Your Disease Risk Quiz: Pancreatic Cancer

Your Disease Risk, located on Siteman Cancer Centers website, is an interactive quiz which roughly estimates your risk of cancer by asking specific questions about your lifestyle. These questions include gender, age, family history, eating and exercise habits, height/weight, and other activities such as smoking or drug use. Using these criteria, the Your Disease Risk website determines your risk for specific diseases such as various types of cancer, heart diseas, osteoporosis or stroke.

Once on the website, the user can select a disease risk questionnaire for various types of cancers such as breast, cervical, pancreatic, prostate and stomach cancers.

It is not intended as medical advice, but cites prevention guidelines. These guidelines include recommendations for exercise, smoking cessation tips and healthy eating strategies. The questionnaire only takes a few minutes to complete, and a health risk bar graph is compiled from responses. The responses are grouped into risk categories: below average, average, and above average risk.

Give the quiz a try. It is worth knowing. I completed the pancreatic cancer quiz and it was determined that I have a below average risk for contracting pancreatic cancer.

Source: Siteman Cancer Center: Barnes Jewish Hospital, Washington University School of Medicine

http://www.yourdiseaserisk.wustl.edu/hccpquiz.pl?lang=english&func=home&page=cancer_index

Cancer Care Support Groups

Cancercare.org is an online cancer support website for various individuals. This website has support resources for patients, caregivers and or family members as well medical professionals. On this website, there is a specific section for the bereaved.

These support services include telephone and online cancer support, face to face support ( New Jersey and New York City area) and printed materials for anyone that requests services. Telephone support services are administered by oncology social workers and are presented on a variety of cancers. Specialized services include support for children with cancer, patients with rare cancers, and end of life services.

On the Cancercare Website, there is a specific webpage for pancreatic cancer. This page states the available support services available for anyone affected by pancreatic cancer.

Source: CancerCare.org
http://www.cancercare.org/get_help/help_by_diagnosis/diagnosis.php?diagnosis=pancreatic

Lustgarten Foundation for Pancreatic Cancer Research PSA

The Lustgarten Foundation for Pancreatic Cancer Research has filmed a new Public Service Announcement with former President Jimmy Carter. In this Public Service Announcement, President Carter speaks about how his family was affected by pancreatic cancer. President Carter also speaks about how the Lustgarten Foundation has been researching specific pancreatic cancer genes.

To view the public service announcement and to see information the Lustgarten Foundation for Pancreatic Cancer Research has compiled, please visit thier website at http://www.lustgarten.org/.

To view the public service announcement, please click on the following link

Source: The Lustgarten Foundation for Pancreatic Cancer Research Website

http://www.lustgarten.org./LUS/Content/CDA/ArticlesDetail.jsp?ContentId=448

Confronting Death- Oprah Winfrey Show October 22, 2007

The October 22, 2007 Oprah Winfrey Show featured a segment titled "Confronting Death". This segment featured Randy Pausch, a Computer Sciences professor at Carnegie Mellon University. Pausch was diagnosed with pancreatic cancer over one year ago. Just recently, Pausch was given only a few months to live.

His final lecture was given in September 2007 to Carnegie Mellon students. This lecture has been downloaded over over one million times online. Pausch stated the original audience for this lecture were his three small children. It is definetely a very moving lecture which has some very practical advice for anyone.


Source: Oprah Winfrey Show Website
http://www2.oprah.com/tows/pastshows/200710/tows_past_20071022.jhtml

Risk Factors for Pancreatic Cancer

I wanted to alert readers of the risk factors for pancreatic cancer. Various pancreatic cancer risk factors are preventable--but some are inherent.

According to Cnn.com Health website, here are the following risk factors for pancreatic cancer.

Risk factors
The vast majority of pancreatic cancers occur in people older than 65. Other important risk factors include:

Race. Black men and women have a higher risk of pancreatic cancer.

Sex. More men than women develop pancreatic cancer.

Cigarette smoking. If you smoke, you're two to three times more likely to develop pancreatic cancer than nonsmokers are. This is probably the greatest known risk factor for pancreatic cancer, with smoking associated with almost one in three cases of pancreatic cancer.

Abnormal glucose metabolism. Having diabetes may increase your risk of pancreatic cancer. Insulin resistance or high insulin levels may also be risk factors for pancreatic cancer.

Hereditary pancreatitis. Your chances of developing pancreatic cancer increase if you have hereditary chronic pancreatitis. Hereditary pancreatitis (HP) is a rare genetic condition marked by recurrent attacks of pancreatitis — a painful inflammation of your pancreas.

Excess weight. People who are very overweight or obese may have a greater risk of developing pancreatic cancer than do people of normal weight.

