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Pancreatic cancer declining, but among most deadly
Question of the Day
Pancreatic cancer is notoriously lethal _ there are almost as many deaths from it each year as there are new cases. The deaths this week of Apple founder Steve Jobs and Nobelist Ralph Steinman bring unusual attention to this less-well-known type of cancer that has actually been declining despite no big advances in treatment or finding it early.
A decline in smoking, one of the top risk factors for the disease, may be behind the drop in cases.
Jobs lived more than seven years after being diagnosed with a neuroendocrine tumor _ a less common, slower-growing and more treatable type of pancreatic cancer than the kind that killed Steinman a week ago and actor Patrick Swayze two years ago.
The Apple chief kept details of his illness behind a firewall and declared he was cured after cancer surgery in 2004. However, five years later, gaunt and having lost a lot of weight, Jobs had a liver transplant. Experts said it was likely because his cancer had returned or spread.
A liver transplant sometimes can cure the type of cancer that Jobs had. But if it comes back, “it’s usually in one to two years,” said Dr. Michael Pishvaian of Georgetown University's Lombardi Comprehensive Cancer Center.
In January, Jobs announced his third and final leave of absence. He resigned in August and died on Wednesday.
Part of what makes pancreatic cancer so deadly is that the pancreas is as vital as the heart. You can live with just part of a liver or a colon, or only one kidney or lung. But the pancreas is a fish-shaped organ that makes digestive enzymes and insulin and other hormones that enable the body to make energy from food.
In the United States, pancreatic cancer is the fourth leading cause of cancer deaths. About 44,030 people will be diagnosed with it and about 37,660 people will die of it this year in the U.S., the American Cancer Society estimates.
Possible symptoms are fatigue, back pain, abdominal pain, unexplained weight loss, loss of appetite, jaundice and nausea, according to the Lustgarten Foundation, a private group that finances research on the disease.
This cancer often is not found until it is advanced or has spread, and overall survival is dismal: 20 percent after one year and only 4 percent after five years.
However, with a neuroendocrine tumor like the one Jobs had, “people can live a longer time; median survival is five to eight years,” said Dr. Alan Venook, a pancreatic cancer specialist at the University of California, San Francisco.
The lifetime risk of developing pancreatic cancer is about 1 in 71, according to the cancer society. Men and blacks account for more cases than women and whites, possibly because of differences in smoking rates. Smokers have two to three times more risk of developing the disease. Use of smokeless tobacco also raises the risk.
Obese people, those who don’t exercise much and diabetics also have more risk for pancreatic cancer. Alcohol use might play a role: Most studies haven’t tied it to pancreatic cancer, but heavy drinking can lead to diabetes and liver and pancreas problems that pose a cancer risk, the cancer society says.
The best hope for a patient is that the tumor is operable. That was the case in February 2009, when U.S. Supreme Court Justice Ruth Bader Ginsburg had a small, early-stage pancreatic tumor removed at New York’s Memorial Sloan-Kettering Cancer Center.
On the horizon are immune system treatments _ research that Steinman, the Nobel recipient from Rockefeller University in New York, was studying in the lab and trying on his own pancreatic cancer.
By Matt Kibbe
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