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In the Spotlight: Pancreatic Cancer

This month for our "Rare Diseases" topic we're going to discuss pancreatic cancer (PC).  While not as unheard of as other conditions that we'll be covering, this cancer is still a relatively rare (thankfully) diagnosis.  There have been some high profile people diagnosed with PC in the past several years, including Patrick Swayze, Supreme Court Justice Ruth Bader Ginsberg, and Steve Jobs.  However, compared to lung cancer which has over 200,000 new cases per year, PC rates are closer to 40,000 per year.


Snapshot:  Pancreatic cancer is a rare but comes with a poor prognosis for most people who receive the diagnosis. Men are 30% more likely to get PC than women, and it is most common over the age of 60 (under 40 is rare). PC is the 4th leading cause of cancer-related death in the United States.  One-year survival rates are approximately 25%; however 80% of people living with PC are diagnosed late, after the cancer has advanced or metastasized (moved to other parts of the body, usually the nearby lymph nodes or liver), giving them a poor prognosis with an average 6 to 10 month survival rate. There are several risk factors for developing PC including having a family history, being older, smoking, poor diet, obesity, or having type 2 diabetes.

What is It?
Symptoms tend to vary, depending on where the cancer is located, its size, and type of tissue that is affected. These may include abdominal pain, lower back pain, and jaundice (yellowing of the skin and eyes), weight loss, and other digestive problems.  These vague, and relatively common symptoms, make PC difficult to diagnose and patients may not seek medical treatment, or are told they have some other benign condition to explain their symptoms, which gives the cancer time to grow.  Some people will experience pancreatitis (inflammation of the pancreas) prior to developing PC.

How Common is It?
In 2010, approximately 43,000 people in the United States were diagnosed with PC (or .01% of the population).

What About Diagnosis and Treatment?
Pancreatic cancer is often diagnosed by blood tests and imaging studies.  Liver enzyme tests may show abnormalities.  CT scans, ultrasounds, and needle biopsies all can diagnose PC.  Approximately 85% of patients present to their doctor with left-upper abdominal pain, that may radiate to the back, and is usually made worse by eating.

Treatment varies depending on the stage and location of the cancer. Surgery can be used for localized PC, however this is only the case for about 20% of patients.  A procedure called the "Whipple Procedure" is commonly used to treat PC affecting the head of the pancreas while a "Distal Pancreatectomy" is used when the cancer affects the tail end.  After surgery, the majority of patients have chemotherapy as additional treatment.  For the 80% of patients where surgery is not an option, chemotherapy and/or radiation are the standard treatments. Unfortunately, chemotherapy doesn't tend to cure PC rather provides some relief for the patient and improves quality of life. Radiation has similar uses and outcomes.  Palliative care, or treatment that focuses on the relief of pain, symptoms and stress brought on by PC, is most commonly used once active treatment is over.

What is the Social and Emotional Impact?
A cancer diagnosis is devastating for anyone. Since the prognosis for most people diagnosed with PC is so poor, the social and emotional impact is significant.  Some research shows that depression may be present prior to a PC diagnosis, although this relationship is not clear. In a 2010 study that compared PC to other cancer diagnoses, patients with PC reported much higher rates of depression (29% compared to 18%) than people living with lung, skin, and other cancers.  Men also experienced much more depression than women (34% versus 23%). When compared to people with stomach cancer, PC patients report significantly more tension, anxiety, fatigue, confusion, bewilderment, and overall poorer mood.

Thoughts about death and dying, and other existential issues, are common in people living with PC - especially if their prognosis is poor.  Because survival rates are typically under 1 year, patients must face an often overwhelming level of emotions in a relatively short period of time. Brief psychotherapy (ie, fewer than six sessions) and cognitive behavioral therapy can to be beneficial for patients undergoing palliative care by addressing depressive symptoms, anxiety, and adjustment to their illness.

Helpful Resources:
National Cancer Institute Pancreatic Cancer Page
Pancreatic Cancer Action Network (PANCAN)
American Cancer Society Pancreatic Cancer Page
Michael Rolfe Pancreatic Cancer Foundation

One More Thing...
I personally know of someone who has died because of pancreatic cancer, which is part of the reason I chose to write about PC for this month's entry.  Dr. Eric Van Denburg was my clinical training director while I was at the Jesse Brown VA Medical Center as part of my graduate training in psychology in 2009.  In 2011, Eric was diagnosed with and passed away from advanced pancreatic cancer.  He was a pivotal part of my training to be a psychologist, and I'm sure the hundreds of other trainees and thousands of veterans he served would also sing his praises.  I've joined his daughter Alysa's team to run the Michael Rolfe Foundation Pancreatic Cancer 5K this coming Memorial Day weekend.  Here's more information on Eric, his team, and the organization if you're interested.

Team Eric's Page

Best,
Dr. T.

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