DR. HOOK- Bad business: Pancreatic cancer one of the worst

In Issue 634
By JOHN HONG, MD
In the category

Published August 23, 2007 in issue 0634 of the HooK.

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.

100 2nd st nw . charlottesville va 22902 . 434.295.8700 . fax 434.295.8097

>> buy HooK schwag

Discuss " DR. HOOK- Bad business: Pancreatic cancer one of the worst " Below

Posted by 8/24/2007 6:45:11 AM

I liked your article and your funny sense of humor. I notice you aren't convinced there is "treatment" for pancreatic cancer. I agree...I am watching my 44 yr old baby brother die from this. Why isn't there a good treatment for Pancreatic Cancer? That's my question. Perhaps you could mention to readers that the funding for research for this cancer is close to NOTHING. If more people knew this maybe they would donate their dollars to PanCan. I believe most people already know that Pacreatic Cancer kills just about anyone who gets it, but do they know how little funding there is for research for it? More attention should be given to raise awareness for this nasty nasty cancer. More money needs to be donated to research for this nasty nasty cancer. I'm glad you have educated the readers about this killer, but it would have been even better had you informed them how they can help...by donating to PanCan for starters. I am in no way associated with PanCan, but I AM watching my baby brother slowly lose his battle to this. He's fought long and hard, knowing all along the odds were not good for survival. Like you said, can they really call it "treatment"? It's sad that in this day and age there is a cancer so evil, and there is no research, no treatment, and very little hope for someone diagnosed with it.

Thanks,

Clare Bozell

Your Name:
Your Email (optional):
Comment:
Image Verification:
Please type the letters above:

	* We want vibrant debate, so please comment on this story. People say the darndest things, but if they use language stronger than "darn," if they use ethnically or racially disparaging language, or start comparing people to Hitler, they may find that we've deleted the comment without warning. A few more rules: no libel, no slander, and no lying. And please stay on the topic.