Gas, fatigue and abdominal discomfort can be signs of pancreatic cancer

Gas, fatigue and abdominal discomfort can be signs of pancreatic cancer

Pancreatic cancer is a cruel and stubborn killer that has so far defied the best efforts of medicine to have an early diagnosis and effective treatment. In November, he took the life of my friend Peter Zimroth, a 78-year-old New York public service attorney who most recently oversaw the partial deactivation of the Police Department’s stop-and-search strategy.

Zimroth was on my “most admired” list before he even married esteemed actress Estelle Parsons, who was 16 years his senior. Even during his year-long treatment during the pandemic, Zimroth remained dedicated to the public good: he created a brightly colored T-shirt and cap with an urgent appeal: “Smash the virus! Get vaccinated” and raised more than $73,000 for support research at Memorial Sloan Kettering Cancer Center, where doctors scrambled to buy him more time.

He was in good shape and healthy before the symptoms set in – in his case, stomach pains and constipation. By then the disease had spread and it was too late to operate. His death follows that of several well-known people who succumbed to the same illness: Supreme Court Justice Ruth Bader Ginsburg, Representative John Lewis, TV presenter Alex Trebek and Apple co-founder Steve Jobs.

Although pancreatic cancer is relatively rare, it is so deadly that it is poised to become the second leading cause of cancer-related deaths in the United States by 2040. It currently accounts for about 3% of all cancers and 7% of all cancers. deaths from this disease.

Overall, only one in 10 people diagnosed with pancreatic cancer survive five years. Healing is almost always a stroke of luck, when the disease is detected at an early stage, free of symptoms, during an abdominal exam or unrelated surgery, and the tumor can be surgically removed.

Brian Wolpin, director of the gastrointestinal cancer center at the Dana-Farber Cancer Institute in Boston, told me this is such a difficult disease to detect early because “it’s relatively uncommon in the population, and the symptoms it causes, such as weight loss , fatigue and abdominal discomfort, are nonspecific and likely due to other conditions”.

As a result, he said, “when 80 percent of patients come into my office for the first time, I know it’s highly unlikely that we’re going to cure their cancer.”

Risk factors for pancreatic cancer

Still, there are several important risk factors for the development of pancreatic cancer. Smoking doubles the risk and accounts for about a quarter of all cases. Being obese, gaining a lot of weight as an adult, and carrying extra weight around your waist, even if not much above average, also increase your risk.

Perhaps this is why type 2 diabetes, most often linked to being overweight, is also a major risk factor. Other risks include chronic pancreatitis, a persistent inflammation of the pancreas, often linked to excessive alcohol consumption and smoking, and workplace exposure to certain chemicals, such as those used in the dry cleaning and metalworking industries.

Advanced age is also a risk factor – about two-thirds of cases occur in people aged 65 and over. And family history can also play a role, including inherited genetic conditions such as mutations in the BRCA1 or BRCA2 genes, which are most often associated with breast and ovarian cancer.

Diabetes as a warning sign

It has long been known that the best chance of surviving most cancers comes from early detection, when the malignancy is entirely confined to the organ or tissue in which it originates. (Blood cancers present different problems.)

The pancreas is a very small, carrot-shaped organ – about 15 cm long and less than 5 cm wide – that is well hidden between the ribs and stomach.

Early pancreatic cancer does not produce a lesion that can be felt and rarely causes symptoms that warrant a definitive medical evaluation until it has escaped the organ’s confines and spread elsewhere.

But scientists are studying a possible early warning sign: a link between pancreatic cancer and the recent emergence of type 2 diabetes. Diabetes also arises in the pancreas. The organ contains cells specialized in producing the hormone insulin, which regulates blood sugar levels.

Although it is not yet known which comes first, diabetes or cancer, some research suggests that the recent emergence of type 2 diabetes may foreshadow the existence of cancer lurking in the pancreas.

An initial 2005 study of 2,122 Rochester, Minnesota residents by Suresh Chari, now a gastroenterologist at the University of Texas MD Anderson Cancer Center, found that three years after being diagnosed with diabetes people had six to eight times greater propensity than the general population to have the disease.

Together with colleagues at the Mayo Clinic, he also identified a gene called UCP-1 that could indicate the development of this cancer in people with diabetes.

More recently, Maxim Petrov, professor of pancreatology at the University of Auckland School of Medicine in New Zealand, led a study in September 2020 of nearly 140,000 people with type 2 diabetes or pancreatitis, or both, who were followed for up to 18 years. years old.

The results revealed that those who developed diabetes after a bout of pancreatitis were seven times more likely to have pancreatic cancer than those with type 2 diabetes.

Translated by Luiz Roberto M. Gonçalves

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