Pancreas Diagram
27 April 2016

Pancreatic Cancer: Hard To Diagnose, Hard To Treat

Pancreatic cancer is quite possibly the most difficult form of malignancy to treat, largely because it is very hard to diagnose. While the cancer is relatively common, leading to approximately 53,000 new diagnosis every year, the prognosis is rarely favorable.

For patients diagnosed with stage II pancreatic cancer, the 5-year survival rate is between 5% and 7%, according to the American Cancer Society. Unfortunately, due to the disease’s non-specific symptoms and strange effects on the body, up to 95% of patients are diagnosed with pancreatic cancer only after the malignancy has spread from the organ in which it began.

What Is The Pancreas?

The pancreas is a large, long gland in the abdominal cavity, directly behind the stomach. As its location may imply, the pancreas’ work is primarily devoted to maintaining healthy digestion, in part by creating insulin, glucagon and several other hormones that regulate your body’s blood sugar levels.

Human Pancreas

Pancreatic “juices” secreted into the small intestine contain enzymes that help break down food materials and extract their nutrients.

Every pancreas is made up of two basic cell types:

  • Exocrine cells – these cells form the glands and ducts of the pancreas, which manufacture enzymes and deliver them into the small intestine. Most cells in the pancreas are of this type.
  • Endocrine cells – these cells form clusters, known as islets of Langerhans after the German pathologist who discovered them in 1869, which produce hormones, releasing them directly into the bloodstream.

Both types of cells can become cancerous, but the cancers that they become are very different.

Cancers Of The Pancreas

The vast majority of pancreatic cancers are pancreatic adenocarcinomas, which begin when exocrine cells in the organ’s ducts mutate and divide uncontrollably. Far less common are cancers that, while also beginning in exocrine cells, start in the cells that actually manufacture enzymes.

Less than 5% of all pancreatic cancers, classified as islet cell tumors or pancreatic neuroendocrine tumors, begin in the endocrine cells. Pancreatic neuroendocrine tumors, or NETs, though, need not be cancerous. Many growths that begin in the organ’s hormone-producing cells are benign.

But benign or malignant, these tumors can themselves produce and secrete hormones. Unfortunately, these hormones, which are being produced by a potentially-cancerous tumor, don’t always cause an identifiable set of symptoms, making them very difficult to diagnose quickly. Fortunately, they’re also considered the simplest pancreatic cancers to treat, usually through a relatively simple surgical procedure.

Symptoms Of Pancreatic Cancer

Early in their development, pancreatic cancers almost never present any signs or symptoms. When symptoms do occur, they can include:

  • Jaundice, a yellowing of the skin and eyes
  • Pain in the back or abdomen
  • Unexplained weight loss
  • Lack of appetite
  • Stool lighter in color than usual
  • Dark urine
  • Extreme fatigue

But all of these signs can be associated with other conditions, and many pancreatic cancers are missed by physicians.

How Common Is Pancreatic Cancer Misdiagnosis?

Very common. In fact, an initial pancreatic cancer misdiagnosis may affect up to almost 1 of every 3 patients who are ultimately diagnosed with the disease.

That was the result of Dr. Douglas Swords’ study, which looked at the rate of misdiagnosis among patients in Salt Lake City. Swords, a surgery resident at the University of Utah, reviewed the records of 313 pancreatic cancer patients, finding that a staggering 31.3% had received incorrect diagnoses.

Apparently, some of these patients had even received more than one wrong diagnosis. While 98 total patients had been misdiagnosed, Swords reported 119 diagnoses other than pancreatic cancer.

Pancreatic Cancer Often Mistaken For Other Conditions

Here are the top 3 conditions physicians mistook for pancreatic cancer:

  1. Gallbladder disease – 38 patients
  2. Gastroesophageal reflux (or “acid reflux”) disease – 15 patients
  3. Peptic ulcer disease – 11 patients

An initial misdiagnosis, Swords wrote, delayed an accurate cancer diagnosis by an average of 3.5 months. While that may not sound long, the surgeon found that patients who had been misdiagnosed were around 40% more likely to have an advanced stage cancer at the time of diagnosis.

Even more immediate ramifications of a misdiagnosis were also observed. For example, 15 out of the 38 patients who were misdiagnosed with gallbladder disease underwent a cholecystectomy, a completely unnecessary surgery to remove the gallbladder.

Who Gets Misdiagnosed?

In his study, Swords found that symptoms and age had a huge impact on how likely a patient was to be misdiagnosed.

Is Age, A Major Risk Factor, Also A Major Stumbling Block?

Pancreatic cancer is largely tied to age, and many sources report that age is the primary risk factor for developing the disease. That’s certainly true; more than 97% of patients are diagnosed after reaching the age of 55. Nearly 30% are diagnosed between the ages of 75 and 84, and 72 is the median age at which patients are diagnosed, according to statistics maintained by Pancreatic Cancer Action.

But at least in Swords’ report, this intimate connection between age and pancreatic cancer seemed to “blind” diagnosing physicians to even the possibility that a younger patient could have the disease. Misdiagnosed patients were, on average, five years younger than those patients who were accurately diagnosed from the start.

Are Symptoms Any Guide?

Symptoms played another huge role in misdiagnosis. Patients who had been misdiagnosed were more likely to have presented with:

  • abdominal pain (85% vs. 60%)
  • weight loss (85% vs. 75%)
  • nausea and vomiting (50% vs. 40%)

Of course, symptoms come in handy for diagnostic purposes. And true to form, patients who were misdiagnosed rarely exhibited jaundice, a classic indicator of pancreatic cancer. It’s likely, then, that only a specific combination of symptoms tipped doctors off to the disease’s presence, while symptoms in isolation, no matter how common among people with pancreatic cancer, flew under the radar.

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