Understanding Pancreatic Cancer

Kristie L. Kahl: What can you tell us about the pancreas and what it normally does in the body?

David Whitcomb: The easiest way to explain it is to think about something we all understand. This is a lemon and I'm going to bite into this lemon and one of the digestive organs in my body will work on it. What happens is that the acid in the juices, when they're in my mouth, stimulate the salivary glands to squirt juices into my mouth. And there's two types. The first one is bicarbonate, which neutralizes the citric acid, so the acid goes away. The second thing is there are sugars. And an enzyme, which is a biological scissor, cuts the complex sugars down into simple sugars. And so suddenly, the juices from the lemon go from being so sour to being sweet and not acid anymore. Your pancreas is just like that. It sits right behind the stomach.

When the stomach is filled with food, it changes the food by putting acid in it. And then when the acid goes into the small intestine, the pancreas squirts juices that are the same kind that come from your salivary glands, the bicarbonate and enzymes. And it breaks the food down into simple molecules that your intestine can absorb and it can go through your body. The biggest difference between the salivary glands and the stomach and in the pancreas is that the pancreas makes digestive enzymes that eat proteins. And so it can tread complex proteins into simple amino acids. But if those become active inside the pancreas, it's very bad because the word pancreas means all meat and it literally digests itself. And so instead of digesting a meal, one of the problems we see is digestion of the pancreas, which is the first of three major problems that physicians deal with when they deal with the pancreas.

Kristie L. Kahl: What are some of the diseases of the pancreas?

David Whitcomb: The first one I mentioned is when there's a sudden digestion of the pancreas, it's called acute pancreatitis. Individuals will have sudden severe abdominal pain and often vomiting and it doesn't go away with anything at home. You go to the hospital, they find out your pancreas is inflamed, and it usually takes two or three days for that to settle down. In some cases, it goes bizarre and, in those cases,, the person can be very sick.

The second major problem is chronic pancreatitis. It's where the pancreas has been changed to a scar and the inflammation of the pancreas is a terrible problem because it leads to a number of additional problems. The additional problem from chronic pancreatitis is that it can lead to both diabetes and also to pancreatic cancer. The pancreas not only makes enzymes to break complex sugar down into simple ones, but it releases insulin to signal the cells of the body to take the sugar out of the bloodstream and into the cells for energy. If those cells are damaged, it means that you can't get the signal and you have to inject the insulin into your body in order to replace that function of the pancreas. So acute and chronic pancreatitis, diabetes and cancer are the three big problems that physicians worry about.

Kristie L. Kahl: Is there more than one type of pancreatic cancer that exists?

David Whitcomb: There are relatively benign types of tumors, more common in women than men. There's also endocrine tumors. We talked about the cells that make insulin every once in a while, they'll turn into a type of cancer that is slow growing, and that's what Steve Jobs had – neuroendocrine cancer. And then the third type is called a duct cell. It is one of the types of cells, called adeno carcinoma, and that is the most common and the most feared type because that can lead to very rapid metastasis and even death.

Kristie L. Kahl: Why is early detection so important?

David Whitcomb: Once pancreatic cancer has spread, it's resistant to therapy, even the most advanced and hard-to-tolerate therapies. Even with those therapies, only about 10% of people survive five years. There's only a few other cancers that are so bad as this. However, if it's detected early and removed, then the outcome can be extremely well. People will live 10 or 20 years. That is an important distinction: How can you identify and remove a cancer before it's severe?

Kristie L. Kahl: What are we doing in the early detection of pancreatic cancer?

David Whitcomb: The pancreas is an interesting organ. The pancreas lays behind the stomach across the backbone. So, physicians can't actually feel it, either from the front or the back or the sides. And the early symptoms are often just that you feel uncomfortable, a little bit of abdominal pain, and it doesn't have distinct signs and symptoms, You can't feel it on a physical exam. Many times it is very hard to detect. That is really a challenge. It's not like a prostate or breast exam that doctors use. So that makes it a challenge. It's just located in an obscure location that's hard to hard to reach.

If you recognize that the cancer can grow pretty quickly, people live a long period of time. But you can't do advanced testing on everybody, every few months, because it's just physically impossible. What we try to do is identify people who have a very high likelihood of getting cancer or have early signs and symptoms. Those individuals then undergo screening to see whether or not they actually have pancreatic cancer. Trying to identify it early, based on the earliest signs and symptoms, is extremely important. And if we can identify it, then we've got a way to treat it if it's caught early.

Kristie L. Kahl: How can we raise more awareness?

David Whitcomb: The awareness is largely in primary care doctors and in individual people who are becoming more aware to live a healthy life. They actually have to pay attention to their diet, their lifestyle and those types of things. I think that having a family history is probably a rude awakening to many people. They understand how bad this is and want to try to do what they can do to prevent it. And that's the number one thing to do.

There's very simple things that we've studied. For example, cigarette smoking is one of the worst things and we've had large families we've studied that have inflammation of the pancreas from early age of life, and the risk of cancer was very high. Forty percent of people who got pancreatic cancer by 70, we noticed that the age of onset of cancer and the likelihood of getting cancer was markedly increased in those who smoked, versus those that didn't smoke. We told the family 20 years ago don't smoke, and they stopped, and cancer just plummeted in the family. So now it's down to less than 7% and we think it's going to get even better.

So, that's probably the most important thing: a healthy lifestyle. No smoking, fruits and vegetables, especially things like broccoli and those types of things are best way to prevent it. The early signs and symptoms are a little bit more subtle so they can be hard to catch. The most important signs is unintended weight loss. If you're starting to lose weight, you want to check with your doctor. The second one is abnormal blood sugar. If your blood sugars start getting abnormal, and there's no other explanation for it, then that's another sign. The third one is the skin color. If you start to turn a little bit yolk, especially looking at the whites of your eyes, that's another sign that it maybe pancreatic cancer. So those are the kinds of things that are important for early detection, but more importantly, prevention.