breast the benefits of routine mammography have been hotly debated, MRI is even worse. MRI finds cancers of the breast that would not be otherwise been detected, however, they also lead to a huge number of unnecessary biopsies
18
@Frank
Finding a small tumor on the pancreas with ultrasound is very difficult, especially with an obese patient. You would have so many false negatives or false positives that the benefits of screening with ultrasound would be nil. Ultrasound is great for a lot of medical imaging needs, screening for tiny tumors of the pancreas is not one of them.
12
@SusieQue -- you dont do ultrasound on the surface of the abdomen to detect pancreatic tumors or cysts. You go down through the stomach. Its called an endoscopic ultrasound, and it has nothing to do with the amount of fat a person has. The procedure even allows the practitioner to biopsy the cyst to determine whether it's mucinous
7
The incidence of pancreatic cancer was not quoted correctly.
The average lifetime risk of developing pancreatic cancer is ~1/63 or about 1.6%, not 13/10,000. Thus, the chance of developing pancreatic cancer is about 1/8 the chance of developing breast cancer. The 13/10,000 figure represents the annual incidence of a pancreatic cancer diagnosis. This annual incidence manifests over several decades adding up to the lifetime risk so at any one point in time, the risk of developing breast cancer is much lower than the 12.5% lifetime risk. Annual incidence estimates are important because they reflect more closely the probability that someone will have a detectable cancer at the time they undergo diagnostic testing. Although recent guidelines do not recommend pancreatic screening for average risk individuals, this guideline did not address individuals considered to have significantly higher risk of developing pancreatic cancer, such as individuals with cancer susceptibility mutations that predispose them to developing pancreatic cancer. Recent evidence from our group at Johns Hopkins indicate that pancreatic surveillance can increase the chance that a pancreatic cancer will be detected at an early stage (Stage I) where it is much more likely to be curable.
Michael Goggins, MD
Baltimore, MD
94
@Michael Goggins
A mutation HPNCC known as lynch syndrome , primarily early colon cancer is also a risk factor for pancreatic cancer.
2
@Michael Goggins
After reading your comment I went looking for numbers, and your 1.6% is the rate of lifetime incidence for 2013 to 2015 - when the probability of dying from pancreatic cancer was 1.4% . ( Based on information provided by the American Cancer Society on their website)
The lifetime incidence rate given in the article is 13/100,000. It doesn't jibe with other stats.
I think it's important to note how the incidence of pancreatic cancer rises significantly with age, say from .05% in one's 40's to .65% in one's 70's. [Cancer facts and Figures 2013; at www.cancer.org].
1
I don't have a comment, but have a question. Are people like pathologists, medical examiners, and morticians at higher risk of pancreatic cancer because they handle formaldehyde soaked tissues as part of their profession?
12
As a student nurse back in the 1960’s we handled formaldehyde and even benzene that we now know is scary stuff.
We even mixed chemotherapy drugs in the nurses station with other people around with no protective gear, no hepafilters, no masks nor gloves; spills, wipe it up.
4
@JRS
I suspect a lot of people with later in life cancers have stories like these.
Look at how many people are still using Round Up instead of paying a neighbor kid to pluck the weeds after a rainfall.
Where do they think those chemicals go after teh weeds and dandelions are killed? Duh. Their choices leech into our water supply and everyone gets to drink chemicals because it makes life easier. Lol.
5
@Midway:
If you are refering to Roundup , it is rapidly biodegradeable once it hits the soil when sprayed on weeds, and after a few days, it leaves absolutely no trace in the soil.
1
Now I'm on my soapbox again. There is everything we can do to prevent it, and little we can do to treat it. It is 99% nutrition and lifestyle, and 1% bad luck. 2/3 of Americans are overweight which automatically puts them at high risk. Add in alcohol, smoking, and even if thin, a poor diet. This is about what we are eating, how much we are eating, and when we eat it. Talking about processed foods, meat, excess protein, and lack of vegetables (bit fruit!). You are at high risk if you consume meat or animal protein more than once a week, sugar, soft drinks or juice, eat almost any processed foods, and consume less than 7-9 servings of vegetables. I've just narrowed my window down to about 10% of the population. Every time you slurp up a soft drink, sweet beverage, or dessert, your blood sugar spikes, and so does your risk of pancreatic cancer. So sick of these stupid clueless articles.
16
@Mary Rivkatot Please listen to the doctors and scientists on this. Although all of your recommendations are good ones, most cancers are not preventable by diet., and the best scientific consensus is that only somewhere between 10% to 20% of cancers can be prevented by a better diet.
https://www.cancerresearchuk.org/about-cancer/causes-of-cancer/diet-and-cancer
I know people don't like to hear this because it suggests that we are helpless -- but for the most part we are. Of course for certain cancers, such as lung cancer, smoking plays a large role. But this is not the rule.
What this means is that detection and treatment are going to be the most prevalent means of battling cancer, not prevention. This, of course, is not an argument against eating healthy - 10% ~ 20% reduction in cancer risk is surely better than nothing.
82
@Mary Rivkatot
I've known many people with pancreatic cancer who were normal weight, exercisers, sensible eaters and light or non drinkers. One was a registered dietician who ate well and kept her weight to +/- 5 pounds until she died of pancreatic cancer at 62. My aunt was slender, didn't like sweets and never drank; she too died of pancreatic cancer at 62. Turns out that there's a genetic mutation in our family that probably caused her disease and that may be the reason for a cousin's prostate cancer and my niece's death at 28 from ovarian cancer. Your attributing these cancers to sugar, alcohol, bad diet and lack of exercise is simplistic and lacking in educational insight.
141
@Davina Wolf
Among notable families that share the unfortunate trait as your own is that of former President Jimmy Carter whose father, two sisters and brother Billy died of it. His mother had it too. In a 2007 Times article, Carter ascribed his good fortune in part to never having smoked, whereas the others had, and the article cited studies showing that smoking doubles or triples the chances of getting it, while noting that genetics played a strong roll.
