Medical Question: Why is pancreatic cancer so virulent?

[Northern Piper]

The Beloved and I visited a friend today in hospital. He's just been diagnosed with pancreatic cancer and has been given a very gloomy, short-term prognosis.

This is the third person we've known with pancreatic cancer, and in each case the prognosis was much the same: a matter of months.

What is it about cancer of the pancreas that makes it so virulent?

[SnoopyFan]

Apparently because by the time they catch it, it has already spread to other parts of the body:

http://health.yahoo.com/health/cance...cer/index.html

I'm sorry to hear about your friend, but remember that ALL types of cancer have survivors, even one as bad as pancreatic. And doctors have been known to be, um, wrong sometimes (they're paid to be pessimistic).

[dauerbach]

Actually the article is not precisely accurate. Pancreatic cancer rarely kills through distant metastases. It is locally invasive and obstructs important structures, particularly the common bile duct and the adjacent arteries and veins. In addition, the pancreas is extremely difficult to operate on, being a delicate structure whose cells produce enzymes that can digest the body itself. The tumors are not particularly sensitive to radiation or chemo. The cancer is usually fairly well advanced at the time of diagnosis. All this means that by the time it is discovered it is generally advanced and untreatable. It does not, however, spread distantly throughout the body.

[Earl Snake-Hips Tucker]

It does not, however, spread distantly throughout the body.

You got a medical cite for that? I did a Google search on "pancreatic cancer metastasizes" and one of the first hits mentions "a study to find out why pancreatic cancer metastasizes so often."

[Jackmannii]

Pancreatic cancer (assuming we're talking about ductal adenocarcinoma, far and away the most common type) does actually metastasize frequently, often to the lung, peritoneum, liver, lymph nodes etc.
There are no distant metastases in only about 10-15% of autopsies (source for above figures is the latest edition of Tumors of the Pancreas, Armed Forces Institute of Pathology).

Local obstructive problems can definitely be fatal, along with problems caused by metastases. Untreated mean survival is about 3 months, which increases to 10-20 months with surgery. The tumor is usually so widespread by the time of detection that surgery cannot remove it all.

[Northern Piper]

Thanks for the replies, everyone.

Follow-up question: why is it that the cancer is normally detected quite late, as some of you have noted? Is it something to do with the function of the pancreas? It's a humble little organ that doesn't like calling attention to itself, not like those flashy kidneys?

[Qadgop the Mercotan]

Please, daurbach. Pancreatic cancer metastasizes like wildfire. Have your facts straight before replying in GQ, especially in serious issues.

My condolences, Northern Piper. It's a very difficult thing to face.

This website, from Johns Hopkins Hospital, has tons of information about it. http://pathology.jhu.edu/n.web?EP=N&FL=PANCREAS

[Northern Piper]

Thanks, Qadgop.

[omni-not]

except that a work colleague of mine died from it four years ago. Don't know if it was cancer as such though. Although it was definitely an acute infection of the pancreas. Had a first 'attack' the day after his return from Japan in 1986, and had been in 'remission' 13 years before he was to be taken to the hospital again (quite suddenly). He died a couple weeks later, as I understand it, from complications.

[artemis]

One reason the cancer is usually detected so late, Northern Piper, is that the early symptoms are rather non-specific (mild upper abdominal discomfort). By the time things progress to the point where it's obvious that the trouble isn't merely heartburn but something more serious, the tumor is generally metastatic. Pain originating from internal organs is typically poorly-localized and often dull, making it difficult to determine the precise source of the trouble, so cancers arising in those organs can be difficult to detect in their early stages.

[BobT]

Northern Piper
I can only offer the consolation that at least you will get to say goodbye to your friend.

My father passed away from pancreatic cancer last September and we did not know he had it until after he died. He presented in the ER with a pulmonary embolism and that was it. He had not been feeling well for a few weeks, but we did not suspect anything worse than pneumonia.

[dauerbach]

What I was saying was that unlike say breast or melanoma or colon cancer it is very unusual to find pancreatic cancer that spreads to distant organs like brain or lung. I sort of dump local lymph node metastases into local invasion although I suppose that is taking slight liberties. Almost everyone who dies of pancreatic cancer dies of complications developing right where the organ lies. And the hopkins web site you cited shows the same thing.

[MichaelColey]

I don't have any scientific or medical information to add, but I've had a couple friends with pancreatic cancer in the past year. One died within a couple weeks. The other has made it about six months (and counting).

