Brenda Spriggs, MD, MPH, MBA
Pancreatic cancer is usually particularly aggressive. In the U.S., there will be approximately 45,000 pancreatic cancer diagnoses in 2013 and nearly 40,000 deaths. Fewer than 10 percent of people are diagnosed before the disease spreads to lymph nodes or elsewhere, and even in that most favorable category, fewer than 1 in 4 will survive 5 years. The last stages often occur rapidly.
The pancreas lies at the back of the upper abdomen, crossing the spinal column. This region is rich in nerves, and the invasion of cancer causes severe, often disabling pain. The pain is more likely to be in the back, and relief is sought by leaning forward and avoiding movement. The fetal position is also frequently taken. The lack of mobility increases the risk of pneumonia.
Pancreatic cancer causes yellowing of the skin and eyes by 2 principal effects. The first is the blockage of the bile duct by tumor and the second is the invasion and destruction of the liver. Jaundice causes itching, which may be as disabling as the pain of advanced cancer. Repeated scratching inflicts damage to the skin but no relief, and those injuries may become infected.
Profound weight loss is common in late pancreatic cancer. The causes are obstruction of the stomach or intestine; loss of appetite; persistent nausea from disease or treatment; diabetes and diarrhea caused by loss of pancreatic function; and the generalized wasting effect of advanced cancer.
The combined effects of poor nutrition, diminished function of the liver, pancreas, and other organs, immobility, and suppression of the immunity system by cancer and treatment, lower resistance to infection. The final, terminal event in late pancreatic cancer is often pneumonia.