14
"pale odd-smelling feces that float."
Why beat around the bush. This has a name. It is called steatorrhea. Numerous disorders can cause this. Undiagnosed celiac disease being a big one.
25
@Don Wiss
Yes, it does have a name. But for this information to help anyone, it needs to be understandable by people who haven't been to medical school.
13
@Don Wiss:
Diagnosing feces by their appearance is not an exact science. Being a plant based person for the most part, I can tell you for a fact that they can be highly irregular based on what you are consuming. I would be more alarmed if they were hard and dense all of the time
Little we can do to prevent it? That would seem to be at odds with research that suggests that diet and lifestyle could be important factors. A 72% increase in probability with each daily 50g of poultry consumption might make you think twice about that next nugget. https://www.ncbi.nlm.nih.gov/pubmed/22610753
5
A good diet is nice, and not smoking even better; but even clean-living, assiduously conscientious healthy eaters, like a cousin of mine, can get cancer -- in her case, uterine sarcoma.
Really, people have to stop this business of ascribing full health and long life to healthy diets. Of course it helps. Cancer is in no small part due, however, to heredity.
49
@CMtR
Last sentence of the abstract:
"The positive association of poultry consumption with pancreatic cancer might be a chance finding as it contradicts most previous findings."
8
@B.
Heridity means you likely have grown up eating the same kind of diet that your parents and grandparents did, and adopting the same lifestyle. It's not shaming or blaming cancer victims to note that other groups, with different lifestyles, do not share their risks.
Industrialized nations with chemicals that seep into the water and air supply are less healthy for life than places where these chemicals are not present. Pills, alcohol and processed foods are not something that all of us have been built to consume. Our bodies cannot handle it, and some of us have reactions to the poisons when being ingested, well before our liver or pancreas has spent years trying to eliminate them internally. Be careful what you consume, and what you teach your children about life and quick pill fixes.
1
I am 78. I have been told for some years I am pre-diabetic and test near the threshold. My mother died of Diabetes 2. No physician has told me I am at risk for pancreatic cancer. The typical physician response has been a hand wave and the statement, Just stop eating white carbs. I conclude from this that parts of the medical profession are collectively uninformed or incompetent or lazy or or stupid or all four. I've learned from experience to trust my cardiologists. But internists and other PCPs...?
11
@Tom
Small increase in risk. The main risk factor for pancreatic cancer is bad luck.
11
@Tom -- the slow development of pre-diabetes is almost a normal finding as people grow older: its just beta cell senescence. The sudden onset of frank diabetes is what's associated with pancreatic cancer.
8
@Ed Luck comes into the picture when we don't understand or have not spend time understanding or there is no money in finding a therapy. Luck is when people are in the dark. I am sure, if we can beat down AIDS so we can with this disease.
1
My sister and uncle died of pancreatic cancer. I often pray that a cure can be found. My new prayer will be that noninvasive biomarkers mentioned in the article are created to detect the cancer early. Thank you for writing this article. Listing the possible symptoms was very helpful. I have one minor grammar correction. The editorial sited is titled not entitled.
17
@Sharon J And I think you mean cited and not sited.
4
Cancer never really goes away; it just goes to sleep sometimes.
15
Because pancreatic cancer is rare, it does not make economic sense to test for it population-wide, unlike for lung cancer in smokers or colon cancer. But a multi-cancer test...
See the recent:
“Detection and localization of surgically resectable cancers with a multi-analyte blood test,” PMID 29348365.
Abstract:
“Earlier detection is key to reducing cancer deaths. Here, we describe a blood test that can detect EIGHT common cancer types through assessment of the levels of circulating proteins and mutations in cell-free DNA. We applied this test, called CancerSEEK, to 1005 patients with nonmetastatic, clinically detected cancers of the
ovary, liver, stomach, PANCREAS, esophagus, colorectum, lung, or breast.
CancerSEEK tests were positive in a median of 70% of the eight cancer types. The sensitivities ranged from 69 to 98% for the detection of five cancer types (ovary, liver, stomach, pancreas, and esophagus) for which there are no screening tests available for average-risk individuals. The specificity of CancerSEEK was greater than 99%: only 7 of 812 healthy controls scored positive [and who knows if they didn’t have undetected cancers?]. In addition, CancerSEEK localized the cancer to a small number of anatomic sites in a median of 83% of the patients.”
Available at:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6080308/pdf/nihms982921.pdf
Perhaps someday we’ll all get such a test every 5 years, like a colonoscopy every decade. Its all about cost and false positives.
11
@SRP again: Prior to Obamacare—or tomorrow, if the GOP is successful in their challenges to the ACA—health insurance companies could deny coverage for pre-existing conditions.
So what happens when someone gets a blood test that detects cancer proteins/DNA, even if it is very, very early in the cancer development process? No profit-making health insurance company will touch that person and they’ll cancel their existing policies if they can. But that is the very PURPOSE of social insurances: to lighten the load on those of us unlucky enough to suffer such disasters. The purpose of social insurances is to SHARE RISK, not to enrich the executives and shareholders of corporations able to optimally cherry-pick or deny/hinder customers.
Let’s not let diagnostic science get ahead of our justice and laws. We need firm federal laws today disallowing cancellations or rate discrimination based on pre-existing conditions.
Where is such action by President Trump and the GOP Senate?
No other developed, civilized country on Earth has this problem.
The Dems are fools for not making PRE-EXISTING CONDITIONS and test results a major, well-publicized campaign issue today.
(And better yet, universal, automatic single-payer health care...)
