A Cup of Coffee – Pancreatic Cancer

Welcome back! Last week, we talked about my high school reunion. I hope some of you could relate! If you missed that blog and would like to catch up, please click HERE.

This week, my husband took me to see the 35th anniversary of the release of Dirty Dancing. After the movie ended, we talked about Patrick Swayze and the fact that he passed away from pancreatic cancer. It got me thinking about this type of cancer, and I decided to do some research on its signs and symptoms to share with you all.

Authors Note: Please read the two comments left at the end of this blog by two doctors who I personally know and trust. If you have Pancreatic Cancer, their comments may be important to you.

How does Pancreatic Cancer come to be?

Pancreatic cancer happens when malignant (cancerous) cells grow, divide, and spread in the pancreas. The pancreas is a 6-inch-long, spongy, tube-shaped organ located in the back of the abdomen, behind the stomach. It has two major jobs in the body: to make digestive juices (called enzymes) that help break down food, and to make hormones — including insulin — that control the body’s use of sugars and starches.

Famous People who have experienced pancreatic cancer

WebMD lists the following famous celebrities who battled pancreatic cancer: Jeopardy host Alex Trebek, Supreme Court Justice Ruth Bader Ginsburg, Apple co-founder Steve Jobs, Aretha Franklin, John Hurt, Luciano Pavarotti, Sharon Jones, Alan Rickman, John Birks “Dizzy” Gillespie, Sally Ride, Michael Landon, Joan Crawford, Gene Upshaw, Benjamin Orr, Charlotte Rae, and actor Patrick Swayze are among those who have died of pancreatic cancer.  

Do you know the symptoms?

People often don’t have symptoms in the early stages of this disease. The Mayo Clinic lists the following symptoms that could appear…

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

How many people survive it?

Know that survival rates can’t predict what will happen to any single person and may not reflect newer types of treatment. 

That said, The American Cancer Society says that: A relative survival rate compares people with the same type and stage of pancreatic cancer to people in the overall population. For example, if the 5-year relative survival rate for a specific stage of pancreatic cancer is 50%, it means that people who have that cancer are, on average, about 50% as likely as people who don’t have that cancer to live for at least 5 years after being diagnosed.

Where do these numbers come from?

The American Cancer Society relies on information from the SEER* database, maintained by the National Cancer Institute (NCI), to provide survival statistics for different types of cancer.

The SEER database tracks 5-year relative survival rates for pancreatic cancer in the United States, based on how far the cancer has spread. The SEER database, however, does not group cancers by AJCC TNM stages  (stage 1, stage 2, stage 3, etc.). Instead, it groups cancers into localized, regional, and distant stages:

• Localized: There is no sign that the cancer has spread outside of the pancreas.
• Regional: The cancer has spread from the pancreas to nearby structures or lymph nodes.
• Distant: The cancer has spread to distant parts of the body such as the lungs, liver or bones.

5-year relative survival rates for pancreatic cancer

Based on people diagnosed with pancreatic cancer between 2011 and 2017.

SEER Stage	5-year Relative Survival Rate
Localized	42%
Regional	14%
Distant	3%
All SEER stages combined	11%

Understanding the numbers

• These numbers apply only to the stage of the cancer when it is first diagnosed. They do not apply later on if the cancer grows, spreads, or comes back after treatment.
• These numbers don’t take everything into account. Survival rates are grouped based on how far the cancer has spread, but your age, overall health, how well the cancer responds to treatment, tumor grade, extent of resection, level of tumor marker (CA 19-9), and other factors will also affect your outlook.
• People now being diagnosed with pancreatic cancer may have a better outlook than these numbers show. Treatments improve over time, and these numbers are based on people who were diagnosed and treated at least five years earlier.

*SEER= Surveillance, Epidemiology, and End Result

Is there anything that specifically causes it?

According to The Mayo Clinic,

“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, Lynch syndrome, and familial atypical mole-malignant melanoma (FAMMM) syndrome
• 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”.

How is it diagnosed?

This particular cancer can be tricky to diagnose early on. A doctor may not see or feel a small tumor during a routine exam. To help make the diagnosis, you may get imaging tests such as an ultrasound or CT scan. These studies also help your doctor choose the most appropriate treatment. For an actual diagnosis, you’ll get a biopsy (your doctor uses a needle or does an operation to take a bit of tissue from the tumor for testing).

Can it be removed?

Surgery to remove the tumor can sometimes cure cancer if it hasn’t spread past the pancreas. Your surgeon will keep as much of the normal pancreas intact as possible. If the tumor is too large to remove, a different type of surgery might be an option. The goal would be to help ease some of the symptoms and prevent certain problems related to the size of the cancerous mass.

Do I need radiation therapy?

This therapy uses high-powered radiation to kill cancer cells. You could possibly receive radiation therapy 5 days a week for several weeks. This schedule helps to protect normal tissue by spreading out the total dose of radiation. Radiation therapy can help relieve pain or digestive problems caused by large tumors.

How about chemotherapy?

Chemotherapy uses drugs to destroy cancer cells and stop them from growing or multiplying. It may involve one drug or a combination of drugs, and you may get it by mouth or by injection. The drugs enter the bloodstream and travel through the body, making chemotherapy a good choice for cancer that has spread. You may also get it after surgery to kill any cancer cells left behind.

What is targeted therapy?

Targeted therapies attack specific parts of the cancer cells, seem to have fewer side effects than chemotherapy, and are less harmful to normal cells. Doctors can use a targeted therapy called erlotinib (Tarceva) along with chemo to treat advanced pancreatic cancer. Side effects can include a rash, diarrhea, appetite loss, and fatigue.

What is immunotherapy?

