The pan­creas and can­cer

The Star Malaysia - Star2 - - HEALTH - Starhealth@thes­tar.com.my

STEVE Jobs, my idol, has died. Most of my gad­gets are at­trib­uted to him and his com­pany – my iPhone, my iPad, my Mac­Book Pro. I heard that he suf­fered a rare sort of pan­cre­atic can­cer. But seven years ago, he de­clared that he was cured of the dis­ease. What hap­pened?

Jobs had a rare form of pan­cre­atic can­cer called an islet cell neu­roen­docrine tu­mour.

The state­ments at­trib­uted to him about his can­cer cure seven years ago is mere spec­u­la­tion from the press, as Jobs kept a there are a few dif­fer­ent types of tu­mours that can oc­cur in the pan­creas. very tight lid on his ill­ness.

But it’s pos­si­ble that his can­cer had ei­ther re­turned, or spread, which ac­counted for his liver trans­plant in 2009.

It is very likely that his can­cer had fur­ther spread, or his new liver had failed. That is why he died. Per­haps more de­tail will emerge in time to come. How did Jobs man­age to live so long with pan­cre­atic can­cer, but Pa­trick Swayze didn’t?

Jobs had can­cer of the pan­cre­atic islet cells. If treated, some peo­ple with this dis­ease can live as long as 20 to 30 years.

Swayze had a more com­mon type of pan­cre­atic can­cer called ade­no­car­ci­noma, one that in­volved the pan­cre­atic duct cells. The sur­vival for Swayze’s type of can­cer is only a few years at best. De­scribe our pan­creas. What does it do?

The pan­creas is a pear-shaped or­gan lo­cated in our up­per ab­domen be­tween our stom­ach and our spine. Pain from it usu­ally ra­di­ates to our back.

It’s only about six inches long, and di­vided into two main por­tions:

> The ex­ocrine: This is the part of our pan­creas con­sist­ing of ducts and small glands called acini. They pro­duce en­zymes that help break down the pro­teins, car­bo­hy­drates and fats that we eat. The sub­stances that are se­creted via the pan­cre­atic juice also neu­tralise our stom­ach’s acids.

> The en­docrine: This is made out of the islets of Langer­hans. These are the islet cells that we are talk­ing about per­tain­ing to Jobs. They se­crete glucagon, which in­creases our blood su­gar level, and in­sulin, which stores glu­cose, pro­teins and fat.

The islet cells are cru­cial to our blood su­gar reg­u­la­tion. They are scat­tered through­out our pan­creas. So tell me more about islet cell tu­mours.

These tu­mours are in­ter­est­ing and strange. An islet cell tu­mour can be ei­ther be­nign or can­cer­ous (like Jobs’).

It can ei­ther be func­tional or non-func­tional. Non-func­tion­ing islet cell tu­mours make up the ma­jor­ity of islet cell tu­mours.

A func­tion­ing islet cell tu­mour is one that pro­duces hor­mones.

A non-func­tion­ing islet cell tu­mour does not pro­duce hor­mones.

Jobs pub­licly de­clared he had a “hor­monal” prob­lem. So we can spec­u­late that he might in­deed have had a func­tion­ing islet cell tu­mour. Then again, maybe not.

There are five types of func­tion­ing islet cell tu­mours, which are based on the types of hor- mones the tu­mour makes. Note that some tu­mours may make two or three hor­mones si­mul­ta­ne­ously.

> Gas­tri­noma: This one makes too much gas­trin, a hor­mone that causes our stom­ach to pro­duce too much acid. Need­less to say, a pa­tient who suf­fers from this will be hav­ing a lot of gas­tri­tis prob­lems.

> In­suli­noma: This one makes too much in­sulin, which leads to re­ally low blood sug­ars and can lead to a hy­po­gly­caemic coma. An in­suli­noma is only 10% can­cer­ous.

> Glucagonoma: This one makes too much glucagon, which causes the re­verse re­sult of an in­suli­noma. So now there’s too much su­gar in your blood.

> Vipoma: This one makes too much VIP (va­soac­tive in­testi­nal pep­tide), a hor­mone that helps move the water in your in­testines. Nat­u­rally, when you move too much water, chronic and very wa­tery di­ar­rhoea en­sues.

> So­mato­stati­noma: This one makes too much so­mato­statin, a hor­mone which stops the se­cre­tion of other hor­mones like in­sulin, gas­trin and the growth hor­mone. How do you treat pan­cre­atic can­cer?

This will de­pend on whether your tu­mour is be­nign or ma­lig­nant.

The trou­ble with most pan­cre­atic can­cers is that they present very late, es­pe­cially in Malaysia.

They are dif­fi­cult to di­ag­nose most of the time be­cause the symp­toms the pan­creas throws out are non-spe­cific – like fa­tigue, malaise, loss of ap­petite, loss of weight.

And when you find out, it’s usu­ally very late.

In this as­pect, it’s usu­ally bet­ter to have a func­tion­ing islet cell tu­mour that alerts you by throw­ing out hor­mones.

Then you will have symp­toms ac­cord­ing to the hor­mones that are ex­ces­sively thrown out, and you will seek treat­ment much ear­lier.

Tu­mours are re­moved by surgery. If the can­cer cells have spread to the liver, a por­tion of the liver has to be ex­cised.

Chemo­ther­apy and var­i­ous tar­geted ther­a­pies are then used to shrink the rest of the tu­mour.

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