Your pancreas.

What you need to know about your pancreas

Abstract: The pancreas is an organ of great significance – poorly recognised, it has great effect on the body both in health and in its own disease. Insulin is produced by the pancreas and diabetes remains an epidemic in the developed word. Pancreatic cancer is despite the benefits of early detection in any cancer, not always an easy candidate for this. yet poorly recognised as such.

Metabolism words jumbled together

It’s interesting, but for such an important organ, we don’t generally either know or talk much about it. A few years ago, my step father of 37 years, suddenly pain which developed into pancreatic cancer in his mid-70s . Being of the generation that felt it weak to seek advice, he left the pain a few months before telling us, assuming it would go away. It didn’t and by the time it was diagnosed (which wasn’t particularly prompt) it was stage 4.  

Alas, this was for him, the end and in a short period he succumbed to it. Being a fighter, he died with a  travel brochure on his bed, already planning his next trip to Malta, with my mother, less than 4 months after diagnosis.

We were in England with them at the time and it all happened very quickly and left us all somewhat “shell-shocked”. Last year, some years after this, I got abdominal pain spreading to my back and realized that I also had a pancreas!

Don’t feel badly about not considering your pancreas, the pancreas was generally ignored in the past, both as an organ and site of disease, although the first description of the pancreas is attributed to the Greek physician Herophilus (325-255 B. C.) – but it was not until the 17th century that the main duct of the organ was described, and its significance noted.

At that time, it was still thought that the pancreas was not essential to digestion and no association between the pancreas and diabetes. In 1848 Claude Bernard discovered the function of the pancreas in digestion and in 1889, Reginald Fitz firmly established pancreatitis as a disease entity.

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Canadian physician Frederick Banting and a medical student Charles H. Best discovered the hormone insulin in pancreatic extracts of dogs on July 30, 1921, when they injected the hormone into a diabetic dog and found that it effectively lowered the dog’s blood glucose levels to normal.

Incidentally Banting was an accomplished painter and had ties with the famous Canadian painters, ‘The group of seven’.

In 1927, the first case of hyperinsulinism (too much insulin) due to a tumor of the islet cells which produce it was reported. In March 1940, surgeon, Dr. O. Whipple performed the first recorded one-stage pancreaticoduodenectomy.

This in essence remains a surgical mainstay. Much progress has been made since then and today transplantation of isolated islets and portions of even the whole pancreas is a reality.

The pancreas, is a glandular organ 6-8 inches long, located in the abdomen and is part of the digestive system, it produces insulin and other important enzymes and hormones that help break down foods and are secreted into the small intestine.

The pancreas extending horizontally across the abdomen, the largest part laying on the right side of the abdomen where the stomach attaches to the first part of the small intestine, the duodenum. At this point, the partially digested food passes from the stomach into the small intestine and it is here that it  mixes with the enzymes.

The pancreas

There are several different disorders of the pancreas including acute pancreatitis, chronic pancreatitis, hereditary pancreatitis, and pancreatic cancer. The assessment of pancreatic diseases can be difficult due to the inaccessibility of the pancreas. Emphasis will be made here of pancreatic cancer, given its severity and that 90% of cases are in those 50 plus.

The evaluation of pancreatic diseases

As mentioned, the diagnosis of pancreatic diseases can be difficult due to the inaccessibility of the pancreas, which makes the 1848 experiments even more impressive (given they didn’t have anaesthesia then)!

There are several methods to assess the pancreas following initial investigation and should include a physical examination, which is challenging given the pancreas is deep in the abdomen near the spine.

Blood tests are often beneficial in determining whether the pancreas is involved in a specific symptom but may be deceptive. The best diagnostic means are medical imaging tests – CT (computed tomography) scan, endoscopic ultrasound, and MRI (magnetic resonance imaging).

Tests to assess the pancreatic ducts include ERCP (endoscopic retrograde cholangiopancreatography) and MRCP(magnetic resonance cholangiopancreatography). Due to its remoteness, surgical exploration may be the only way to confirm the diagnosis.

Acute pancreatitis is of sudden onset and causing inflammation of the pancreas, frequently associated with severe upper abdominal pain.

The pain may often be severe lasting several days and may include nausea, vomiting, diarrhea, bloating, and fever. In the U.S, the most common cause of acute pancreatitis is gallstones although other causes include chronic alcohol consumption.

Hereditary conditions, trauma, medications, infections, electrolyte in-balances, high lipid levels, hormonal abnormalities or other causes may occur. Medication is usually ineffective, and treatment is usually supportive although most  patients recover completely.

Chronic pancreatitis is a progressive disorder associated with the systematic destruction of the pancreas.

More common in men and a disease of middle age usually between age 30 and 40. Initially, chronic pancreatitis may be confused with acute pancreatitis because the symptoms are similar to begin with, the most common symptoms being upper abdominal pain and diarrhea.

As the disease becomes more chronic, patients can even develop malnutrition and weight loss. If the pancreas becomes destroyed in the latter stages of the disease, patients may develop diabetes (diabetes mellitus).