10
Very timely article. To get right to point, someone I care about but for whom I have no real decision-making ability is dying of this cancer. Discovered late stage, with large masses found in his liver and lungs. 85 y/o with family history of pancr cancer, and who has opted for no treatment. Now under 'hospice care' with visits from nurse 2-3x per week...mainly to take his vitals and check his meds. He was on about 5 meds for itchy throat, pain, for when he felt agitated (can't sleep) and for nausea. Hasn't had interest in solid food for about 7 days. Dropped from about 145 to 119 over past month or so. Past few days has had little to no interest in liquids.
Overall, his biggest complaint is the nausea...not so much any 'pain'. Vomits about 4 times per day...presumably it's all just bile. Sound horrible when he's 'trying' to vomit.
Honestly, the hospice we are using seems more focused on a 'program' of meds vs 'compassion' or true concern over how he's feeling. Is this nausea normal or understandable, perhaps due to mass in liver? He's tried 'edibles' on and off and suggests that sometimes they seem to help, other times not.
What else can we do to help with his nausea/vomiting?
Any homeopathic remedies or treatments to help him feel somewhat better?
Thank you!
17
@Lisa Have they tried a med like ondansetron/Zofran for him? It comes in a form that quickly dissolves in the mouth, if he can still tolerate oral intake. It was originally developed for chemotherapy-associated nausea. As far as homeopathy, I have found both homeopathic Ipecacuanha and Nux Vomica helpful for nausea and vomiting. Whole Foods carries both of them. You of course would NOT want to use syrup of ipecac!
@ Lisa
Zofran brand name for Ondasterone.
I use it as needed and it works.
I gave it to my mom and if unable to swallow pill form other forms available in suppository and IVs
Does cause GI motility to slow to crawl and wicked constipation too.
But for late stage hospice. Care this may help. Sometimes the narcotics cause emesis . I cannot take any narcotic class 2 pain meds. During major surgery recovery I was given IV pediatric dose Tylenol / acetaminophen and it controlled my pain. Stop giving him fluids. Give him ice chips. As able. Hospice nurses should know all of this. Any solid pill can be given perirectally for absorption if swallowing difficult. Our mucous membrane and skin are porous to medications.
3
Has your doctor prescribed Marinol, ondansetron, etc.?
1
"Among 100,000 people of average risk, pancreatic cancer develops in only 13. By contrast, more than four in 100 people will develop colon cancer, and one woman in eight who lives to age 80 will develop breast cancer."
Far be it for me to question stats like those above. But it seems within the past three years, of the 10 friends/loved ones I know who were diagnosed with cancer, pancreatic cancer was the one all of one person had.
The ages were anywhere between 50s - late 70s.
Thus far, my husband's cousin, who will turn 78, has been pancreatic cancer free for three years. I am completely stunned yet thrilled to pieces by his improved health.
I think of all the cancers out there, pancreatic scares me the most because the symptoms don't appear until the cancer shows up in other areas of the body, and even if it is diagnosed "in time" the living heck someone goes through via the chemo and other treatments with little hope of survival is terrible & painful.
When our dear friend passed away after her 4 year struggle with this cancer, my husband and I decided that we would take a different path should either of us ever get that cancer. We decided quality vs. quantity was what mattered most to us. I realize that outlook is not for everyone and I am certainly not encouraging nor condoning, but rather simply sharing a different perspective.
My sense is by the time medical minds and screenings catch up to this horrific disease, my husband and I will be long gone.
30
@Marge Keller
Love reading your posts Marge Keller - don't go anywhere!
@Marge Keller Anecdotal evidence proves nothing.
I wonder if the number of deaths from this cancer were higher if there would be more profit in it for companies to research a test ?
I wonder if because it is so profitable to sell insulin that companies do not research for a cure ?
I wonder of cures scare off companies ( by killing profits from maintenance medicines) to researching and finding a real cure .
I wonder if preventative medicine is just not very profitable compared to treating all the sick people ?
If the medical and Pharma worlds are driven by profits, I wonder if we are doomed by their actions or inactions ?
I wonder if the insurance companies are just the bookies who fixe the odds so that they won and we lose ?
We, they people, make all these groups rich winners in a game where they make the rules, fix the odds, and collect the winnings.
I wonder......
29
@ZEMAN Hi, I work in drug development. Yes, there is more incentive to find a cure if the market is larger. there are exceptions, as most pharmaceutical companies have programs to target diseases with unmet medical needs regardless of profit, but these are usually minor.
No, there is no incentive for companies to *not* find a cure for a disease because they think curing a disease will reduce the market for it. Cancer is not going away -- and being able to successfully treat it means you will have a demand for your cure. And really, folks in pharma are not so cynical. I would love be part a cure for a particular cancer regardless of the financial outcome. This is a reward in and of itself that is greater than any financial reward. I gave my career to this.
No one in pharma "fixes" the odds. We change the odds. Juts look at all of the cures now available that were not available 50 years ago. We are happy to pay some company $1K to make a better cell phone, but why would we not want to reward a company that cures disease? I don't understand the logic here. Again, I don't personally make money from any of these cures -- I have a normal salaried position - - but it seems to me that incentivizing companies to do everything they can to come up with a cure is in everyone's interest. Otherwise there is nothing.
38
@ZEMAN I will also add that if we want to set up public corporations to pursue drug development on a non-profit basis that would be great; tell your Congressional representative. But I doubt it will make medicines that much cheaper, esp. for new drugs. Profit accounts for about 15 ~ 20% of a drug price, advertising another 20 ~ 25%. So at most you will see a reduction of about 40% in drug costs. Drug development is a frightfully difficult field and involves a huge amount of laboratory trial and error you can find something you think might work. This is why it often takes 10 years for a drug to get to the market.
10
@Marc
And a lot of people are needed to be diagnosed and die testing out those new drug products too.
Let's be honest.
One very important flag is only two words in the list of the final sentence: onset of diabetes. We were not told this when my husband developed an aggressive type 2 diabetes that quickly escalated to taking insulin. Most type 2 cases can be treated with oral meds.
