Wellness
Beth HonzDirector of Nutritional Services
Page 8 Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8
I’m participating in the Race for the Cure next weekend, (walking it, ‘cause I’m a weenie). I read recently who Susan G. Komen was, and why early detection is such a big part of her foundation. While there are web pages out there that are pro/con cancer prevention via nutrition, I’m on the fence, and I’m afraid to say, I don’t know a whole lot about the topic. I’m much better at dealing with nutritional issues once a person has been diagnosed, and is beginning treatment. And while this will likely have nothing to do with nutrition, (it’s too early to discuss how to correctly thaw and cook a turkey), and while I don’t want to steal Breast Cancer’s thunder (because the Susan G. Komen Foundation is important and does amazing work), I’d like to talk about pancreatic cancer this week. I’d like to talk about it because unlike breast cancer or prostate cancer, early detection in pancreatic cancer is not really an option.
Pancreatic cancer is the fourth leading cause of death in the United States, and yet, this is a topic about which your average American is probably fairly under-educated. November is Pancreatic Cancer Awareness Month (I only know this because I just Googled it), and there are purple bands that may be purchased to support awareness, but it pales in comparison to some of the larger awareness groups. The research money spent on pancreatic cancer is just a fraction of what is spent on breast or prostate cancers. Each year, roughly 42,470 people are diagnosed with pancreatic cancer, and the prognosis is grim. For all 4 stages of cancer combined, there is a 1-year survival rate of about 20%. The 5-year survival rate is about 4%. There is no regular screening for it; no way to perform a pancreas self-exam. What makes pancreatic cancer particularly heinous is that generally, by the time it is detected, the malignancy is too complicated to be removed, or has spread to the surrounding organs (which generally happens quickly) or the lymph nodes. If it can be removed, the average survival is 18 to 20 months, with a 5-year survival rate of 20-25%. The symptoms are kind of vague:
• Pain in the upper abdomen or upper back.
• Yellow skin, yellow whites of the eyes, (called jaundice), amber-colored urine.
• Weakness.
• Loss of appetite.
• Weight loss.
• Nausea/Vomiting (quite often, in the absence of jaundice, these are the symptoms that get someone into his/her doctor’s office. If cancer has spread to the gallbladder, someone might have problems digesting fat, which could lead to nausea/vomiting and strange looking diarrhea)
So what does your pancreas do, and can you live without it? Your pancreas is packed into the middle of your abdomen and surrounded by the stomach, small intestine, liver, spleen and gallbladder. Your pancreas is a pretty important organ, although you can live without it. Its main function is to produce hormones and pancreatic juices. Probably the most important hormone produced by your pancreas is insulin. In a nutshell, insulin helps to take the energy produced by carbohydrates from your blood stream and distributes it into cells. Your pancreatic juices are also particularly important as it contains pancreatic amylase and pancreatic lipase which are enzymes critical in the digestion of carbohydrates and fats respectively. You can live without your pancreas because scientists have developed insulin injections and oral pancreatic enzymes which perform the same functions as their natural counterparts. (And here’s my nutrition tag: Because a person with pancreatic cancer may need to take insulin or pancreatic enzymes, that person should see a dietitian who specializes in cancer.)• Yellow skin, yellow whites of the eyes, (called jaundice), amber-colored urine.
• Weakness.
• Loss of appetite.
• Weight loss.
• Nausea/Vomiting (quite often, in the absence of jaundice, these are the symptoms that get someone into his/her doctor’s office. If cancer has spread to the gallbladder, someone might have problems digesting fat, which could lead to nausea/vomiting and strange looking diarrhea)
The risk factors for developing pancreatic cancer are also not terribly specific:
• Age: Most people diagnosed are over the age of 60.
• Smokers: People who smoke cigarettes are 2-3 times more likely to develop pancreatic cancer, (although I read a cohort study where people who quit smoking over 10 years ago have the same risk as those who never smoked Arch Intern Med. 2009;169(8):764-770)
• Diabetes and Chronic Pancreatitis: People who have chronic issues with their pancreas are more likely to develop pancreatic cancer.
• Gender: Men are more likely than women to develop pancreatic cancer.
• Race: African Americans are more likely to develop pancreatic cancer than Asians, Hispanics or Caucasians.
• Genetics: People who have a parent or sibling with pancreatic cancer are 3 times more likely to develop it. Also, if they have a family history of colon or ovarian cancer they are more likely to develop pancreatic cancer.
The above study also looked at dietary habits and alcohol consumption with no real conclusions as to how they may affect pancreatic cancer development. The National Cancer Institute lists other reports indicating that people whose diets were high in fat were at risk for developing pancreatic cancer. • Smokers: People who smoke cigarettes are 2-3 times more likely to develop pancreatic cancer, (although I read a cohort study where people who quit smoking over 10 years ago have the same risk as those who never smoked Arch Intern Med. 2009;169(8):764-770)
• Diabetes and Chronic Pancreatitis: People who have chronic issues with their pancreas are more likely to develop pancreatic cancer.
• Gender: Men are more likely than women to develop pancreatic cancer.
• Race: African Americans are more likely to develop pancreatic cancer than Asians, Hispanics or Caucasians.
• Genetics: People who have a parent or sibling with pancreatic cancer are 3 times more likely to develop it. Also, if they have a family history of colon or ovarian cancer they are more likely to develop pancreatic cancer.
Depending on how advanced the tumor is at the time of diagnosis, there are a few treatment options: (and, again, this is a dietitian explaining these procedures. There are smarter, more knowledgeable people out there)
• Surgery: There are a few different surgical options, but the procedure best associated with pancreatic cancer is called the Whipple Procedure (named for Allen Oldfather Whipple. His first Whipple procedure patient lived 8-ish months). This is where surgeons remove the head of the pancreas, the gallbladder, part of the stomach, part of the small intestine, and the bile duct. This is supposed to leave enough of the pancreas to produce insulin and pancreatic juices, but most people who undergo this procedure need to take supplemental pancreatic enzymes.
• Chemotherapy: Generally given through the blood stream. Most patients will have a port placed. This is a kind of a fancy IV where the internal part has direct access to the patient’s bloodstream, but it has outside access so that the patient isn’t poked with a needle every time he goes in for a treatment.
• Radiation Therapy: Depending on where the tumor is located, the radiation may be provided externally, (the machine is outside the body, and sends radiation towards the cancer) or internally, (radioactive stuff is given through needles, catheters or pods and then placed directly into or near the tumor)
Depending on how advanced the tumor is, these treatment options may be combined. Most patients still have some kind of chemotherapy or radiation or both after a Whipple procedure. • Chemotherapy: Generally given through the blood stream. Most patients will have a port placed. This is a kind of a fancy IV where the internal part has direct access to the patient’s bloodstream, but it has outside access so that the patient isn’t poked with a needle every time he goes in for a treatment.
• Radiation Therapy: Depending on where the tumor is located, the radiation may be provided externally, (the machine is outside the body, and sends radiation towards the cancer) or internally, (radioactive stuff is given through needles, catheters or pods and then placed directly into or near the tumor)
And just like we always say at OWL, it is key for patients to have strong family support.
So that is pancreatic cancer in a nutshell. A tiny nutshell. Like I stated earlier, there are people far smarter than me who could explain things better. If you have questions regarding pancreatic cancer, talk to your doctor or other healthcare professional. I found the following web pages useful:
www.cancer.gov
www.pancreatic.org
www.pancan.org/
Have an excellent day:
Thanks:
Beth
