Q: Our neighbor developed yellowing of the skin and after a series of examinations, was diagnosed with cancer of the pancreas. Where is the pancreas and what does it do? What causes cancer of the pancreas? Can it be cured or prevented?

--Erlinda G. Iloilo City

A: The pancreas (“lapay,” in Filipino) is a thin, flattened abdominal organ that lies behind the stomach. It is about six inches long. It consists of a wide end (head) that adheres to the first part of the small intestine, a tapering other end (tail) that touches the spleen, and a body (the part between head and tail) that forms the bulk of the organ.

The pancreas is a vital organ that produces most of the enzymes necessary for the digestion of food. It also produces several hormones that are important for proper digestion and metabolism, including insulin, whose deficiency leads to diabetes mellitus.

Cancer of the pancreas, which is more common among men than women, and among people who are over 60 years old, is a relatively rare malignancy. Worldwide, it accounts for only two to three percent of new cancer cases annually, but because it spreads quickly and often diagnosed at a late stage, it is usually fatal. Even with the best treatment, most pancreatic cancer patients succumb to metastases and other complications of their illness; only five percent survive more than five years from the time of diagnosis and very few cures have been recorded.

In its early stages, cancer of the pancreas usually presents no signs and symptoms. Often, its initial symptom consists simply of a mild, vague and diffused abdominal pain that may radiate to the back. Loss of appetite and weight loss are common, but usually late, manifestations of the disease. Other fairly frequent but late manifestations of the disease include yellowing of the skin (jaundice), itching, nausea and vomiting, fatigue, and depression. Occasionally, also during the late stages of the illness, a hard, fixed mass is palpable in the abdomen.

At present, there is still no reliable screening test available for detecting cancer of the pancreas in its early stages. After signs and symptoms have appeared however, the cancer is fairly easy to diagnose, unfortunately by this time, it is invariably too late to cure the disease. The diagnostic procedures that can detect cancer of the pancreas singly or in combination include ultrasound imaging, MRI, CT scanning, and endoscopic and laparoscopic examinations.

Treatment of pancreatic cancer involves any or a combination of surgery, radiotherapy (x-ray treatment) and chemotherapy (drug treatment). If the cancer is detected early (a rare occurrence) and still confined to the pancreas, surgical removal of the mass can lead to a cure. However, if the mass has already spread to surrounding tissues or other organs (as is often the case upon diagnosis), surgery is no longer curative, but it is still sometimes done for palliative reasons (e.g., to relieve obstruction to the flow of bile).

Chemotherapy and radiotherapy are the usual treatment for cancer of the pancreas that has spread to nearby tissues and other organs, but these modalities are employed not to cure the disease but to relieve the symptoms.

To date, the exact cause/s of pancreatic cancer is/are unknown. However, certain risk factors associated with the disease have already been identified including smoking, increasing age (especially over age 60), smoking, a diet that is rich in meat and fat, long-standing diabetes, chronic pancreatitis, occupational exposure to petroleum and certain other compounds, family history of pancreatic cancer, and family history of genetic syndromes that increase cancer risk.

In as much as its cause is unknown, there is no proven measure that can prevent cancer of the pancreas. But you can reduce your risks of developing the malignancy if you follow these imperatives: Do not smoke; exercise regularly; maintain a desirable body weight; and, adhere to a diet that is low in fat and meat but high in fruits and vegetables.

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