DR. HOOK- Bad business: Pancreatic cancer one of the worst
Hypochondria is a horrible thing. One of my best friends suffers from it– although it's getting better each year. I didn't realize he suffered from hypochondria when initially he kept thinking he had testicular cancer. What he had was a groin pull. In his head it was definitely testicular cancer, and it was no ball of fun for him– or me!
"Are you sure it isn't testicular cancer?" "See your doctor." "He keeps saying it's a groin pull. My doctor doesn't believe me." "Neither do I, so see your doctor."
Then one night while eating Thai-French fusion at a hot spot on Melrose Avenue, he told me he was convinced he had pancreatic cancer because his stomach was upset. (Ah, how about the 50 pounds of Thai peppers you just ate in 50 gallons of coconut milk?) Bingo! That was when I realized he had hypochondria! But what if he did have pancreatic cancer?
Pancreatic cancer is the #4 cause of cancer deaths, and it has a very low survival rate. We lost state senatory Emily Couric to it in 2001. Annually, about 33,000 cases of pancreatic cancer are diagnosed and about 32,000 people die from it. Because it's so hard to detect early, it's usually metastatic by the time of diagnosis.
The risk factors for pancreatic cancer are pretty general: male sex, African American, older than 45 years, smoking, diabetes, chronic pancreatitis, and family history. Symptoms are usually pretty mild, beginning perhaps three years before diagnosis is made. Abdominal pain from the navel going straight to the back is consistent with pancreatic pain (like an amniocentesis gone too far).
Anorexia and early satiety (meaning you lose your appetite soon after eating) contribute to weight loss. Also eating can induce or increase this dull abdomen pain. Bloating and burping can be early signs, but let's face it– most of us suffer from gas, so it's pretty nonspecific. Fatty stools and diarrhea are a result of lacking pancreatic enzymes to digest food. A Virchow node (a lymph node in the left supraclavicular fossa– the valley just above the collar bone) can be a bad sign of pancreatic cancer.
Abdomen ultrasound is about 80 percent successful in detecting pancreatic cancer. A CT scan is 90 percent sensitive, but it's much more expensive and harder to get approved by health insurance. (I had to fight tooth and nail for a patient to get her CT scan pre-authorized by her health insurance, and it did detect pancreatic cancer– something she so sadly succumbed to early this year.)
Treatment– can we call it that? Even with such a low survival rate, I think so. An oncology professor of mine once said, "A person is not a statistic. Each person is different."
There isn't any curative chemotherapy, and 15 percent of patients who are initially diagnosed are surgical candidates for an attempt to cure the disease. The five-year survival rate is 25 percent if there's no spread to lymph nodes, and 10 percent if lymph nodes are affected. Newer adjuvant chemotherapy after surgery helps survival.
I appreciate all the emails I get from readers, like Harold C. who asked me to write on pancreatic cancer because he knows someone affected by it. But it's such a major bummer to hear about unfortunate illnesses. I wish life was nothing but hypochondria, such as only a groin pull or indigestion.
Dr. Hook cracks a joke or two, but he's a renowned physician with a local practice. Email him with your questions.