Pancreatic Cancer in the United States

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Pancreatic cancer is one of the most common – and most deadly – forms of cancer in the United States. As the fourth most common cause of cancer-related death in the United States, pancreatic cancer has a very poor prognosis for those who are diagnosed (O'Neill, Atoria, O’Reilly, LaFemina, Henman, and Elkin 5132). Despite the many medical advances that have been made in the past few decades, pancreatic cancer remains one of the deadliest diseases in the United States. Improving outcomes for patients with pancreatic cancer is a top priority for researchers and patients alike. In this paper, I’ll (1) provide a description of pancreatic cancer as a health concern, (2) explain what is thought to cause it, (3) discuss it’s incidence in the United States, (4) explain the organ system that is affected, (5) and describe the medications and surgeries currently used to treat the disease.

Pancreatic cancer is a malignant neoplasm that arises in the pancreas. For all stages combined, fewer than 20% of those diagnosed with pancreatic cancer survive their first year with the disease, and only 3% live for a full five years after diagnosis (Warshaw and Fernandez-Del Castillo 455). This makes pancreatic cancer the type of cancer with the lowest five-year survival rate. Symptoms of pancreatic cancer include pain, jaundice, and weight loss. Jaundice does not occur until the tumor has metastasized, and other symptoms often do not develop until the disease is advanced (Pancreatic Cancer Progress Review Group 3). The diagnostic tools used to detect pancreatic cancer are not always able to detect early stages of the disease, meaning that most patients’ tumors have metastasized at the time of diagnosis (Fernandez-Zapico, Kaczynski, and Urrutia 563). Pancreatic cancer is diagnosed in four stages that indicate the severity and progression of the disease. In the first stage, the pancreatic tumor does not directly extend into adjacent tissues and does not involve the lymph nodes in its region. In the second stage, the tumor does extend into surrounding tissues but still does not involve the lymph nodes. In the third stage, the tumor has spread to the surrounding lymph nodes, and in the fourth stage, the disease has metastasized to distant organs (Warshaw et al. 459).

The cause of pancreatic cancer is unknown, though several environmental factors like chemicals in the drinking water are known to play a role. Those with a family history of pancreatic cancer are three times more likely to develop the disease than other members of the population (Pancreatic Cancer Progress Review Group 18). Cigarette smoking has also been demonstrated to increase the risk of pancreatic cancer, with studies demonstrating both that smokers have higher rates of pancreatic cancer than the rest of the population and that pancreatic tumors can be induced in mice by administering tobacco-specific nitrosamines (Warshaw et al. 455). Diet has been demonstrated to play a role as well. Individuals who eat a high-fat or high-meat diet have elevated rates of pancreatic cancer, and individuals who eat high levels of fresh fruits and vegetables have lower rates. Occupational exposure to certain carcinogens has been associated with pancreatic cancer as well. Manufacturers of 2-naphthylamine, benzidine, and other gasoline derivatives are five times more likely to develop pancreatic cancer than the rest of the population (Warshaw et al. 456). Individuals with Diabetes Mellitus or chronic pancreatitis are more likely to develop pancreatic cancer, though the direction of causation remains unclear. Further research is necessary to better understand how these risk factors are involved in the causation of pancreatic cancer.

The incidence of pancreatic cancer in the United States has been increasing since the 1930s, though at a slower rate since 1973 (Warshaw et al. 455). For reasons that are not fully understood, men are 30% more likely to get pancreatic cancer than women. Blacks are also diagnosed more frequently than whites, with an incidence of 15.2 per 100,000 (Warshaw et al. 455). The median age at diagnosis is 71, and the onset of disease is rare before the age of 45 (Pancreatic Cancer Progress Review Group 18). More than 70% of cases occur in adults aged 65 or older (O’Neill et al. 5132). This means that pancreatic cancer is primarily a problem for older adults in the United States.

