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Senior Citizen Health & Medicine
Pancreatic Cancer Surgery Can Help Those Even Over
80
More than 70% with
pancreatic cancer are seniors over age 65
June 13, 2006 A new study of pancreatic surgery
during the last 35 years at Johns Hopkins University in Baltimore has
found that contrary to what many both in and out of medicine may
believe, major pancreatic cancer surgery can successfully be performed
on patients in their 80s, 90s and even older. It is welcome news for
senior citizens, aware that 70 percent of those found with this deadly cancer
are over age 65.
(See more
about pancreatic cancer below news story.)
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Pancreatic Cancer Risk Higher In Newly Diagnosed
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Aug. 1, 2005 The onset of hyperglycemic diabetes
in adults age 50 or older may be a signal of underlying pancreatic
cancer. The risk of developing the deadly cancer within three years
after a new diagnosis of diabetes is eight times higher than for the
average same-age individual (1 in 120), according to researchers at the
May Clinic Cancer Center. For years, there has been controversy over
whether type 2 diabetes predisposes people to pancreatic cancer or if
diabetes is an indicator of underlying pancreatic cancer. This is the
first study to evaluate the importance of using age at diabetes
diagnosis as an indicator for pancreatic cancer.
Read more...
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Health & Medicine |
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Pancreatic cancer surgeon Charles J. Yeo, M.D.,
Samuel D. Gross Professor and chair of surgery at Jefferson Medical
College of Thomas Jefferson University and Thomas Jefferson University
Hospital in Philadelphia and Jeffersons Kimmel Cancer Center, and
colleagues reported the study recently in the Journal of
Gastrointestinal Surgery.
Dr. Yeo and co-workers examined records of nearly
2,700 cases of the standard Whipple operation for pancreatic disease,
including cancer. Of these, about 1,000 operations were performed in the
last four years.
The Whipple procedure entails the surgical removal
of the head of the pancreas, the duodenum (part of the small intestine),
part of the common bile duct, the gallbladder and sometimes a portion of
the stomach.
● Of this group, 207 patients were 80 years old
or older. Those who were 80 to 89 years of age had a mortality rate of
4.1 percent (8 of 197), and a complication rate of 52.8 percent.
● Those younger than 80 years old had a mortality
rate of 1.7 percent, with a complication rate of 41.6 percent.
● Of 10 patients 90 or older, the researchers
reported no deaths after surgery, though half had complications.
● Of those 80 to 89 years old, 59.1 percent lived
for at least one year, while 60 percent of patients 90 years and older
lived that long after surgery.
Such complication rates for individuals at least 80
years old are what would be expected, Dr. Yeo says, and involve
conditions that afflict many that age, such as heart disease, diabetes
and high blood pressure. The general aging population isnt dying from
pancreas disease, he notes. They are dying from other causes.
If there is a mass that is respectable (removable
by surgery) in the pancreas, chances are that we can take it out safely
and the patient will do well, Dr. Yeo says. As the population ages,
more individuals may be eligible for such surgery.
The five-year survival of those who were operated
on for cancer is comparable to the general population, he says. In the
general population, five-year survival in healthy individuals at age 80
is 69 percent. In our study, it was 55 percent, which isnt that much
different.
For various reasons, many of those older than 80
have been told they are not candidates for pancreatic cancer surgery.
Whether it was because of other health issues, poor scans or just a
mindset that operating on the pancreas after age 80 doesnt make much
sense, there have been reasons not to operate on these individuals.
The take home message is, if an experienced group
of surgeons safely perform the right operation, the patient likely will
do fine, Dr. Yeo says. Patients usually can leave the hospital in a
week and can be on a survival curve that approaches the normal curve of
the general population.
According to Dr. Yeo, new imaging techniques,
improved early detection and screening of high-risk groups, and new
therapies on the horizon have begun to change the way pancreatic cancer
is viewed. Were actually making great progress when it comes to
pancreatic cancer, he says.
Pancreatic cancer, the fifth-leading cause of
cancer death in this country, takes some 30,000 lives a year. The
disease is difficult to treat, particularly because it is frequently
detected after it has spread to other areas on the body.
Only 4 percent of all individuals with pancreatic
cancer live for five years after diagnosis, and approximately 25 percent
of those diagnosed with pancreatic cancer who undergo successful
surgical removal of their disease live at least that long.
But recent figures give new hope: of those who live
for five years after surgical resection, some 55 percent will be alive
at least another five years.
About Pancreatic Cancer from American
Cancer Society
Key Statistics About Cancer of the
Pancreas?
The
American Cancer Society estimates that 33,730 Americans (17,150 men and
16,580 women) will be diagnosed with cancer of the pancreas during 2006.
Over the past 15 to 25 years, rates of cancer of the pancreas have
slowly dropped in men and women.
An estimated 32,300 Americans (16,090 men and
16,210 women) will die of pancreatic cancer in 2005, making this type of
cancer the fourth leading cause of cancer death overall.
Researchers have identified several risk factors
that increase a person's chance of developing cancer of the exocrine
pancreas.
Age: The risk of developing cancer of the pancreas
increases with age. Almost all patients are older than 50 years. More
than 70% are older than 65 years and nearly 90% are older than 55.
Gender: Men are 20% more likely to develop cancer
of the pancreas than are women.
Race: African Americans are 40% to 50% more likely
to develop cancer of the pancreas than whites. This may be explained by
smoking and diabetes in men and overweight in women.
