Q: More than 10 years ago, a close friend was found to have cancer of the pancreas. He was told that there was almost no hope for a cure, and he died within six months. My wife has just become jaundiced. Her doctor suspects she may have a pancreatic cancer and has suggested that she have tests done. I would like to know what tests are done to diagnose cancer of the pancreas and whether the chances for survival are better now than in the past.
Q: The pancreas' location deep in the abdomen allows cancers to grow and spread without giving any early warning signs. As a result, pancreatic cancer is one of the most dreaded forms of malignancy, and for unknown reasons, its frequency has been increasing dramatically in recent years. It is now the fifth-leading cause of cancer death. As with all cancers, early detection and treatment offer the best hope for survival.
The five-year survival rate from carcinoma of the head or tail of the pancreas is less than 3 percent because it is rarely detected before the tumor has spread to local lymph nodes, the liver and more distant sites. The picture is better for carcinomas involving the head of the pancreas, which account for about 80 percent of pancreatic cancers and are often suspected at a relatively early time when obstruction of the bile duct causes jaundice.
Your wife will probably undergo an ultrasound examination to look for gallstones, one of the most treatable causes of jaundice. If no gallstones are found, she will likely be scheduled for nuclear magnetic resonance imaging of the abdomen and possibly an ERCP (endoscopic retrograde cholangiopancreatography) -- passage of a tube through the mouth into the duodenum followed by an injection of dye into the pancreatic duct or sampling of tissue from the duct. These procedures usually can locate a pancreatic cancer and determine whether it has spread to the liver.
The only possible cure for a pancreatic cancer is surgical removal of a carcinoma of the head of the pancreas, along with most of the duodenum and local lymph nodes.
As recently as 10 years ago, 20 percent to 25 percent of patients died as a direct result of the operation. Improvements in technique have reduced the operative mortality to about 1 percent in those medical centers that have the experience gained from performing many of these operations each year. When combined with radiation and chemotherapy, recent five-year survival rates have been about 20 percent and may be significantly higher if no tumor is left behind in the pancreas, and the cancer has not spread to the lymph nodes.
Dr. Margolis is professor of medicine and biological chemistry at the Johns Hopkins School of Medicine.