The most common cause of chronic pancreatitis in the United States is chronic alcohol consumption. Additional causes include cystic fibrosis and other hereditary disorders of the pancreas. For a significant percentage of patients there is no known cause.

The treatment for chronic pancreatitis depends on the symptoms and most therapies centre on pain management and nutritional support. Oral pancreatic enzyme supplements can be used to aid in the digestion of food and those who develop diabetes require insulin to control blood sugar. The avoidance of alcohol is central to therapy.

In some cases, pancreatitis is related to inherited abnormalities of the pancreas or intestine – Hereditary Pancreatitis

Inherited abnormalities of the pancreas or intestine, (Hereditary Pancreatitis) may cause acute recurrent attacks of pancreatitis in early life (under 30) can often progress to chronic pancreatitis. The most common inherited disorder that leads to chronic pancreatitis is cystic fibrosis and recent study demonstrates genetic testing can be valuable in identifying patients with a predisposition to hereditary pancreatitis.

As in chronic pancreatitis, hereditary pancreatitis is a progressive disease with a high risk of permanent damage. Patients with these disorders may have chronic pain, diarrhea, malnutrition, and/or diabetes. Again, treatment focuses on pain control and pancreatic enzyme replacement.

Pancreatic cancer is the fourth most common cause of cancer death in men and the fifth in women.

Pancreatic cancer is the fourth most common cause of cancer death in men and the fifth in women and accounts for more than 37,000 new cases per year in the United States alone, where pancreatic cancer is the 12th most commonly occurring cancer in men and the 11th most commonly occurring cancer in women.

There were 460,000 new cases in 2018 and it was estimated that 53,070 Americans had been diagnosed with pancreatic cancer in 2016, estimated deaths were 41,780.

It is estimated that 5,500 Canadians were diagnosed in 2017, (more than 338,000 worldwide) and that estimated deaths in Canada were 4,800.

Median age by gender (Canada) 1984-2014. This shows an aging society in Canada to which this disease is related NOT the increase in the disease.

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Pancreatic cancer is the 4th leading cause of cancer-related deaths in Canada.

Pancreatic cancer is the 11th most common cancer in England with around 8500 people diagnosed every year. In England approximately 17 people per 100,000 population will be diagnosed and it is the 5th  largest cancer morbidity with 7,800 deaths every year. While there are multiple risk factors, pancreatic cancer is known to be a disease of older age groups, as only 10% of patients develop this condition below the age of 50.

Studies from the United States show a dramatic increase in rates of pancreas cancer recently surpassing breast cancer to become the 3rd leading cause of cancer death in the U.S.

If the cancer is detected at an early stage when surgical removal of the tumor is possible, the 5-year survival rate is 34% – only about 10% of people are diagnosed at this stage.

If the cancer has spread to surrounding tissues or organs, the 5-year survival rate is 12%, but 52% of people are diagnosed after the cancer has spread to a distant part of the body when the 5-year survival rate is 3%.

In 2017, it was an estimated that;

5,500 Canadians were diagnosed with pancreatic cancer.
4,800 Canadians died from pancreatic cancer.
2,800 men were diagnosed with pancreatic cancer, 2,400 died
2,700 women were diagnosed with pancreatic cancer and 2,400 died.

 Cancer of the pancreas is resistant to many standard treatments including chemotherapy and radiation therapy and grows insidiously and alas does not cause symptoms initially – classic presentation of pancreatic cancer being painless jaundice with no other symptoms. Interesting work in prevention has indicated the use of antioxidant rich foods, whose vitamin C, E, and selenium intake was in the top 75% were 67% less likely to develop pancreatic

Vague symptoms including back/abdominal pain, jaundice and nausea usually appear only after the cancer is at an advanced stage making it difficult to treat. Confirmation is usually made using different radiographic imaging techniques.

If detected in the early stages, pancreatic cancer may be cured by surgical resection, but there are no detection tools to diagnose this disease in its early stages when surgical removal of the tumor is still possible.

Unfortunately, early detection is more the exception than the rule and at later stages, improvement of the quality of life by control of symptoms and complications is and was, all that was available to my step-father.

Antioxidant Trio Slashes Pancreatic Cancer Risk

Researchers analyzed a recent study in GUT when the seven-day food diaries of more than 23,500 people aged 40 to 74. Forty-nine people developed pancreatic cancer within 10 years of entering the study. Researchers then compared diets among people diagnosed with pancreatic cancer to those of nearly 4,000 people without pancreatic cancer.

People who ate more selenium were 50% less likely to develop pancreatic cancer compared to those who ate the least amounts of selenium-rich foods, and those whose vitamin C, E, and selenium intake was in the top 75% were 67% less likely to develop pancreatic cancer than those who ate the lowest amount of foods rich in this trio of antioxidants.

Researchers only looked at foods rich in these nutrients.

See antioxidants

It is referred to as a silent killer as it’s difficult to detect and spreads so quickly.

If in doubt ask your doctor.

Someone close to me died of it and if we can save just one more person it will all have been worthwhile.

Stephen Bray 2019

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