Recent headlines about “Jeopardy!” host Alex Trebek battling stage-4 pancreatic cancer have helped raise public awareness of this very serious illness that, according to the American Cancer Society, accounts for about seven percent of all cancer deaths in the US and has a five-year survival rate of only nine percent when all stages are combined. Considering these rather grim statistics, it’s understandable that many people view pancreatic cancer as one of the more worrisome forms of cancer and fear being diagnosed with the disease. But is this perception entirely accurate?
According to Jeffrey Sutton, MD, surgical oncologist at the University of Toledo Medical Center, pancreatic cancer’s troubling reputation is somewhat justified. There are two reasons for this: The first is that pancreatic cancer can develop with relatively few, if any, symptoms, and when symptoms do occur, they’re likely to be vague and easily mistaken for other more benign conditions. The second is that pancreatic cancer tends to be very aggressive and can metastasize to the liver, lungs, or other nearby organs, or advance locally into surrounding blood vessels, relatively early in the disease process.
However, Dr. Sutton emphasizes that not all lesions that occur in the pancreas are cancerous and not all of them require surgery. “Pseudocysts, for example, can develop following bouts of pancreatitis, or chronic inflammation of the pancreas. These lesions do not progress to cancer and often go away on their own, though they can persist if large enough. There are also premalignant lesions, such as intraductal papillary mucinous neoplasms, or IPMNs, that can evolve into cancer over a long period but can be removed surgically if caught early,” he explains.
Furthermore, not all forms of pancreatic cancer are equally aggressive. “In addition to benign and premalignant lesions, there are types of pancreatic cancer that are much less aggressive than adenocarcinoma, which is the form we usually think of. For instance, pancreatic neuroendocrine tumors, or PNETs, are by definition pancreatic cancer and need to be treated surgically, but they tend to be much more indolent, meaning they grow and metastasize relatively slowly,” Dr. Sutton says.
Painless jaundice (yellowing of the skin and eyes) is the “textbook” sign of pancreatic cancer. Patients may also experience vague abdominal pain, changes in their stool or urine color, unexplained weight loss, loss of appetite, persistent fatigue, and other symptoms. Dr. Sutton also notes that later-onset insulin resistance or diabetes occurring in people who appear otherwise healthy warrants a medical evaluation to rule out the possibility of an underlying pancreatic malignancy.
Though no direct cause of pancreatic cancer has been identified, it is known that, as with many other cancers, smoking tobacco and drinking alcohol to excess can increase one’s risk of developing the disease. “Smoking and excessive alcohol consumption can lead to recurrent bouts of pancreatitis that can cause normal cells within the pancreas to go awry and develop into tumor cells,” says Dr. Sutton. Obesity, eating an improper (Western) diet exceedingly high in saturated fats and low in fresh fruits and vegetables, and a sedentary lifestyle have been linked to pancreatic cancer as well.
Certain inherited genetic mutations are also known to increase risk. Dr. Sutton notes that in addition to new spontaneous mutations that occur within the cells of the pancreas, it is also now known that BRCA1 and BRCA2 gene mutations, associated in most people’s minds with breast cancer and gynecologic cancers of the ovaries and uterus, also increase the lifetime risk of developing pancreatic cancer.
Can pancreatic cancer be cured? Dr. Sutton states that there is both good news and bad news in this regard. “The good news is, pancreatic cancer can be curable. The bad news is, it cannot be cured without surgery,” he says. “Unfortunately, four out of five patients with pancreatic cancer present so late that it cannot be surgically resected because it has either already metastasized to other organs or advanced locally into nearby organs or tissues that can’t be resected, such as the main blood vessel that feeds the intestines. In addition, most cases of pancreatic cancer occur in the older population, so many patients just aren’t strong enough to tolerate surgery to remove it.”
Dr. Sutton further explains that all patients treated with surgery also get chemotherapy and some may get radiation or a combination of chemo and radiation. Nonetheless, surgery is the only route to a cure, and that can take one of two main forms depending on the location of the cancer—distal pancreatectomy if it’s on the left side of the pancreas, or the Whipple procedure, also known as pancreaticoduodenectomy, if the cancer is situated on the right side of the pancreas.
Traditional open surgery through a relatively large incision is the most common approach when removing pancreatic tumors. However, significant progress is being made in the realm of laparoscopic and robotic surgery, allowing more and more surgeons to perform these procedures with a minimally-invasive approach. In fact, Dr. Sutton has extensive experience in performing these surgeries robotically.
“This technology allows me to sit at a console and perform the procedure with robotic instruments inserted into the abdomen through several very small—approximately penny-sized—incisions. A high-definition, 3D camera is also placed through one of these incisions into the abdomen, allowing me to visualize the surgical field in very high resolution. Contrary to popular misconception, the robotic system does not actually perform the surgery itself. Rather, special sensors on my hands translate my movements very precisely to the robotic instruments, so what I’m doing outside the patient’s body is mimicked on the inside,” he says.
When it comes to a potentially deadly disease like pancreatic cancer, the proverbial ounce of prevention is worth much more than a pound of cure. Unfortunately, no reliable screening tool is currently available for the disease. Dr. Sutton’s best advice is to make healthy lifestyle choices, including adopting a good diet, exercising, and avoiding smoking and excessive alcohol consumption. If you experience any of the symptoms associated with pancreatic cancer, don’t hesitate to see your doctor. Also, if you have a family history of pancreatic cancer or factors that increase the risk of developing the disease, it may be worthwhile to explore the option of genetic counseling.
For more information, or to schedule an appointment with Dr. Sutton, call The Eleanor N. Dana Cancer Center at 419-383-6644. ❦