Immunotherapy uses your immune system to fight disease. For pancreatic cancer, doctors can use pembrolizumab (Keytruda) to block a protein called PD-1 so that the immune system can attack cancer. Side effects can include fatigue, skin problems, joint pain, and gut problems (constipation, diarrhea, and nausea). More serious side effects can happen if the immune system starts to attack the body itself.

Is it time for Palliative Care?

Palliative therapy is recommended to help ease symptoms and manage pain at any stage of this disease. The goal is to improve the quality of life in mind, body, and spirit.

Where can I find support?

For resources to help you and your loved ones as you journey through your pancreatic cancer, reach out to these organizations:

• Pancreatic Cancer Action Network helpline: 877-435-8650
• American Cancer Society: 800-227-2345
• Cancer Care: 800-813-HOPE (4673)

Can I prevent Pancreatic Cancer?

You can take action against the risk factors you can control.

The American Cancer Society’s tips:

• If you smoke, quit now.
• Get to a healthy weight and be physically active.
• Eat a healthy diet, focusing especially on plant foods.
• If you drink alcohol, keep it moderate. Heavy drinking may be a risk factor.

If I’ve already been diagnosed, what can I do besides chemo/radiation therapy?

According to John Hopkins, “Regardless of treatment type, pancreatic cancer takes a toll on the body and a person’s ability to maintain a healthy diet and nutrition. Below are some tips patients with pancreatic cancer find helpful to optimize nutrition during and after treatment.

1. Monitor and maintain a healthy weight. It is normal to lose some weight after being diagnosed with pancreatic cancer and beginning treatment. Excessive weight loss and poor nutrition can cause a decrease in the body’s ability to fight infection and tolerate treatment. To help maintain a healthy weight:
   • Weigh yourself weekly.
   • Consult your care team and dietitian if you are losing more than 1 or 2 pounds a week. They can teach you ways to increase calorie and protein intake.
   • Avoid excessive weight loss, and seek help early with your care team to optimize nutrition.
2. Stay hydrated. Drink enough fluid during cancer treatment to prevent dehydration.
   • Aim for eight 8-ounce glasses (64 ounces) per day.
   • To avoid feeling full at mealtime, drink fluids one hour before or after a meal.
   • Choose beverages that contain calories and nutrients.
   • Avoid excess caffeine and alcohol, which may lead to dehydration.
3. Eat small, frequent meals. Frequent small meals will ensure your body has enough nutrients to tolerate treatment. Smaller meals are often better tolerated when enduring treatment side effects like nausea and lack of appetite. Consider setting an alarm to eat five to six meals per day every three to four hours.
4. High-protein foods with every meal. Protein-rich foods help the body repair damaged cells and assist the immune system in recovering from illness. Lean proteins are easy to digest and should be included with each meal and snack.
   • Baked, grilled, or boiled lean meats such as chicken, turkey, and fish
   • Eggs
   • Nut butter such as peanut, almond, or cashew
   • Low-fat dairies such as milk, yogurt, and cheese
   • Beans
   • Soy products/tofu
   • Protein bars
5. Consider the use of liquid supplements or shakes. As a side effect of treatment, sometimes food becomes less palatable or difficult to digest. When it is difficult to eat, liquids are easier to digest and can often be better tolerated. Be sure these supplements are protein-rich. Foods that may help increase your caloric intake include:
   • Protein drinks
   • Bone broths to add to soup broths
   • Shakes made from Greek yogurt or high-protein milk
   • Pureed soups
   • Smoothies
6. Choose foods that are easy to digest. Side effects of pancreas cancer treatment can impact digestion. Chopped, soft, or boiled foods are easier for the body to digest. Avoid foods like red meat, pork, or raw vegetables during times when digestion is a challenge.
7. Choose essential whole grain foods. Whole grains are a good source of energy for the body, providing complex carbohydrates and fiber.
   • Oatmeal
   • Whole grain bread
   • Brown rice
   • Whole grain pasta
   • Bulgur
   • Corn
   • Farro
   • Quinoa
8. Choose colorful foods. Whole fruits and vegetables are colorful foods high in antioxidants, which can help fight against cancer. Eat at least five servings per day of fruits and vegetables.
9. Include healthy fats. Unhealthy fried, greasy, and fatty foods may cause digestive issues and increase the risk for cardiac disease. Healthy fats such as these provide energy, support cell growth, and protect organs:
   • Olive oil
   • Canola oil
   • Avocado
   • Seeds
   • Nuts
   • Fatty fish
10. Limit sweets and added sugars. Patients with pancreatic cancer often have trouble digesting foods high in sugar. Foods such as soda, cake, candy, or desserts can increase blood sugar levels and often don’t provide nutritional benefits. Avoid these foods, and replace them with foods of high nutritional value.
11. Watch for changes in bowel habits. Pancreatic cancer and treatments can often lead to changes in bowel habits including diarrhea, constipation, bloating, and gas. If you experience changes in your bowel habits, let your health care team know. You may need to change your diet or medications or add supplemental pancreatic enzymes taken with meals. These may help with the absorption of nutrients and vitamins from your food.
12. Stay active. Exercise can help stimulate appetite and natural endorphins, and staying active may create a sense of well-being and allow you to eat more. When possible, engage with family and friends during mealtime to make the experience more enjoyable.”

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As always, this blog is not a replacement for sound medical advice. I am not a doctor. Please make an appointment to see your healthcare provider and put a good plan in place that works for you and the needs of your body.

That’s all I have for you this week, dear reader. I’ll see you back here next Wednesday to share another cup of coffee. Until then, be good to yourself and each other.

Mind, Body, Spirit…Osteopathic Doctors treat the whole person, not just the ailment. Is your PCP a DO? Would you like to learn more about Osteopathic Physicians? Click HERE!