Eighteen months later, a bout of pancreatitis (which because of pain cannot be ignored) led to tests that imaged a distal tumor of the pancreas. Partial removal led to a five year survival, but a precancerous condition in the remainder of the organ led to another tumor, which was discovered on routine follow-up imaging. He had a Whipple surgery and has been cancer-free for three more years. No radiation or chemo after either surgery.
Seek the very best center for pancreatic disease and the very best surgeon if you qualify for surgery. We did. So far, so good.
97
@hlr and what center was that?
13
@HLR - when my husband was diagnosed with PC in 2016, we were urged by his GI to find a surgeon who had performed Whipple procedures at least "hundreds" of times. We're in the Northeast, so this meant Yale or Memorial Sloan Kettering. My husband picked the renowned William Jarnagin, Chief of Surgery at MSK. We just celebrated my husband's third year of survivorship.
33
My husband died from this cancer at the age of 51, leaving me a young widow with a child who had just started college. He was a heathy man prior to the diagnosis. He worked out, was not overweight, and was rarely sick, so the backache and stomachache he had were quickly dismissed by our doctor. It wasn't until the blood work that was done to rule out the flu, about a month later, that the diagnosis was made. He died a month later after a grueling battle. We since discovered his family has a digestive cancer cluster including pancreatic cancer, which killed his grandmother although at a much older age. Our son is at risk. This article told me nothing new, unfortunately. Cancer is such a complex disease, and pancreatic cancer particularly difficult due to difficulties in diagnosis, but also in treatment. Little works. The survival rates for the garden variety pancreatic cancer are even worse than the number quoted. Islet cell drives the rates up as this variety, although rare, has longer survival. Until we devote resources to understanding this disease and funding early detection studies, rates will continue to climb, especially given the relationship between type 2 diabetes and pancreatic cancer. One need look no further than our growing obesity rates to see potential future patients.
75
@j After having jaundice and horrific itching, I saw my dermatologist, who said I needed a liver test right away. The liver test was very bad, and when they put a stent in they saw the cancer. I was diagnosed with pancreatic cancer in March and am now on chemo. I discovered there has been lots of funding for pancreatic cancer-according to NIH more than $2 billion. NIH also states that for over 40 years no new treatments have been discovered and they don't see any treatments on the horizon. It is the fastest growing "common" cancer--in the top 3 of worst cancers. I have lymph nodes involved--which is not good. Although my surgeon (at a top hospital) feels he can get it all out, my oncologist says 80% of the time the cancer returns--usually within s few months to a year. My prognosis is not good--but I will fight with all that's in me--I want every breath I can get!
3
Wouldn't the list of symptoms be better placed at the beginning of the article, given that many do not read to the end?
27
@Ann O. Dyne
No. Those "possible" symptoms could describe many disease and digestion difficulties. It's not as easy as you think...
7
My best friend of almost 60 years was a robust, active six foot 235 pound man when he went to his Primary care doctor for a routine physical. She noticed a yellow tinge to his eyes and skin and decided to do more tests.
After many tests it was determined that he had Pancreatic Cancer at an early stage. It was telling when the girls in the office had tears in their eyes when they heard the news as he left the office with the name of an oncologist.
My friend disclosed this to of course his family and only me and told us he was going to fight this and beat it.
He then went through the normal course of treatment, and seemed to be doing fine with his tests after treatment, but they continually detected cancer in the blood and then would continue to treat him.
While this was going on I saw my friend growing weaker losing copious weight, and losing his confidence in his ability to beat it.
During the process of treatment I met him for lunch and after brought him to a nearby chapel that was built because of the documented "cures" to the sick and hurting people that a lite candle and praying to Christ via St Michael allowed. After all why not seek for Divine Intervention for my friend.
After two and one half years of valiant fighting my friend lost his battle last December.
As I watch Alex Trebek and his bravery on TV he seems to be following the same footsteps and pattern as my friend, but I wish him the best.
Pancreatic Cancer took my best friend and I miss him!
111
@Jay Terry I am very sad reading this testimonial. I have one of my best friends diagnosed two weeks ago, and I am fearful.
37
@Jay Terry: I just returned from a memorial service for one of my oldest and dearest friends, taken by this disease. My heart breaks for all of us.
12
@Jay Terry So sorry for your loss. I too lost a friend to this disease and I found the only words that offered consolation to me in today's article on Laurie Anderson: "I think of death as a release of love".
1
Little a person can do? Not true. Vitamin D prevents pancreatic cancer.
2
@dan s
Evidence citation please. Dose, dosing frequency and numbers need to treat to achieve stated outcome are essential.
53
dan s, please provide the double blind placebo controlled trial that proves this statement
21
@dan s
One of the difficult parts of having a loved one dying of a disease are the proffers of quack cures. They come out of the woodwork and tout everything from vitamin supplements to caffeine enemas. It is heartbreaking to see your loved on being bombarded with this garbage. Just stop it!
64
Most people in my family die of cancer, but only one (mother) of pancreatic cancer. I hope they work on that test!
14
no, there is something we can do:
eat real food, not too much and mostly plants
but we would rather eat bacon and cheeseburgers and claim there is little we can do
10
@Zenster As someone who always ate "real food, not too much and mostly plants" (long before Michel Pollan popularized this phrase) and was diagnosed with cancer twice before I was 46, I find you're stereotyping people who get cancer as eating bacon and cheeseburgers condescending and hurtful. (For the record, I have a BMI of 22.7.) In some cases, there really isn't a lot we can do.
135
@Zenster
Sure. But there’s something much better : Choose your Parents well.
9
@Liz Thank you for this post and I'm sorry to hear about your diagnoses.
This constant victim blaming of 'you didn't eat whole foods' is extremely uncalled for, and to use your words, condescending and extremely hurtful.
