McGowan Institute for Regenerative Medicine faculty member David Whitcomb, M.D., Ph.D., chief of the division of gastroenterology, hepatology, and nutrition, University of Pittsburgh Medical Center, recently shared his insights regarding the pace of national pancreatic cancer research efforts—efforts which have been very slow, but with some hopeful treatment possibilities.
“Until pancreatic cancer can generate more money for laboratory work and clinical trials, progress will remain slow,” said Dr. Whitcomb. “In 1973, before the advent of CAT scans and other modern diagnostic tools, the average life expectancy for someone diagnosed with pancreatic cancer was three months. Today, despite scanners and other specialized tests, the average is four months.”
“One reason for the lack of improvement,” Dr. Whitcomb said, “is that pancreatic cancer is insidiously virulent.”
Pancreatic cancer is a malignant tumor of the pancreas. Each year about 33,000 individuals in the United States are diagnosed with this condition, and more than 60,000 in Europe. Depending on the extent of the tumor at the time of diagnosis, the prognosis is generally regarded as poor, with few victims still alive five years after diagnosis, and complete remission still extremely rare. Early diagnosis of pancreatic cancer is difficult because the symptoms are so non-specific and varied. Common symptoms include pain in the upper abdomen that typically radiates to the back, loss of appetite, significant weight loss, and painless jaundice related to bile duct obstruction. All of these symptoms can have multiple other causes. Therefore, pancreatic cancer is often not diagnosed until it is advanced.
"Pancreatic cancer is probably one of the most deadly cancers because it's resistant to chemotherapy and radiation therapy, it spreads very quickly and the amount of actual cancer necessary to kill a person is very low," said Dr. Whitcomb.
“Pancreatic cancer recruits immune cells that normally heal wounds and uses them to form scar-like, fibrous sheaths around the tumors. The sheaths not only help shield the tumors from chemotherapy and radiation,” Dr. Whitcomb said, “but protect them from a substance produced by the body known as tumor necrosis factor. As a result, the necrosis factor attacks the patient's healthy tissues instead of the tumors, causing people to waste away and die much more quickly than they would otherwise.”
Obviously, then, pancreatic cancer is devious and deadly, but there are some hopeful avenues opening up in research labs around the nation. One is in cancer vaccines, where research at Johns Hopkins and UPMC has shown some early promise. The best early warning, though, would be finding a genetic profile for pancreatic cancer, so that people at risk of getting the disease could be identified before any tumor cells start growing. At Johns Hopkins, one group will soon release the results of analyzing the entire genome of several pancreatic cancer patients to determine mutations that are characteristic of the disease.
“That's an important step forward, “Dr. Whitcomb said, “but even then, scientists will face years of work to determine what effect the various genetic mutations are creating in the body.”
Dr. Whitcomb is also a tenured professor of medicine, cell biology and physiology, and human genetics at the University of Pittsburgh School of Medicine, as well as director of the Center for Genomic Studies. Dr. Whitcomb specializes in pancreaticobiliary disease research, genetics, regulation of the pancreas through mind/pancreas interactions, and the effects of alcohol on the pancreas. His clinical interests include pancreatic disorders and genetics and functional genomics.
Illustration: McGowan Institute for Regenerative Medicine.
Pittsburgh Post-Gazette (w/3 audio clips) (04/14/08)
NY Times (04/08/06)