Pancreatic cancer difficult to detect, treat

Wanda Gattis of Ripley hopes that someday soon purple ribbons are as well recognized for pancreatic cancer as the pink ones are for breast cancer.
Pancreatic cancer killed Gattis’ mother and grandfather. The 67-year-old woman is one of the lucky few whose pancreatic cancer was caught at an early stage. After successful surgery she’s been cancer free for nearly three and a half years.
But she worries that her 50-year-old daughter might be at risk if progress isn’t made toward early detection and treatment of pancreatic cancer.
“I don’t think Mother could have been saved,” with better treatments, but she would like for her daughter to have better options for early detection and treatment if the worst happens, Gattis said. “I would like to see more testing. I would like to know more.”
With the explosion of research and public awareness, breast cancer survival rates have improved steadily and dramatically – about 2 percent a year between 1998 and 2007, according to the American Cancer Society.
Unfortunately, pancreatic cancer has not seen those gains.
“Patient survival hasn’t changed for 40 years,” said Tupelo gastroenterologist Dr. Stephen Amann, who has a special interest in pancreatic diseases. “It’s still less than 6 percent” for the 5-year survival rate.
Across the United States, more than 43,000 people are diagnosed, Amann said. In Mississippi, 350 cases were identified in 2007.
“75 percent die in the first year,” Amann said.
Even though pancreatic cancer is one of the top cancer killers, the National Cancer Institute puts only 2 percent of its budget into pancreatic cancer research.
“It’s significantly underfunded compared to other cancers,” Amann said.

Problem cancer
Pancreatic cancer is particularly problematic.
The pancreas is a banana-shaped gland tucked behind the liver and the stomach. It produces insulin and other digestive enzymes.
Because of the location, it’s impossible to feel a mass growing in its early stages. Symptoms are, at best, vague and often non-existent, Amann said.
When the tumor is located in the head of the pancreas, it can block a drain into the liver, causing jaundice, Amann said. However, there are a number of conditions that can cause jaundice.
If the tumor is in the tail of the pancreas, there are no symptoms until the cancer has spread beyond the pancreas. Most people are diagnosed after pancreatic cancer has already metastasized to other organs.
Beyond the problems of location and lack of symptoms, pancreatic cancer presents other challenges The pancreas cells in animals don’t work the same way as pancreas cells in humans, Amann said. That means researchers lack a key testing ground for pre-clinical treatments.
Researchers are beginning to make some headway in this area, but the results are still quite preliminary, Amann said.
Most pancreatic cancer is also fed by a different nutrient than most other kinds of cancer. That means the chemotherapy agents that block the fuels for most other cancers aren’t effective against pancreatic tumors.
Researchers are looking for biomarkers with pancreatic cancer that could potentially help with early detection, Amann said.
Right now, patients who are diagnosed when the pancreatic cancer is still localized, go through a difficult procedure that removes part of the pancreas, small intestines, gall bladder and sometimes stomach.
“Some new techniques have improved how patients live after surgery,” but it remains a complex, difficult procedure, Amann said.
Chemotherapy and radiation are also used to fight pancreatic cancer. They have been helpful for patients with metastatic disease, where the goal is not to cure, but to hold back the cancer.
“If you can shrink the tumor, the qualify of life is better for the time you’ve got left,” Amann said.

Survivor story
Wanda Gattis gives credit to God and good doctors that she’s still here.
In June 2007, Gattis had gone to her health care provider, Nurse Practitioner Susan Cappleman in Ripley.
“I thought I was having an acid reflux attack,” Gattis said. Something in Gattis’ symptoms prompted Cappleman to probe deeper and order a CT scan. Acid reflux isn’t a typical symptom associated with pancreatic cancer, but the scan turned up a mass on her pancreas.
Cappleman sent Gattis to Digestive Health Specialists in Tupelo. After another round of scans, she was sent on to the University of Alabama Birmingham.
“It did not look good,” Gattis said.
The surgery is difficult. The incision goes from one side of the abdomen to the other and requires a lengthy recovery.
“It needs to come out or you’ll be dying in six months,” Gattis remembers her Birmingham surgeon telling her.
Gattis had watched her mother die in seven weeks after being diagnosed with pancreatic cancer. For her, the choice was clear.
“I didn’t want to leave my family,” Gattis said.
Gattis ended up having extra trouble with her kidneys after surgery, but that resolved and she got the best news possible. Although the cancer had grown from the size of a dime to the size of a quarter in the three weeks it took her to get to surgery, it was still confined to the pancreas.
“I’m cancer free,” said Gattis, who has annual follow-up exams. “I feel very fortunate and very blessed … Normally it doesn’t return when you can get it like that.”

Michaela Gibson Morris/NEMS Daily Journal