20
Apparently, those who slaughter chickens have 9 times the odds of developing pancreatic cancer and liver cancer. For comparison purposes, those who smoke (for 50 years) double their odds of getting pancreatic cancer, whereas those who drink alcohol (4 drinks a day) triple their odds of developing liver cancer. (https://nutritionfacts.org/video/poultry-exposure-tied-to-liver-and-pancreatic-cancer/)
So I hope that by avoiding eating chicken and smoking, I can decrease my odds of developing pancreatic cancer. I much prefer prevention to detection and treatment.
In fact, I now avoid all animal products (as well as processed food), and eat plant based whole food instead. Lots of veggies and fruits, legumes and whole grains, and in moderation nuts and seeds. And even though I cook most meals at home (there are few options for eating out), and I’m only a fair to middling cook out of necessity, my food is great!!
10
@Dr. J
Evidence?
7
@Jonathan Katz
I was as surprised as you, but apparently there is a link.
https://www.cdc.gov/niosh/nioshtic-2/20039017.html
4
@Dr. J
Quite an article, and there are more related to the subject. Poultry processing plant workers have - in my opinion - quite possible the worst - and most dangerous jobs in the nation. And they get paid barely enough to live on - so that we can have cheap chicken.
1
This article about pancreatic cancer is interesting and helpful, but I wonder why Ms. Brody omits possible nutritional issues. Dr. Michael Greger, at nutritionfacts.org, presents evidence of a connection between the consumption of animal fat and pancreatic cancer. Given the elusive nature of the disease, this seems to be information worth mentioning.
6
@Peter Norris, plant-based diets, exercise, and less animal fats benefit health overall. But it doesn't stop every cancer or heart attack. Cancer is a very complicated disease, with different causes. Why some get it and others don't--we're starting to learn the answers, but it's a long haul.
36
@NR,
As far as I know, nothing stops every cancer or heart attack. But as you pointed out, diet and exercise can reduce the risks.
But we also have to breathe the air and drink the water, all contaminated, from manufacturing and fossil fuel wastes to building materials, clothing, personal care products, etc. Some of us are more susceptible than others, due to our genes, upbringing, etc.
So diet, exercise, and not smoking or drinking alcohol are the best we can do on a personal level.
4
@NR
Obviously nothing can stop all diseases as you state. However, most of us would like to lessen the chances as much as possible.
3
https://sharing.mayoclinic.org/2017/02/24/slaying-the-dragon-of-pancreatic-cancer/
The Mayo Clinic seems to be taking a different approach to treating Stage III. A friend of mine was treated there three years ago and is still in good health today.
17
@Blackstone
Great read on treatment, thanks. The Mayo clinic also published some research 2018 on various metabolic markers that might allow detection three years before diagnosis (primarily an unexplained increase in fasting blood glucose.)
https://newsnetwork.mayoclinic.org/discussion/mayo-researchers-identify-method-to-diagnose-pancreatic-cancer-in-patients-with-early-onset-diabetes/
9
Given the rarity of the disease, false positive testing and overdiagnosis would be an even bigger problem than it is for breast cancer screening.
13
The article and the comments are very enlightening. My suspicion is that pancreatic cancer is a small market that does not appeal to the greed of the companies in the cancer industry. There is so much relatively easier money to be made in the treatment of "easier"' cancers in large markets. Am I being too draconian in this suspicion?
15
@Steve Brocato Actually, no. About six years ago Celgene stated to make a ton of money by hyping abraxane, which is a very expensive modified version of a standard drug. Insurance companies at first declined to pay for it because there was little reason to believe it was better that the cheaper generic. Sadly the insurance companies were right. The costly abraxane has not produced any survival benefit, but it has caused millions to flow to Celgene.
4
in the dark future of climate change, costly medical research will be irrelevant. We live far longer than our great grandparents. Thank a corporation.
2
@Steve Brocato
Literally the first paragraph of the article suggests that your are incorrect.
Which type of diabetes? Isn't onset of Type 2 diabetes relatively common in people over 50 who are obese? So is it obesity that is a risk?
4
@BA
I was diagnosed with an IPMN, my oncologist told me that was the cause of my diabetes. There is such a thing as Type 3 Diabetes, or secondary diabetes which is the result of another medical condition or injury to the pancreas.
9
My mother has pancreatic cancer and has been fortunate enough to have a very good response to treatment and is doing very well. But she had to struggle very hard not just with the disease but with the medical community to get treatment. This cancer's reputation as a swift, hopeless 'death sentence' is a terrible barrier to treatment; it seems to influence primary care doctors and even gastroenterologists - the two doctors you typically see during what is usually a prolonged diagnosis stage before an oncology consult - to be apathetic or even discouraging of seeking treatment.
The organization Pancreatic Cancer Action Network (PANCAN) is a wonderful resource for patients. There are also Facebook pages that are extremely active. There are a lot of people out there fighting this thing.
57
This cancer is deadly. Don't deny.
5
@juris. Wow. Hope you’re not a medical professional, with that bedside manner. So Sara and her family should just shrug and write her mother’s obituary because pancreatic cancer is a challenging problem? With that attitude, medical research would not have persisted to the point where once-deadly diseases like AIDS can now be managed as chronic illnesses with medication. Fortunately, enlightened people don’t heed such negativity. Sara, good on you. Keep at it.
9
@juris I don't think it's possible to deny the seriousness of pancreatic cancer. My point was that pancreatic cancer can be treated, even if the treatments are fewer and less effective than in, say, breast cancer, and even if the problem of late diagnosis makes those treatments far less useful for many patients. The hopelessness surrounding pancreatic cancer is a huge problem for patients who would are trying to live with this thing.
2
@Tom
I'm glad (and hope I infer correctly) that you're doing well. As adenocarcinoma can occur in different organs, can I assume you were referring to adenocarcinoma of the *pancreas* (the topic of this article)?
Since you strongly urge getting genetic testing (and I assume you're not talking about sequencing the entire genome), can you be more specific about what people should ask to be tested for, e.g., is there a *specific* mutation you have in mind?