Diet. A diet high in animal fat and low in fruits and vegetables may increase your risk of pancreatic cancer.

Chemical exposure. People who work with petroleum compounds, including gasoline and other chemicals, have a higher incidence of pancreatic cancer than people not exposed to these chemicals.

Source: Cnn.com Health library April 12, 2006 http://www.cnn.com/HEALTH/library/DS/00357.html

Well, looking at this list I have to be candid and say I am not suprised of my grandmother's diagnosis.

She is older than 65, has a history of diabetes and has excess weight. Her diet is low in fruits and vegetables and high in animal fat. She was also a smoker. Finally, her previous employment was in manufacturing plants and she was exposed to chemicals.

Thomas Jefferson Hospital-Advances in Pancreatic Cancer Care

I found a replay of a live webevent sponsored by Thomas Jefferson Hospital in Philadelphia. This replay shows a mini-Whipple procedure being performed. This mini-Whipple procedure webcast also features a panel discussion by the Jefferson Pancreatic Cancer and Related Diseases medical team. This webcast was originally broadcast on September 18, 2007.

This is interesting if your medical team has recommended this surgery for you. The ability to view the procedure and the panelist discussion enables the patient to make an informed care decision.


This link to the original webcast is found on Thomas Jefferson University Hospital website.

WARNING: This is a webcast of an operating room procedure. This material may be considered graphic.

Source: Thomas Jefferson University Hospital

http://www.or-live.com/jeffersonhospital/1857/

Pancreatic Cancer-- Steve Jobs, Apple Computer CEO

In order for this blog to seem less research based and clinical , I wanted to show individuals that have been diagnosed with pancreatic cancer.

Steve Jobs, Apple Computer CEO was diagnosed with a rare form of pancreatic cancer approximately three years ago. In September 2004, Jobs underwent surgery for an islet cell neuroendocrine tumor, which is a rare form of pancreatic cancer.



Here is an excerpt from a cbsnews.com report regarding information that was sent to Apple computer employees regarding his illness-

"In an e-mail message to employees released by Apple, he said he will be off to recuperate during August and expects to return to work in September. The message did not specify where Jobs underwent the surgery. He identified his cancer as an islet cell neuroendocrine tumor, which he described as rare and said could be cured by surgical removal if diagnosed early. He said his was caught early and would require no chemotherapy or radiation treatment. A far more deadly - and common form - of pancreatic cancer is adenocarcinoma, he said. "I mention this because when one hears 'pancreatic cancer' (or Googles it), one immediately encounters this far more common and deadly form, which, thank God, is not what I had," he said in the message."

Source: CBS News.com
http://www.cbsnews.com/stories/2004/08/02/tech/main633335.shtml

Radiation Therapy as a treatment option

Radiation therapy is considered a treatment option for some pancreatic cancer patients.

Here is some information about radiation therapy.

"Radiation therapy uses high-energy X-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes in the area where the cancer cells are found (internal radiation therapy)."

Source: University of Maryland Marlene and Stewart Greenbaum Cancer Center
http://www.umgcc.org/gi_program/pan-stages.htm#rad

Before and After Illustrations pancreas (pancreatectomy)

If pancreatectomy is considered a treatment option for you, here
are some before and after illustrations.


This is a before illustration. Notice the gallbladder, pancreas, duodenum and small intestine are still in place. These would be all the organs the surgeon will remove.









This is an illustration of what remains once a pancreatectomy has been performed. Notice that the stomach, liver and small intestine are the only organs that remain.

As you can tell, the pancreatectomy is a major surgical process that removes most organs in the gastrointestinal tract.




Source: Cancerhelp.org.uk website
http://www.cancerhelp.org.uk/help/default.asp?page=3124

Total pancreatectomy treatment option

Another treatment option for pancreatic cancer patients is the total pancreatectomy.

This is major surgery--a more severe procedure than the Whipple procedure. The Whipple procedure only removes portions of the gastrointestinal tract. The pancreatectomy totally removes organs in the gastrointestinal area.


Information for the pancreatectomy is found at the Cancerhelp.org.uk website:

Source: Cancerhelp.org.uk

http://www.cancerhelp.org.uk/help/default.asp?page=3124


Text for the link:


Total pancreatectomy

This is very major surgery. It involves taking out

• The whole of the pancreas


• Your duodenum


• Part of the stomach


• The gall bladder and partial of the bile duct


• The spleen


• Many of the surrounding lymph nodes.

Before and after illustrations will be shown in other posts.

Whipple Procedure -- True Photographs

In order to make this blog seem less clinical, I wanted to show the human side of pancreatic cancer.