Cigarette smoking: The risk of developing cancer of
the pancreas is higher among smokers. Heavy smokers have a 2 to 3 times
increased risk than that of nonsmokers. Scientists think that
cancer-causing chemicals in cigarette smoke enter the blood and damage
the pancreas. About 30% of pancreatic cancer cases are thought to result
directly from cigarette smoking. Many experts think this is why the
incidence of pancreatic cancer has been increasing in the last 50 years
and only now is beginning to decline as smoking rates have dropped. This
pattern is very similar to that of lung cancer. A recent study found
that men who smoke and also have diabetes (see below) have a
particularly high risk of developing pancreatic cancer.
Diet: Although older studies have suggested that
coffee consumption might be a risk factor, most recent studies have not
confirmed this. There may be a link, however, with eating a lot of red
meat and pork and especially processed meat (such as sausage and bacon).
Obesity: This is also a risk factor. Very
overweight people are 20% more likely to develop pancreatic cancer.
Diabetes mellitus: Pancreatic cancer is more common
in people with this disease. The risk is highest within 5 years of the
diagnosis of diabetes. The reason for this association is not known.
Most of the risk is found in people with type II diabetes. People with
type I diabetes may have a slightly higher than average risk.
Chronic pancreatitis: Chronic pancreatitis is a
long-term inflammation of the pancreas. This condition is associated
with an increased risk of pancreatic cancer. However, most patients with
pancreatitis never develop cancer of the pancreas. Some recent studies
suggest that the main reason for this association is that patients with
pancreatitis are more likely to also have other risk factors such as
smoking. A small number of cases of chronic pancreatitis appear to be
due to an inherited gene mutation. People with this familial form of
chronic pancreatitis seem to have a high lifetime risk for developing
pancreatic cancer (about 40% to 75%).
Occupational exposure: Heavy exposure to certain
pesticides, dyes, and chemicals related to gasoline may increase the
risk of developing cancer of the pancreas.
Family history: Cancer of the pancreas seems to run
in some families. An inherited tendency to develop this cancer may be a
factor in as many as 10% of cases. Inherited DNA changes that may
increase a person's risk of developing cancer of the pancreas can also
cause an increased risk for certain other cancers. For example, some
people with an inherited tendency for melanoma (skin cancer) can have a
higher rate of pancreatic cancer. People with an inherited mutation of
the breast cancer gene, BRCA2, also have a higher rate of pancreatic
cancer. A mutation of this gene may account for 10% to 20% of familial
pancreatic cancers. Other inherited cancer syndromes like inherited
colorectal cancer may also be associated with pancreatic cancer. Some of
these DNA changes have been found by scientists and can be recognized by
genetic testing. For more information on genetic testing, refer to the
section,
"Do We Know What Causes Cancer of the Pancreas?"
What Is Cancer of the Pancreas?
The Normal Pancreas
The pancreas is a gland located behind the stomach.
It is shaped a little bit like a fish with a wide head, a tapering body,
and a narrow-pointed tail. It is about 6 inches long but less than 2
inches wide and extends horizontally across the abdomen. The head of the
pancreas is located on the right side of the abdomen, behind the place
where the stomach meets the duodenum (the first part of the small
intestine). The body of the pancreas is located behind the stomach and
the tail of the pancreas is on the left side of the abdomen next to the
spleen.
The pancreas contains 2 separate glands: the
exocrine and endocrine glands. The exocrine gland produces pancreatic
juice, which contains enzymes that help you digest fats, proteins, and
carbohydrates in the food you eat. Without these, some of the food you
eat would just pass through your intestinal tract -- sometimes leading
to diarrhea. The enzymes are released into tiny tubes called ducts.
These ducts carry the pancreatic juice to the small intestine. More than
95% of the cells in the pancreas are exocrine glands and ducts.
A small percentage of the cells in the pancreas are
endocrine cells. These cells are arranged in small clusters called
islets (or islets of Langerhans). The islets release 2 hormones, insulin
and glucagon. Insulin is important in reducing the amount of sugar in
the blood while glucagon increases it. Diabetes results from a defect in
insulin production.
Types of Tumors of the Pancreas
The exocrine cells and endocrine cells of the
pancreas form completely different types of tumors.
Exocrine tumors: This is far and away the most
common type of pancreas cancer. Although benign cysts and benign tumors
call cystadenomas can occur, most pancreatic tumor are malignant.
A special type of cancer, called ampullary cancer
or carcinoma of the ampulla of Vater, can develop where the bile duct
and pancreatic duct come together and empty into the duodenum. Because ampullary cancers develop very near the common bile duct, they often
block the bile duct while they are still small and have not spread far.
Ampullary cancers are usually diagnosed at an earlier stage than most
pancreatic cancers. And earlier diagnosis means that people with
ampullary cancers usually have a better outlook for survival than people
with pancreatic cancers. Ampullary cancers are included together with
pancreatic cancer in this document because their treatments are very
similar.
Endocrine tumors: Tumors of the endocrine pancreas
are uncommon. As a group, they are known as neuroendocrine tumors, or
more specifically, islet cell tumors. There are several subtypes of
islet cell tumors that are named according to the type of hormone they
produce.
It is very important to distinguish between
exocrine and endocrine cancers of the pancreas. Each type of tumor has
distinct risk factors and causes; produces different signs and symptoms;
are diagnosed using different tests, are treated in different ways, and
have a different prognosis (outlook for survival).
More detail from the American Cancer Society
click here.
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