Pancreatic Cancer – Episode 44, To Your Health With Dr. Jim Morrow
Popular “Jeopardy” host Alex Trebek just passed away from complications caused by pancreatic cancer. On this edition of “To Your Health,” Dr. Morrow covers pancreatic cancer, its possible causes, including genetic factors, and the limited effective treatment options. Dr. Morrow also offers a Covid-19 update which includes advice on how to handle family visits for Thanksgiving. “To Your Health” is brought to you by Morrow Family Medicine, which brings the CARE back to healthcare.
About Morrow Family Medicine and Dr. Jim Morrow
Morrow Family Medicine is an award-winning, state-of-the-art family practice with offices in Cumming and Milton, Georgia. The practice combines healthcare information technology with old-fashioned care to provide the type of care that many are in search of today. Two physicians, three physician assistants and two nurse practitioners are supported by a knowledgeable and friendly staff to make your visit to Morrow Family Medicine one that will remind you of the way healthcare should be. At Morrow Family Medicine, we like to say we are “bringing the care back to healthcare!” Morrow Family Medicine has been named the “Best of Forsyth” in Family Medicine in all five years of the award, is a three-time consecutive winner of the “Best of North Atlanta” by readers of Appen Media, and the 2019 winner of “Best of Life” in North Fulton County.
Dr. Jim Morrow, Morrow Family Medicine, and Host of “To Your Health With Dr. Jim Morrow”
Dr. Jim Morrow is the founder and CEO of Morrow Family Medicine. He has been a trailblazer and evangelist in the area of healthcare information technology, was named Physician IT Leader of the Year by HIMSS, a HIMSS Davies Award Winner, the Cumming-Forsyth Chamber of Commerce Steve Bloom Award Winner as Entrepreneur of the Year and he received a Phoenix Award as Community Leader of the Year from the Metro Atlanta Chamber of Commerce. He is married to Peggie Morrow and together they founded the Forsyth BYOT Benefit, a charity in Forsyth County to support students in need of technology and devices. They have two Goldendoodles, a gaggle of grandchildren and enjoy life on and around Lake Lanier.
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The complete show archive of “To Your Health with Dr. Jim Morrow” addresses a wide range of health and wellness topics, and can be found at www.toyourhealthradio.com.
Dr. Morrow’s Show Notes
Overview
- Pancreatic cancer begins in the tissues of your pancreas —
- an organ in your abdomen that lies behind the lower part of your stomach.
- Your pancreas releases enzymes that aid digestion and produces hormones that help manage your blood sugar.
- Several types of growths can occur in the pancreas,
- including cancerous and noncancerous tumors.
- The most common type of cancer that forms in the pancreas begins in the cells that line the ducts that carry digestive enzymes out of the pancreas (pancreatic ductal adenocarcinoma).
- Pancreatic cancer is seldom detected at its early stages when it’s most curable.
- This is because it often doesn’t cause symptoms until after it has spread to other organs.
- Pancreatic cancer treatment options are chosen based on the extent of the cancer. Options may include surgery, chemotherapy, radiation therapy or a combination of these.
Symptoms
- Signs and symptoms of pancreatic cancer often don’t occur until the disease is advanced.
- They may include:
- Abdominal pain that radiates to your back
- Loss of appetite or unintended weight loss
- Yellowing of your skin and the whites of your eyes (jaundice)
- Light-colored stools
- Dark-colored urine
- Itchy skin
- New diagnosis of diabetes or existing diabetes that’s becoming more difficult to control
- Blood clots
- Fatigue
· When to see a doctor
- See your doctor if you experience any unexplained symptoms that worry you.
- Many other conditions can cause these symptoms,
- so your doctor may check for these conditions as well as for pancreatic cancer.
Causes
- It’s not clear what causes pancreatic cancer.
- Doctors have identified some factors that may increase the risk of this type of cancer,
- including smoking
- and having certain inherited gene mutations.
- Doctors have identified some factors that may increase the risk of this type of cancer,
Understanding your pancreas
- Your pancreas is about 6 inches (15 centimeters) long
- and looks something like a pear lying on its side.
- It releases (secretes) hormones,
- including insulin, to help your body process sugar in the foods you eat.
- And it produces digestive juices to help your body digest food and absorb nutrients.
How Pancreatic Cancer Forms
- Pancreatic cancer occurs when cells in your pancreas develop changes (mutations) in their DNA.
- A cell’s DNA contains the instructions that tell a cell what to do.
- These mutations tell the cells to grow uncontrollably
- and to continue living after normal cells would die.
- These accumulating cells can form a tumor.
- When left untreated, the pancreatic cancer cells can spread to nearby organs and blood vessels and to distant parts of the body.
- Most pancreatic cancer begins in the cells that line the ducts of the pancreas.
- This type of cancer is called pancreatic adenocarcinoma
- or pancreatic exocrine cancer.
- Less frequently, cancer can form in the hormone-producing cells or the neuroendocrine cells of the pancreas.
- These types of cancer are called
- pancreatic neuroendocrine tumors,
- islet cell tumors or
- pancreatic endocrine cancer.