And (especially if your experience is with *pancreatic* cancer), can you give any example(s) of a back-up plan? My impression has been that the most common plan (let alone back-up plan) is hospice.
Thanks, and be well!
5
“Novel blood tests can detect a combination of pancreatic cancer DNA and pancreatic cancer-related protein markers,”
I'd love to know what these novel blood tests are and if one can have them done.
28
Families with the BRCA 2 gene ( increased risk of breast and ovarian cancer) have an increased risk of Pancreatic Cancer( fortunately not as high as breast or ovarian ). They should meet with their Oncologists and pancreatic Gastroenterologists to discuss options and strategies for screening.
14
My wife died from pancreatic cancer two and a half years ago. For many months prior to the CT scan which spotted the stage 4 tumor, she had been troubled by pain and discomfort. Many trips to the doctor with blood tests that seemed to rule out many serious diagnoses. But one result was puzzling: pre-diabetes. She was not overweight, was very active, had a good diet, no family history. Since pre-diabetes is so common, her insurance would not cover expensive tests like a CT scan. Finally they did allow it. We asked all of her doctors if the pre-diabetes was linked to the cancer. All but one waffled, hemmed and hawed. Covering their behinds. But the doctor who did the biopsy answered, “Probably.”
60
@Fritz
The Mayo Clinic published a couple studies last year that pre-diabetes can be an indication of pancreatic cancer three years before cancer diagnosis:
https://newsnetwork.mayoclinic.org/discussion/mayo-researchers-identify-method-to-diagnose-pancreatic-cancer-in-patients-with-early-onset-diabetes/
10
Please name the Insurance Company
7
@Fritz similar story with my mom. She was somewhat overweight but was exercising more and attributed her weight loss to that.. she always had gerd and even though she saw gastro twice a year they missed it until my mom and dad asked for the Endo ultrasound... Stage ... Inoperable. I believe it was the tumor causing the pre diabetes ( high A1c)
2
I was diagnosed with adenocarcinoma three years ago (mid 30s). I could write a book on my experience over the last three years, but given the space constraints, this is what I have learned: 1) Genetic testing is critical! A genetic mutation in your DNA profile can add new treatments to the table. I can't overemphasize this point. Please, please, please, get tested. 2) Don't wait for doctors to come to you with options - you need to do as much homework as possible and don't be scared to challenge doctors. They don't have all the answers and in many cases are simply overwhelmed by sheer volume of terrified patients. Make sure you have a back up plan whenever you start a new treatment so you can adjust quickly if your treatment does not work out as planned. 3) Massive coordination among researchers, medical community, biotechnology companies and the public is needed. 4) Next time you see someone raising money for cancer research, please consider donating. GI cancer research is woefully underfunded. 5) Share your stories. We all need to compare notes and experiences.
181
@Tom
Did you also want to share any positive actions re treatments?
The following website promotes genetic testing to obtain certain genetically targeted therapies.
https://pancreatica.org/genetic-testing-for-pancreatic-cancer/
6
After a friend died of pancreatic cancer I saved this quote from my research. Why has no one mentioned this ?
a gene called KRAS, and is important because mutations in the gene are so common. “Every single pancreatic cancer patient has KRAS,”
7
@ Tom. Yes - and try to make sure your sample is tested at a lab that is participating in NCI sponsored trials like MATCH - companies developing new treatments that target specific cancer associated biomarkers sign up for this program and if you have the biomarker you might get admitted to a trial.
7
The big picture is pancreatic cancer is undetectable until too late, and, in most cases, is a death sentence. Screening for DNA in blood might lead to earlier detection, but due to location, early metastasis, and poor results from treatment, it would still be a death sentence for most. Maybe we should spend more resources on heart disease, metabolic issues, and screening for breast, colon, and prostate cancer. Pancreatic cancer stimulates interest among researchers and surgeons because it is a difficult problem and is a good reason to do a massive operation testing a surgeon's skill to the max. However, the current treatments are risky and rarely curative.
7
@james doohan It's true that the Whipple surgery is risky and often isn't curative in the long-term. But the other treatments - chemotherapy and radiation - are no riskier in pancreatic cancer than in other cancers. In terms of ROI, I'm curious if any other disease has gone from being essentially untreatable to having multiple treatment options in only the past 20 years. There was basically no systemic treatment of pancreatic cancer until the approval of gemcitabine in 1997. Today there are several drugs and combinations oncologists can use to help people have more time alive. Which is, after all, the only thing any of us really get - more time, not immortality.
21
@james doohan We should be spending more money on research for all diseases. We waste money on useless walls, overseas military follies, domestic "pork" projects by legislators, etc. By your reasoning we would have avoided putting money into research on diseases with previously poor outcomes that we now have treatments or preventative measures for ( example, vaccines ). A recent example is research for Metastatic Melanoma ( previously not curable ) with markers identified that led to targeted therapies for these patients with dramatic improvement of outcomes. Research and science are important across the board. Do not dilute this. Other nations will do it and reap the rewards.
19
@james doohan Thanks, that's really encouraging.
3
More emphasis is needed on preventative measures. Of course genetics and family history may predispose some people, but spelling out the value of lifestyle changes may motivate some people to make those changes.
8
My wife died of pancreatic cancer. It is often stated that there is no screening for this disease. However, once my wife was diagnosed with it, she was regularly tested with a simple blood test for the CA-19-9 tumor specific antigen level to check on activity levels of the disease. The levels went down to almost normal after heavy rounds of chemotherapy, but the cancer returned and with it the CA-19-9 levels went way up. This is a simple blood test , it was used to confirm original diagnosis, why can't it be used as a screening tool? A false positive here and there, so what, look what's at stake. Or is it just money, insurance companies and federal agencies? I have asked this question repeatedly and have never received a satisfactory response.
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@Michael Ryan
For a test to be useful in screening the general population, it has to (a) detect a high proportion of cases with disease (high sensitivity); (b) not be abnormal in significant numbers of individuals WITHOUT the disease (high specificity); and (c) identify the disease at a stage in which treatment is significantly more effective compared to later detection.