Due to my grandmothers advanced stage of pancreatic cancer, she is not a candidate for a Whipple procedure.

I found an interesting website regarding a persons diagnosis of pancreatic cancer. Diehl Martin is an individual who was diagnosed with pancreatic cancer in 2004. Diehl Martin is an engineer, photographer and pancreatic cancer survivor.

Mr. Martin's website is complete with photographs and descriptions of his various treatments for pancreatic cancer.

Here is his link to his Whipple procedure weblink

WARNING: This weblink contains photographs which may be considered graphic.

Source: Diehl Martin personal website
http://diehlmartin.com/whipple.html

Whipple Procedure -- After Illustration

This is an illustration of what occurs during a Whipple procedure. Notice that the pancreatic tumor is removed as well as a section of the small intestine.

Source: Mayo Clinic Website
Illustration http://www.mayoclinic.org/

Whipple Procedure- Before Illustration

This is a photo of a pancreas before the Whipple procedure. Notice the pancreas tumor on the left, plus the large portion of the duodenum and the gall bladder.

Source: Mayo Clinic Website
Illustration: http://www.mayoclinic.org

Surgery as a Treatment Option

There are many treatment options for pancreatic cancer. The three major types of treatment include:

Surgery, Radiation Therapy and Chemotherapy. In this posting, surgical options will be detailed.


The surgical options include:

Whipple Procedure: A surgical procedure in which the head of the pancreas, the gallbladder, part of the stomach part of the small intestine, and the bile duct are removed. Enough of the pancreas is left to produce digestive juices and insulin.

Total pancreatectomy: This operation removes the whole pancreas, part of the stomach, part of the small intestine, the common bile duct, the gallbladder, the spleen and nearby lymph nodes.

Distal pancreatectomy: The body and the tail of the pancreas and usually the spleen are removed.

If the cancer has spread and cannot be removed, the following types of surgery may be performed to relieve symptoms:

Surgical biliary bypass: If cancer is blocking the small intestine and bile is building up in the gallbladder, a biliary bypass may be done. During this operation, the doctor will cut the gallbladder or bile duct and sew it to the small intestine to create a new pathway around the blocked area.

Endoscopic stent placement: If the tumor is blocking the bile duct, surgery may be done to put in a stent (a thin tube) to drain bile that has built up in the area. The doctor may place the stent through a catheter that drains to the outside of the body or the stent may go around the blocked area and drain the bile into the small intestine.

Gastric bypass: If the tumor is blocking the flow of food from the stomach, the stomach may be sewn directly to the small intestine so the patient can continue to eat normally.


Source: National Cancer Institute, U.S. National Institutes of Health
http://www.cancer.gov/cancertopics/pdq/treatment/pancreatic/Patient/page4


I had no idea that gastric bypass surgery was a surgical option for pancreatic cancer patients. That is something I would have never thought of as a cancer treatment option.

The Stages of Pancreatic Cancer

I have heard about stages of cancer before and I had very limited information. My knowledge consisted of knowing there were numbered stages. I had no idea what each stage meant. I didn't even know if it was "better" to have a higher or a lower number.

When I heard that my grandmother had Stage IV B cancer, I knew it was important to find out what each stage meant. Before I began this project, I didn't even know what the criteria for classification was. According to http://www.pancreatica.org/, there seems to be a controversy from medical practitioners in the United States regarding pancreatic cancer staging. The information is as follows:


... " This classification rests on knowing the status of the TNM (that is Tumor, lymph Nodes and distal Metastasis)."

So after reading that paragraph I realized that the TNM factor was essential in determinng the stage.

I continued to read on http://www.pancreatica.org/

Here is the text on staging:

"Stage I pancreatic cancer includes tumors which have not spread into certain proscribed sensitive areas and which have no involved regional nodes or distal metastasis.

Stage II includes tumors which have spread into the duodenum, bile duct, or "peripancreatic" tissues AND which have no involved regional nodes or distal metastasis.

Stage III cancer includes tumors which may have OR may not have spread into these aforementioned areas and which have involved regional nodes, but which show no evidence of distal metastasis.

Stage IVA includes tumors which have spread into the stomach, spleen, large bowel OR the adjacent large vessels AND which have involved regional nodes, but show no evidence of distal metastasis.

Stage IVB includes pancreatic tumors of any kind with node status of any kind AND with evidence of distal metastasis"

Source: Pancreatica.org Website
http://www.pancreatica.org/faq.html#anchor2852712

My grandmother has stage IVB cancer. The cancer has spread to her liver--so this fits the criteria of distal metastasis.

Unfortunately, cancer staging is not like basketball or football where you "want" the highest number. I had secretly hoped cancer staging was like golf, where you start with the highest number and strive for a lower number.

