Not All Jaundice Comes From The Liver

A jaundiced eye (Photo by CDC/Dr. Thomas F. Sellers/Emory University)

Pancreatic cancer is one of the most common gastrointestinal cancers, one of the most difficult to diagnose at an early stage, and is generally associated with a poor long time prognosis. There are no screening tests for pancreatic cancer and most people find out they have this disease when they develop what is termed “painless jaundice.” Other common symptoms include vague abdominal pain, back pain, fatigue and weight loss. Most people with this condition, however, have no symptoms until jaundice develops. When someone first comes to medical attention with painless jaundice, the working diagnosis should be pancreatic cancer until proven otherwise. Making the diagnosis is simple and requires a CT scan or MRI of the abdomen. Most people with pancreatic cancer are found at initial diagnosis to have end stage, inoperable disease.

Why is pancreatic cancer so difficult to diagnosis at an early stage? The pancreas is a medium sized organ that is situated deep in the middle of the abdomen. It consists of three parts: the head, body and tail. Most pancreatic cancers are located in the head, a structure that the bile ducts, which drain the liver and gallbladder, run through. When the tumor becomes large enough to obstruct the bile ducts, jaundice occurs. By this time, most tumors have already spread into adjacent structures such as the lymph nodes or the blood vessels. When this happens, surgery will not help as the disease has already spread beyond the pancreas. When cancer arises in the body or tail of the pancreas, there is no jaundice to alert anyone that a cancer is present so this type of cancer almost universally comes to medical attention at a very late stage in the disease and these cancers have an even worse prognosis than those found in the pancreatic head. There are no blood tests to screen for pancreatic cancer and routine screening with either ultrasound or CT scan is not recommended, as routine imaging has not been shown to be cost-effective. This is a huge dilemma as the incidence of pancreatic cancer appears to be rising.

Pancreatic cancer is diagnosed in about 37,000 Americans each year while an estimated 34,000 Americans die each year of this disease. Only two out of 10 people diagnosed with pancreatic cancer will live more than one year after diagnosis and less than four percent of people diagnosed with pancreatic cancer will be alive five years after the diagnosis is made. Risk factors for pancreatic cancer include smoking, male sex, age over 60, diabetes, diets high in red meat and low in fruits and vegetables, being overweight, being African-American, having H. Pylori infection and having a family history of pancreatic cancer. The only curative treatment for pancreatic cancer is surgery although people who are eligible for a curative operation are few and far between. Aside from curative surgery, patients with pancreatic cancer can be treated with palliative surgery, chemotherapy, radiation therapy or endoscopic stenting. The good news is that chemotherapies are getting better and new immunotherapies are prolonging life with fewer side effects than older treatments. Much research is needed to develop better diagnostic tools to diagnose pancreatic cancers earlier and to develop more effective therapies.

There is no way to prevent pancreatic cancer but some people have speculated that watching one’s diet, eliminating smoking and avoiding second hand smoke, and exercising may help reduce the risk of acquiring this disease. There can be no harm in trying to reduce one’s potential risk factors for this deadly disease.

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