CA 19-9 isn't considered highly sensitive, and more importantly it can be elevated in conditions that are far more common than pancreatic cancer. In the general population, only a small proportion of individuals with high CA 19-9 will be found to have pancreatic cancer (low positive predictive value). These individuals would be subject to costly and invasive testing (including surgery), and screening would cause more harm than good. And it also hasn't been established that those identified with pancreatic cancer by screening would have improved outcomes.
This is basically the same story as CA-125 and ovarian cancer.
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CA19-9 has been used as a tool for testing screening programs by numerous groups.
The bottom line is that even when we studied high risk groups at the highest risk for pancreatic cancer, testing CA19-9 did not improve outcomes.
The main reason screening is so much more difficult in pancreatic cancer is due to anatomy. The breast and colon etc have no important anatomical landmarks nearby. The pancreas is next to two major blood vessels that we cannot resect.
Additionally, we typically say that pancreatic cancer is systemic at diagnosis, meaning that unlike colon cancer for example, which grows in a stepwise manner, pancreatic cancer can spread to a different organ even when small.
These two things make screening ineffective.
Another reason why CA19-9 (and every tumor marker) cannot be used for screening is due to their high variability. They fluctuate tremendously on a day to day basis, influenced by smoking, inflammation, bowel movements etc.
When you already have metastatic cancer, are on chemo and you are checking these labs every 2-4 weeks, those small fluctuations even out. Especially when you are talking about people whose tumor markers may be 10x normal. Additionally, there is no real harm in subjecting someone with a prognosis of 15 months to extra radiation from scans. That is completely different from the scenario of screening where we are doing tests on healthy people where a high CA19-9 is much more likely to be due to another reason than cancer.
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@Anil Singh
“A false positive here and there” would involve large numbers of people in invasive and risky follow ups for the trade off of possibly helping a few people. That risk benefit isn’t looking so good.
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I would like to see research on whether or not a high sugar diet (not complex carbohydrates) contributes to Pancreatic cancer. Since that precious organ regulates our insulin, I am wondering if an overload of processed sugars taxes it. It seems logical to me. On the other hand, cancer doesn't have to have a logical reason to appear.
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@Kathleen My mother did not eat much sugar, but she smoked tobacco for over 30 years. (Dead of pancreatic cancer 6 weeks after diagnosis at age 74.)
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@Kathleen
Similar to Marilyn Sue Michel I have had 2 relatives die from pancreatic cancer, both were smokers. I would be interested in statistics on the number of non-smokers that get pancreatic cancer.
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@Marilyn Sue Michel
Similar story with my mom, except she was only 44 when she died. Had smoked cigarettes since her early teens, very slender always (5'9, 125 pounds), and didn't care for sweets.
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Sadly, the article ends with recommendations for spotting symptoms of pancreatic cancer that are signs, not of early onset, but of advanced disease. It would be very exciting if there was a pancreatic cancer test like the PSA test for prostate cancer which is sensitive if not very specific but it provides the all important early warning.
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@A Goldstein
As I have learned first hand, even a very high PSA score is no indication of cancer. I have a PSA over 10 and have had 2 negative biopsies. I have a huge prostate and my Prostate Density Score is normal for someone with a prostate the size of mine.
While having an MRI as part of my advanced prostate screening an IPMN was discovered on my pancreas. I was assured it was not cancer "yet" but that someday, when they could not say, it would become cancer.
I was given three choices, one, do nothing and when it turns into cancer "you die, because we can't cure pancreatic cancer." Two was Whipple surgery where the head of the pancreas, gall bladder and parts of my small intestines and stomach would be removed. Choice three was a complete removal of the pancreas and attaching an insulin pump. I chose Whipple surgery
So while a high PSA count didn't turn out to be prostate cancer, negating that possibility discovered a different, more dangerous condition. Ironic.
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@A Goldstein PSA test is a terrible model. It has done more harm than good.
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@DavidFNYC - I wish you the best as you battle your cancer. In addition to the conventional PSA test, there are better blood tests available now, one of which is the 4KScore, which has greater accuracy.
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I was struck by the sentence: "In fact, surgery is a treatment option in relatively few patients because the cancer is usually already too advanced at diagnosis for surgery to have survival value."
My wife died from pancreatic cancer at age 51. The surgeon operated on her despite the fact that her cancer was too advanced. This particular surgeon even wrote a book on the subject and violated his own guidelines.
Her relatives thought him a hero for doing it. But, in reality, all the surgery did was increase her misery and shorten her remaining life.
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@Stephen, yes, I am sorry. The surgery to remove a tumor from the pancreas often has profound effects on the body’s continuing functioning. To be “successful”, a lot of reconstructing typically has to occur. Ms. Brody’s article greatly underplays this.
Doctors like to cure things, and I saw a weird mix of bravado and fatalism among the high paid specialists who saw my father. It was the palliative care folks who did the most to ease his way.
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@Clare The operation they performed is called a Whipple procedure. It is a pretty extreme bit of surgery involving removal of part or the entire pancreas, the duodenum, a portion of the common bile duct, gallbladder, and sometimes part of the stomach. I do not imagine any reconstruction would be possible.
I agree with you about the " bravado and fatalism." In my wife's case, I would add extreme arrogance and self-dealing on the part of the surgeon.
I also feel the need to say that almost all her other care providers were exemplary, caring, wonderful people and a credit to the medical profession.
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@Stephen
I am one of the fortunate ones, an IPMN was found during an MRI for a different issue. It had not become malignant so surgery was a viable option. I had Whipple surgery in February 2017 and it is one of the most debilitating surgeries one can have. There was no reconstruction.
After the removal of so much of the inner abdominal cavity there was plenty of room for what was left to move around as I did.
