Thoughts of pancreatic cancer trouble reader

DEAR DR. ROACH >> Recently I was diagnosed with exocrine pancreatic insufficiency after symptoms of unexpected and sustained diarrhea for three months.

I was also diagnosed with NAFLD (nonalcoholic fatty liver disease) last November. A year ago, I first noticed slight weight loss (5 pounds) and decreased energy. I am 69 years old, 6 foot, 2 inches tall and currently weigh 173. I underwent a colonoscopy (unremarkable) and a stool exam that showed below normal elastase (189 vs. 200 being the low end of normal). I will begin a drug therapy next week, using pancreatic enzymes, but I worry about pancreatic cancer. Recently I had two friends die of pancreatic cancer. I just can’t seem to get past the worry that I may have it. What do you suggest?

— D.C.

DEAR READER >> The pancreas has two main jobs: to make insulin and other hormones (this is the endocrine function, from the Greek roots meaning “secretion within”), and to make digestive enzymes (exocrine, meaning “secretion outside”). The pancreatic digestive enzymes are critical for proper absorption of food, especially the fats we eat.

Without pancreatic enzymes, food cannot be digested, and people will notice diarrhea, often with visible fat; abdominal discomfort; and weight loss. It takes nearcomplete insufficiency of the pancreas to develop severe symptoms.

There are several conditions that can cause exocrine pancreatic insufficiency. In my career, virtually all of the cases I have seen were due to recurrent episodes of pancreatitis, from alcohol or stones. However, cystic fibrosis and surgical removal of part of the pancreas, stomach or intestines can also lead to EPI, along with a few other rarer conditions.

Pancreatic cancer is one cause of EPI, because a tumor can block the duct that releases the enzymes. Because you haven’t identified any other cause of EPI and have had some weight loss, I would think a scan (CT or MRI) to look for pancreatic cancer or other structural pancreas problems would be prudent.