- This type of cancer is called pancreatic adenocarcinoma
Risk factors
- Factors that may increase your risk of pancreatic cancer include:
- Smoking
- Diabetes
- Chronic inflammation of the pancreas (pancreatitis)
- Family history of genetic syndromes that can increase cancer risk,
- including a BRCA2 gene mutation,
- Family history of pancreatic cancer
- Obesity
- Older age, as most people are diagnosed after age 65
- A large study demonstrated that the combination of
- smoking,
- long-standing diabetes
- and a poor diet
- increases the risk of pancreatic cancer beyond the risk of any one of these factors alone.
Complications
- As pancreatic cancer progresses, it can cause complications such as:
- Weight loss.
- A number of factors may cause weight loss in people with pancreatic cancer.
- Weight loss might happen as the cancer consumes the body’s energy.
- Nausea and vomiting caused by cancer treatments or a tumor pressing on your stomach may make it difficult to eat.
- Or your body may have difficulty processing nutrients from food because your pancreas isn’t making enough digestive juices.
- Weight loss.
- Pancreatic cancer that blocks the liver’s bile duct can cause jaundice.
- Signs include yellow skin and eyes,
- dark-colored urine,
- and pale-colored stools.
- Jaundice usually occurs without abdominal pain.
- A growing tumor may press on nerves in your abdomen,
- causing pain that can become severe.
- Pain medications can help you feel more comfortable.
- Treatments, such as radiation and chemotherapy, might help slow tumor growth and provide some pain relief.
- In severe cases, your doctor might recommend a procedure to inject alcohol into the nerves that control pain in your abdomen (celiac plexus block).
- This procedure stops the nerves from sending pain signals to your brain.
- A growing tumor may press on nerves in your abdomen,
- Bowel obstruction.
- Pancreatic cancer that grows into or presses on the first part of the small intestine (duodenum) can block the flow of digested food from your stomach into your intestines.
Treatment
RESECTABLE LESIONS
- Surgical resection is the only potentially curative treatment for pancreatic ductal adenocarcinomas.
- Approximately 15% to 20% of patients have resectable disease,
- but less than 20% of patients who undergo surgery survive five years.
- Although immediate postoperative mortality is less than 5%,
- the median survival is about 12 to 19 months.
- Studies support the recommendation that pancreatic resections should be performed at high-volume institutions,
- generally those that complete at least 15 pancreatic resections annually.
- Higher-volume centers have reported
- decreased mortality rates,
- shorter hospital stay,
- and lower overall cost compared with low-volume institutions.
- Approximately 15% to 20% of patients have resectable disease,
- The classic surgery for resection of a carcinoma of the head of the pancreas is a pancreaticoduodenectomy,
- also known as a Whipple procedure.
- In this surgery, the gallbladder, common bile duct, second portion of the duodenum, and the head of the pancreas are resected.
- also known as a Whipple procedure.
- Tumors involving the body or tail of the pancreas are rarely resectable.
- They are usually advanced at diagnosis and cause symptoms late in their development.
- There is no standard for providing adjuvant treatment of pancreatic ductal adenocarcinomas postoperatively.
- Chemotherapy improves survival by two to three months compared with observation alone.
UNRESECTABLE LESIONS
- More than 80% of patients present with disease that is not surgically resectable.
- Although a histologic diagnosis is not necessary before surgery,
- it is required for treatment of locally advanced,
- unresectable,
- or metastatic disease.
- Some studies have addressed the use of chemoradiation with or without chemotherapy to convert unresectable disease status to resectable.
- Postresection, these patients have survival rates similar to those with disease initially determined to be resectable.
- it is required for treatment of locally advanced,
LOCALLY ADVANCED LESIONS AND METASTASIS
- The primary goals of treatment for advanced pancreatic cancers are palliation and improved survival.
- In some patients who have good performance status (i.e., adequate nutrition and pain control),
- some effect on survival may be achieved.
- In some patients who have good performance status (i.e., adequate nutrition and pain control),
- The National Comprehensive Cancer Network recommends
- systemic chemotherapy
- followed by chemoradiation therapy as a treatment option.
- systemic chemotherapy
PALLIATIVE CARE
- Very often, when this is diagnosed, there is already nothing that can be done for the patient. It is just that bad a disease.
Prevention
- You may reduce your risk of pancreatic cancer if you:
- Stop smoking.
- If you smoke, try to stop.
- Talk to your doctor about strategies to help you stop, including support groups, medications and nicotine replacement therapy.
- If you don’t smoke, don’t start.
- Stop smoking.
- Maintain a healthy weight.
- If you are at a healthy weight, work to maintain it.
- If you need to lose weight, aim for a slow, steady weight loss — 1 to 2 pounds (0.5 to 1 kilogram) a week.
- Combine daily exercise with a diet rich in vegetables, fruit and whole grains with smaller portions to help you lose weight.
- Maintain a healthy weight.
- Choose a healthy diet.
- A diet full of colorful fruits and vegetables and whole grains may help reduce your risk of cancer.
- Choose a healthy diet.
- Consider meeting with a genetic counselor if you have a family history of pancreatic cancer.
- He or she can review your family health history with you and determine whether you might benefit from a genetic test to understand your risk of pancreatic cancer or other cancers.