For almost nine months I had to take small steps so my stomach wouldn't lag too far behind the rest of me.
I am sorry to hear your wife suffered so much for naught.
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My father died of the disease in 1997--6 months after being diagnosed. It's disheartening that 22 years later there's still no diagnostic test. Kudos to organizations like the Kenner Family Research Fund in NY for the push to developing a test.
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@MER
Yes my mom was diagnosed in 1993 and passed 1994.
Pancreatic.
My baby sis .... 10 years younger .... ovarian stage 4 misdiagnosed as IBS and gastritis by her PC and gastrologist.
When she developed abdominal ascites she was rushed from Vermont to Mass. General where instead of debulking surgery stat ;the doc did paracentesis to relieve her discomfort and then sent her home with ovarian cancer still growing and spreading for four months of Cisplatin . By the time the “ world class “ surgeon did debulking the ovarian cancer was in her liver and lungs and stomach and dotted her mesentery. She went thru 5 years of false hope in treatment. Between treatments her wealthy in laws took her on world class vacations. So she tried to live and danced at her son’s wedding in 2016 and died in 2017. 49 at diagnosis. Her water well in the country was near a paper mill Superfund dumping site. They never tested her water. I often wonder about the cause. We all have polycystic ovarian .
syndrome.
So yes I too would think by now with every human affected by this scourge we cannot work at breakneck speed for diagnostic tools and better surgical and chemo outcomes. Why not. ? We have no leadership other than PanCan really unless someone can share a better solution . More in-depth journalism is needed.
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Investigating clinicaltrials.gov you will find over 600 ongoing worldwide trials of treatments for all stages of pancreatic cancer as well as searches for early detection biomarkers.
Also, Immunotherapy seems to be a promising treatment.
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Article ought to distinguish adenocarcinoma and neuroendocrine tumors which have very different outcomes.
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Only a blood test that detects pancreatic cancer in very early stages, when/if developed, could be used for everyone.
This blood test would allow for early detection, before symptoms develop.
A pancreatic MRI for large parts of the non-symptomatic population is not feasible.
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I am fortunate regarding this concise, important article - but, I was also an experienced Operating Room RN who knows this condition to be a stealthy, insidious entity. As with many issues regarding healthcare, the general public hasn't a clue as to what's happening and what they should do about it (but that's another issue for another time).
That was why I insisted my surgeon check out my pancreas when he was do testing for my gallbladder symptoms. Sure enough two shadows showed up on my pancreas and a follow-up MRI showed them to be an IPMN with low risk (because they were not near a duct nor of alarming size).
Now I have an annual MRI (so far, so good) and enjoy Thanksgiving dinner because I had my gallbladder removed after those tests.
My thoughts to the uninformed: Stay engaged, question your provider and don't be intimidated - a perfect example would be to demand an ultrasound or radiography for abdominal aortic aneurysm if you ever had a history of smoking. Too many providers rightfully strive to get people to stop smoking at the expense of evaluating the damage that might have been done.
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@Tim I too have an MRI (actually a variant called MRCP) every year, followed by an EGD/EUS (google it). The EGD component will give you more info than the MRI Most of the time. My ad passed from PC in 2002. It was a horrible death.
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@Tim
I wish I had known. I had gallstones which culminated in pancreatitis and emergency surgery. It was all quite painful and took years for full recovery. Am I now at an increased risk for pancreatic cancer because of this? No one could/would tell me at the time.
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@Tim
I was diagnosed with and IPMN and was told that it was only a matter of time before it became malignant. They just could tell when that would be. I was given the option of monitoring it but told that "when it turns to cancer you die because we can't cure pancreatic cancer." I also got two surgical options. I had surgery but still have annual screenings.
The impression I was given was that there was no such thing as a low risk IPMN. The surgery was completely debilitating for almost a year, and after that I had to adjust to my new "normal." I often wonder if the surgery was worth it considering I didn't have cancer and don't know for sure if it would have developed in my lifetime. It was just that death sentence of a potential diagnosis that steered me to surgery.
8
I knew five people that have died from cancer in the past five yrs. (non blood family related). Four of them died from Pancreatic cancer. I was stunned by the facts you mentioned ie that although very lethal, is uncommon.
Also although Pancreatic cancer is very lethal, all cancer is very lethal compared to the progress with have made with cardio vascular diseases.
It seems the best we can do with cancer is to prolong life, not cure it.
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@Paul
It is a new day with immuno therapy. It's not perfect yet, but stay tuned. It looks very promising.
4
@Susan-Thank you for your reply. All I am saying is like unlike other diseases that have been wiped out with vaccines or the great advances in cardio vascular diseases with stents, valves etc., cancer is still relatively speaking in the Middle Ages.
Yes progress has been made but it is slow and not complete ie in many cases life is prolonged not cured of cancer.
Four out of the five friends who died from pancreatic cancer lived 3-5 yrs. prolonged by operations/chemo. Only one died within four months.
3
"Aside from avoiding smoking, obesity and Type 2 diabetes, there is little a person can do to prevent it."
Really? Has anyone looked closely at diet and lfestyle factors? As a medical doctor, I would be quite surprised if people on a healthy, plant based diet with healthy lifestyles had the same incidence as people who were not.
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@Gene my husband was an athlete and was very careful about his diet. He died in less than three weeks from the time he was diagnosed from pancreatic cancer. So I agree diet could be an issue but it is not the only factor.
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Kind of weird that a medical practitioner would proffer a “guess” that vegetarians would have less incidence of pancreatic cancer. That “theory” is based on no scientific data, of course, but I suppose it feels good to believe, so you say it.
Rather than guess about what might be helpful, I’d like to encourage sensible people to stick with the facts as we know them for now. Speculation and hope aren’t useful or helpful to the discourse, especially coming from medical professionals.
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My husband was also very healthy and died within 6 weeks of diagnosis. 38 yrs old. He was an avid jogger and played full court basketball every week.
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