Doctors usually give worst-case estimates, which can be wrong. My dad had a bad heart attack about 25 years ago. The doctors gave him six months. He lived 10 more years. I know a six-year-old who had brain cancer and was given a 25% chance to live. He came through it like a champ. I've known several people who were diagnosed with various types of cancers that just completely disappeared.

The spirit and will to live of the person makes a huge difference. A good support group and a positive attitude can often prove doctors wrong.

Michael

[El Zagna]

Originally posted by MichaelColey
Doctors usually give worst-case estimates, which can be wrong.

I am very skeptical of this kind of claim. I think you will find that doctors tend to be very... well, clinical in their prognoses. What the patient hears may be something altogether different.

My brother is an orthopedic surgeon and says that hardly a week goes by that he doesn’t hear from someone that “The doctors told me I’d never walk again.” Of course that’s not what the doctors are saying, but that’s what the patients are hearing.

[Qadgop the Mercotan]

Originally posted by dauerbach
What I was saying was that unlike say breast or melanoma or colon cancer it is very unusual to find pancreatic cancer that spreads to distant organs like brain or lung. I sort of dump local lymph node metastases into local invasion although I suppose that is taking slight liberties. Almost everyone who dies of pancreatic cancer dies of complications developing right where the organ lies. And the hopkins web site you cited shows the
same thing.

Point taken. But it still spreads very frequently to the liver, which I would consider more consistant with a metastasis than a loco-regional spread such as nearby lymph nodes. And once its in the liver, surgery is generally not an option. And hepatic failure is a frequent cause of death from pancreatic cancer.

Thank you for your thoughtful reply, dauerbach.

[syncrolecyne]

Today would have been my uncles 52nd birthday. He was diagnosed with pancreatic cancer in the fall of 1999, and died that October. Actually he also had a heart condition and died of a heart attack, but I am sure the immense stress of dealing with pancreatic cancer brought that on. At the time I didn't know that pancreatic cancer was any worse than other cancers (I just figured they were all the same), but when my mom - a nurse- heard the news - she turned ghost white and stayed that way for days.

My uncle was a very heavy (one carton every 3 days) smoker and drinker, and I always worried so much about his health.

[MLS]

I have heard that pancreatic cancer is also one of the very most painful types. Is this true? If so, is it because of its usually late diagnosis, or is there some other reason?

[dauerbach]

I am sure that there are some doctors who give worse case estimates concerning diseases, particularly cancer, figuring that if the patient is even a little lucky they will live longer and the doctor will get the credit. However, most physicians try to be totally honest with the patient, giving their true best estimate of the prognosis. And there are certain diseases that are essentially always horrible. I remember when Michael Landon developed pancreatic cancer he appeared on the tonight show in what appeared to be good health, but mentioned that the tumor was inopperable. My wife was very upset when I said he would be dead in 4 months, which he was. Treatments have improved but osteosarcoma used to be the same way. It would be treated and you could accurately predict that within two years metastases would be present and the patient would die, and that is what almost always happened. And malignant melanoma is the worse. Although early diagnosis has dramatically improved survival, even a mildly advanced case, particularly one that shows histologic ulceration, is about the most agressive disease you could find.

[gonzomax]

The news says that it has no telltale symptoms like blood in the stool or swelling. When it is finally found it is well percolated. Then it is hard to get at. The doctor said operating on it is much harder than a quad bypass. It does not respond to chemo or radiation.

[lavenderviolet]

The reason pancreatic cancer is painful is because it tends to invade a bundle of nerves near the pancreas called the celiac plexus (http://en.wikipedia.org/wiki/Celiac_plexus ). It's common to go in with a needle and block the celiac plexus to try to alleviate the pain.

Anatomy also has something to do with why it's so hard to detect. If a tumor develops in, say, the tail of the pancreas it has room to grow without bumping into anything that would cause tell tale symptoms like pain.

[irishgirl]

Part of the problem with pancreatic cancer is that the surgery necessary to treat it (because it doesn't respond well to chemo or radiotherapy) is so drastic.

The most common operation is a Whipple's procedure. This operation itself carries a 3-10% mortality rate, is only suitable for early stage cancer in the fit and healthy and you're left without a pancreas, duodenum and part of the stomach. Obviously, this then can cause problems with digesting and processing food, as well as diabetes and other complications.

The prognosis for this cancer is not good and the pain can be severe- some studies have shown that a significant proportion of pancreatic cancer patients commit suicide because of intractable pain, although modern palliative care techniques and treatments make this much less likely than in the bad old days.

Northern Piper- I'm sorry about your friend. Try to hold onto the good.

[samclem]

Since this thread is a zombie and has pretty well been answered, let's close it.

samclem GQ moderator