The pancreas is an oblong glandular organ that belongs to both the digestive and endocrine systems of the body. It produces several important hormones that circulate in the blood and secretes a digestive juice that aids in the digestion and absorption of nutrients. Pancreatic tumors come in one of two forms, affecting either the exocrine parenchyma or the endocrine cells of the islets of Langerhans (Warshaw et al. 456). Tumors based in the pancreas’ exocrine glands are much more common, and non-epithelial tumors of the endocrine cells are very rare. Between 75 and 92 percent of pancreatic tumors are ductal adenocarcinomas, which are twice as frequently found in the “head” of the pancreas as in the “body” or the “tail” (Warshaw et al. 456). Once metastasized, pancreatic adenocarcinomas commonly spread to the lymphatic system, the liver, the peritoneum, and the lungs.

Pancreatic cancer is treated with a variety of medications and surgeries. The standard operation for pancreatic cancer is called a pancreatoduodenectomy, also referred to as “Whipple’s operation” for short (Warshaw et al. 460). Fewer than 20% of patients are eligible for this procedure because of the severity of so many cases (O’Neill et al. 5132). Because simple tumor-removals do not have high success rates, total pancreatectomies are used to both remove malignant tissue and to avoid the recurrence of subsequent tumors in the tissue. In the United States, a less extensive operation that preserves the pylorus has become common, as it allows the patient to avoid a variety of unpleasant post-operative symptoms (e.g. dizziness, lightheadedness, and abdominal pain) without increasing mortality. Many individuals with pancreatic cancer have tumors that cannot be removed due to their extent and severity. For these individuals, doctors offer treatment for jaundice, duodenal obstruction, and pain. Jaundice is treated through the endoscopic placement of stents in the organ, while duodenal obstruction is treated surgically. The pain produced by pancreatic cancer is most commonly treated with narcotics.

Non-surgical and non-palliative treatments for pancreatic cancer involve radiotherapy, chemotherapy, and endocrine therapy. Radiotherapy is used when pancreatic tumors are not removable but still appear to be localized. Chemotherapeutic agents include fluorouracil, mitomycin, streptozocin, and ifosfamide, each of which is commonly used to treat all stages of pancreatic cancer. Fluorouracil is the most used form of chemotherapy, though other medications are sometimes used as well (Warshaw et al. 461). Endocrine therapy is a less common but especially promising form of treatment. Because experimental evidence links pancreatic cancer to sex hormones, researchers have begun to use antiestrogens and antiandrogens in treatment regimens. Other experimental treatments include photodynamic therapy and radioimmunotherapy, both of which are still in the early phases of testing.

Pancreatic cancer remains one of the most common and most deadly forms of cancer in the United States today. Though researchers have made progress in improving mortality and morbidity rates for patients with pancreatic cancer, much research is still necessary. In this paper, I’ve (1) provided a description of pancreatic cancer as a health concern, (2) explained what is thought to cause it, (3) discussed it’s incidence in the United States, (4) explained the organ system that is affected, (5) and described the medications and surgeries currently used to treat the disease. Future research must consider the various risk factors and populations affected to be effective. By setting specific and reasonable goals for improvement, researchers should be able to improve outcomes for pancreatic patients in the future.

Works Cited

Fernandez-Zapico, Martin E., Joanna A. Kaczynski, and Raul Urrutia. "Pancreatic Cancer Research: Challenges, Opportunities, and Recent Developments." Current Opinion in Gastroenterology, vol. 18, no. 5, 2002, pp. 563-567.

O'Neill, Caitriona B., Coral L. Atoria, Eileen M. O’Reilly, Jennifer LaFemina, Martin C. Henman, and Elena B. Elkin. "Costs and Trends in Pancreatic Cancer Treatment." Cancer, vol. 118, no. 20, 2012, pp. 5132-5139.

Pancreatic Cancer Progress Review Group. Pancreatic Cancer: An Agenda for Action. Bethesda, M.D.: National Cancer Institute, 2001.

Warshaw, Andrew L., and Carlos Fernandez-Del Castillo. "Medial Progress: Pancreatic Carcinoma." New England Journal of Medicine, vol. 326, no. 7, 1992, 455-465.