Signs and Symptoms of Pancreatic Cancer

I wanted to list the Signs and Symptoms of Pancreatic Cancer. According to the MayoClinic, the signs and symptoms are as follows:

Signs and symptoms of pancreatic cancer often don't occur until the disease is advanced. When symptoms do appear, they may include:

Upper abdominal pain that may radiate to your middle or upper back. Pain is a common symptom of advanced pancreatic cancer. Abdominal pain occurs when a tumor presses on surrounding organs and nerves. Pain may be constant or intermittent and is often worse after you eat or when you lie down. Because many conditions other than cancer can cause abdominal pain, be sure to discuss your symptoms carefully with your doctor.

Loss of appetite and unintentional weight loss. Unintended weight loss is a common sign of pancreatic cancer. Weight loss occurs in most types of cancer because cancerous (malignant) cells deprive healthy cells of nutrients, and this is especially true in pancreatic cancer.

Yellowing of your skin and the whites of your eyes (jaundice). About half of people with pancreatic cancer develop jaundice, which occurs when bilirubin, a breakdown product of worn-out blood cells, accumulates in your blood. Normally, bilirubin is eliminated in bile, a fluid produced in your liver. But if a pancreatic tumor blocks the flow of bile, excess pigment from bilirubin may turn your skin and the whites of your eyes yellow. In addition, your urine may be dark brown and your stools white or clay-colored. Although jaundice is a common sign of pancreatic cancer, it's more likely to result from other conditions, such as gallstones or hepatitis.

Itching. In the later stages of pancreatic cancer, you may develop severe itching when high levels of bile acids, another component of bile, accumulate in your skin.

Nausea and vomiting. In advanced cases of pancreatic cancer, the tumor may block a portion of your digestive tract, usually the upper portion of your small intestine (duodenum), causing nausea and vomiting.

Digestive problems. When cancer prevents pancreatic enzymes from being released into your intestine, you're likely to have a hard time digesting foods — especially those high in fat. Eventually, this may lead to significant weight loss — as much as 25 pounds or more — and malnutrition.

Source: Mayo Clinic Website
http://www.mayoclinic.com/health/pancreatic-cancer/DS00357/DSECTION=2

My grandmother has had abdominal pain for many years, but has always dismissed it as gas or indigestion. I wish she had spoken to her primary care physician regarding this.

Pancreatic Cancer--What is it?

October 4, 2007

Pancreatic Cancer is a very serious disease. My grandmother is diagnosed with Stage IV B pancreatic cancer. This means that her pancreatic cancer has spread to her liver and preventative procedures can not be performed.

Here is an informational link from the American Cancer Society. This link gives a quick overview of pancreatic cancer.

Source: American Cancer Society
http://www.cancer.org/docroot/CRI/content/CRI_2_2_1X_What_is_pancreatic_cancer_34.asp?sitearea=

I also talked to my Mom today. Grandmom went for her first chemotherapy treatment this afternoon. She got a port put in so the injections will be easier.


This is an interesting link on chemotherapy and ports. This weblink from Mt. Sinai Hospital shows what chemotherapy ports look like.

Source: Mount Sinai Hospital, Toronto
http://www.mtsinai.on.ca/Sarcoma/Chemotherapy/default.htm

Purpose of this Blog

This blog is to help me comprehend my grandmothers recent diagnosis of Stage IV pancreatic cancer. I haven't been told much information from my family regarding this, so I wanted to research more on this particular type of cancer and what can be done.

My grandmother Gladys was admitted to the Robert Wood Johnson hospital in Hamilton, NJ for dehydration. At the hospital the doctors found an "abnormality" and scheduled a biopsy for that same day. After two more days in the hospital, my mother calls me.

Friday, September 14, 2007

I was exiting the Loew's 24 Movie theater with my daughter. We had just finished seeing Hairspray. Like a good moviegoer, I turned off my cell during the movie. I flipped it open as I exited and Isaw that my mother had called twice. I knew it was serious.

She asked me to sit down--so I did. I remember sitting down on the concrete post by the entrance. My mother tells me the details, phrases are said:

"pancreatic cancer"
"stage IV"
"inoperable"
"spread to liver"

The last phrase sent a chill down my spine... "terminal"

I ask my mother what I can do, anything.. and she says no.

My grandmother is too young for cancer. She's a tough woman who has survived so many things. My grandfather passed away two years ago. She lives alone at age 78, in her own apartment. She still drives to the Acme every Thursday for her prescriptions and groceries. She loves watching her "stories" and doing search word puzzles. She is a very funny woman who can tell jokes and gossip forever.

She can't die yet. She's too young. She hasn't given up yet.