Acute Pancreatitis May Be Early Warning of
Pancreatic Cancer, Especially for Senior Citizens
Early discovery of pancreatic cancer offers much
greater opportunity for survival; researchers want esophageal ultrasound
screening after acute pancreatitis
Feb. 28, 2014 – Pancreatic cancer is one of the
most feared, due to its low survival rate, which is primarily due to the
late discovery of the disease. Researchers seeking a way to find this
cancer earlier and, hopefully, save lives have found what appears to be
an early warning sign – acute pancreatitis - for many who will be hit
with this cancer and their discovery may be most important for senior
citizens age 70 and older.
In 2013, more than 45,000 Americans were diagnosed
with cancer of the pancreas. Most over 65 years old.
In the study published in
Clinical Gastroenterology and Hepatology, Saint Louis
University researchers have found a link between acute pancreatitis
(inflammation of the pancreas) and pancreatic cancer, a finding which
they think may lead to some pancreatic cancers being detected earlier.
Principle investigator Banke Agarwal, M.D.,
associate professor of gastroenterology and hepatology at Saint Louis
University, says the study builds on earlier research suggesting a
connection between the two illnesses.
"Our study demonstrates that there is a much higher
risk of pancreatic cancer in patients with acute pancreatitis than
commonly believed," Agarwal said.
Pancreatic cancer, the fourth most common cause of
cancer death in the U.S., is usually diagnosed at an advanced stage
because it has few early warning signs and no established screening
Only 4 percent of those who have pancreatic cancer
survive five or more years after diagnosis. This low survival rate is in
large part due to the advanced stage when most pancreatic cancer is
Not a cure but Stereotactic body radiotherapy (SBRT)
extends life for elderly by months; minimal side-effects even when
burdened by other health problems; two patients lived almost two years -
see video in story
Surgical removal is the only chance to cure
pancreatic cancer, but surgery is not an option in cases where the
cancer has spread. At diagnosis, fewer than 20 percent of cases of
pancreatic cancer are still localized enough to be removed surgically.
Prior to this study there was some evidence of a
higher incidence of pancreatic cancer in patients who are diagnosed with
acute pancreatitis. What was unknown, however, was the rate that acute
pancreatitis precedes a diagnosis of pancreatic cancer and the time
between these two diagnoses.
Using the electronic health records of patients
from the Veterans Health Administration between 1998 and 2007,
researchers were able to determine the likelihood that a diagnosis of
pancreatic cancer follows a diagnosis of acute pancreatitis, how often
pancreatic cancer is preceded by acute pancreatitis, and the time
between an initial episode of acute pancreatitis and diagnosis of
pancreatic cancer. In addition, researchers identified patient
characteristics most associated with a greater pancreatic cancer risk.
The study shows that in patients older than 40 with
an episode of acute pancreatitis, 1.5 percent were eventually diagnosed
with pancreatic cancer compared to 0.13 percent of patients without a
prior episode of acute pancreatitis.
In addition, 12.1 percent of patients with
pancreatic cancer had an episode of acute pancreatitis prior to the
diagnosis of their cancer.
Incidents for Seniors Much Greater
Age, they found, significantly impacts the risk of
pancreatic cancer for patients older than age 70 after acute
pancreatitis. These aging senior citizens were found to have almost four
times the risk of being diagnosed with pancreatic cancer compared to
patients between the ages of 41 and 50.
According to John Hopkins Medicine, the risk of
pancreatic cancer increases with age and more than 80 percent of all
cases develop between the ages of 60 and 80.
In addition, of all the cases of pancreatic cancer
diagnosed after an episode of acute pancreatitis, 55 percent were
diagnosed three to 24 months after the episode of pancreatitis. This
result indicates that many cases of pancreatic cancer potentially could
have been diagnosed earlier had patients with acute pancreatitis been
evaluated for pancreatic cancer.
In light of the late stage when pancreatic cancer
is typically diagnosed and the significant rate of people diagnosed with
acute pancreatitis that are subsequently diagnosed with pancreatic
cancer, the study's authors suggest that patients over the age of 40
with acute pancreatitis should be evaluated for pancreatic cancer with
"As a point of reference, it's useful to consider
that the relative number of patients with acute pancreatitis who are
subsequently diagnosed with pancreatic cancer is greater than that of
cancer discovered during colonoscopy screening," said Agarwal.
Established in 1836, Saint Louis University School
of Medicine has the distinction of awarding the first medical degree
west of the Mississippi River. The school educates physicians and
biomedical scientists, conducts medical research, and provides health
care on a local, national and international level. Research at the
school seeks new cures and treatments in five key areas: cancer, liver
disease, heart/lung disease, aging and brain disease, and infectious