Few get surgery for grim pancreatic cancer

[February 06, 2009]  WASHINGTON (AP) -- Supreme Court Justice Ruth Bader Ginsburg got a shot at survival that unfortunately few people with pancreatic cancer do: not just care from a celebrated specialist but the chance to have surgery at all. As few as 10 of every 100 patients have their pancreatic tumor cut out. The majority have the most aggressive form of pancreatic cancer, called adenocarcinoma, and usually it's too far gone to operate.

This is one of the most formidable cancers. The American Cancer Society estimates that nearly 38,000 people last year were diagnosed with it, and no more than 5 percent overall survive five years.

But look at those whose cancer is caught early enough for surgery, followed by chemotherapy, and that five-year survival grows, reaching anywhere from 20 percent to 24 percent.

And very occasionally -- 10 percent to 15 percent of the time -- patients have a far less aggressive form of pancreatic cancer called an islet-cell tumor. Those sometimes are curable.

Ginsburg's surgeon, well-known specialist Dr. Murray Brennan of New York's Memorial Sloan-Kettering Cancer Center, offered no clue Thursday about what type of cancer the justice has or her prognosis. A court statement characterized it only as apparently early stage.

This is key: Ginsburg, who survived colon cancer a decade ago, reported no symptoms -- but doctors spotted the very small new tumor by accident when she had a CT scan as part of a regular checkup.

Because the small tumor also was in the center of the pancreas, she almost certainly had a slightly easier surgery than most patients, removing what's called the body and tail of the pancreas plus her spleen, said Dr. Aaron Sasson, a pancreatic cancer surgeon at the University of Nebraska Medical Center. Most patients require the more arduous Whipple procedure that removes a trickier side of the pancreas, part of the small intestine, the gallbladder and bile duct, and sometimes part of the stomach.

Why is cancer in such a tiny organ so grim? Not only is it typically aggressive, there's no early detection test. Vague indigestion may be the only early sign. By the time such classic symptoms as yellowing skin, itching, weight loss and abdominal pain appear, the cancer has spread.

Scientists know far less about what causes pancreatic cancer than about most other solid tumors. But smoking and a family history of the disease are considered the top risk factors; high-fat diets, diabetes and a chronically inflamed pancreas may be risks, too.

Once the cancer has spread, chemotherapy helps minimize symptoms and slow its march.

Surgery patients with adenocarcinoma also need chemotherapy, typically the drug gemcitabine, to attack remaining cancer cells, said Dr. John Marshall, a medical oncologist at Georgetown University Hospital who specializes in pancreatic cancer. Their prognosis depends largely on whether the tumor had reached lymph nodes.

But the success rates are frustrating: "Twenty percent is still a crummy number," Marshall said.

So most patients are encouraged to consider enrolling in research studies looking for better treatments. One such study is being closely watched: Testing whether an immune therapy can block the cancer's return when the tumor contained a specific genetic mutation.

[Associated Press; By LAURAN NEERGAARD]

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