Pancreatic cancer is among the top four cancer killers in the United States. The American Cancer Society estimates 42,470 new cases will be diagnosed this year and more than 35,000 people will die of the disease.
Until recently, little could be done to save patients from a cancer with symptoms so subtle it often is far advanced before it is diagnosed.
"For years, there was a negative attitude toward the disease. People gave up on it and thought it was hopeless. You didn't even talk about it," says Dr. Mokenge "Mo" Malafa, division chief of the GI Oncology Program and a pancreatic cancer specialist at the H. Lee Moffitt Cancer Center in Tampa.
Today, awareness is much greater as celebrities like actor Patrick Swayze and Apple Computer co-founder Steve Jobs battle the disease publicly and, willingly or not, bring national attention to the need for more research and the money to fund it.
"The high-profile patients have decided to at least help by sharing their stories, so I think there is a little bit more hope than there used to be," says Malafa.
The pancreas is a small organ, about 6 inches long, that sits in the right side of the abdomen, between the stomach and the spine. It helps us digest food, but its more important job is regulating blood sugar and producing insulin.
Scientists don't know precisely why, but the DNA in pancreas cells can become damaged, causing them to grow and multiply abnormally. Eventually those abnormal cells become malignant and a tumor grows. Having an immediate family member with pancreatic cancer, having diabetes, eating a high-fat diet, smoking and being obese, particularly as a teen or young adult, may all increase your risk for the disease.
It can take years for someone to develop symptoms, so the cancer is often advanced and has spread to other organs, usually the liver, by the time it is discovered.
And those symptoms — diarrhea, nausea, abdominal bloating or swelling, abdominal pain, loss of appetite, weight loss and jaundice or yellowing of the eyes and skin — can point in many directions.
"My tumor was 10 centimeters and the doctor said it was probably growing for 10 years," says Gail Christopher, 51, who was diagnosed with stage IV pancreatic cancer in September.
The Clearwater woman thought a bout of persistent diarrhea was just a bad case of stomach flu. But two days later, when she thought she saw blood in her stool, Christopher went to the ER. Tests revealed a tumor growing in the base of her pancreas. "It was wrapped around my spleen and had metastasized to the liver and possibly my stomach," she says.
Christopher underwent eight months of chemotherapy, standard treatment when the cancer has spread.
She says most of the tumor is gone, but to help ward off regrowth, Christopher is scheduled to have surgery next week to remove a large section of her pancreas and her spleen. Doctors will also use ablation, high heat, to kill tumor cells on the liver.
Pancreatic cancer is very aggressive and difficult to treat. If it hasn't spread to other organs, about a third of all patients are candidates for a complicated surgery known as the Whipple procedure, which is the surgery Steve Jobs had in 2004. Malafa says the procedure, in which the head of the pancreas and other organs are removed and the digestive system is rerouted, cures about 30 percent of patients.
As people become more aware of pancreatic cancer, doctors and patients hope that research dollars will increase, too. According to the Pancreatic Cancer Action Network, the National Cancer Institute spends less than 2 percent of its annual budget on pancreatic cancer research.
Malafa is involved in several pancreatic cancer studies at Moffitt, but he's most excited about one that focuses on early detection of the disease and another looking at the role of vitamin E in prevention.
Also promising is research being done at the James A. Haley VA Medical Center in Tampa. That's where Dr. David Vesely has been working for the past five years on a peptide, a hormone made in the human heart, that stops the growth of pancreatic cancer in laboratory mice, essentially curing them of the disease. You can hear Vesely talk about his work tonight at a meeting of the Pancreatic Cancer Action Network in Tampa.
Vesely says the mice are given human pancreatic cancer cells and within a month have large tumors under their skin. The tumors are treated for four weeks with a very high dose of a synthetic form of the peptide and 80 percent of the mice are cured. Those that aren't cured are left with just 2 percent of their original cancer.
"The cancer never comes back. These mice do not die of pancreatic cancer," says Vesely, who is chief of endocrinology at Haley and is director of USF's Cardiac Hormone Center.
Of course, therapies that work on mice do not always work in humans, so more research must be done. The peptides have been tested in patients with congestive heart failure, where they have been proven safe and effective at strengthening the heart and reducing fluid buildup. Trials on human cancer patients are on hold until $20 million can be raised to fund the next phase of research.
"It's very promising. We are also curing breast cancer and lung cancer (in mice),'' Vesely said. "It's really pretty spectacular."
Irene Maher can be reached at firstname.lastname@example.org or (813) 226-3416.