Dr. Kevin Most: Pancreatic cancer and a new measles outbreak

Dr. Kevin Most

We heard last week of the death of Aretha Franklin from advance pancreatic cancer. Pancreatic Cancer is one of the most deadly cancers we know of, with high mortality rates. One of the reasons is that often when found it is fairly advanced and the treatment options are limited. The five year survival rate from  the time of diagnosis of pancreatic cancer is 7 percent, what is even more concerning is that the one year survival rate is 20%.  With over 50,000 cases in the United States each year, many of us have been touched or are aware of someone who suffered thru this illness. This is a cancer that grows and spreads rapidly. We really do not have risk factors that make us consider this to be screened for.  There are very few hereditary or genetic causes that have been found. It appears that a sedentary lifestyle, obesity, tobacco use and thw western diet we are all exposed to may have some cause.

 

The diagnosis is very difficult and often not made until it is in the advanced stages, the pancreas lies in our belly and the cancer can often grow silently for months before any symptoms are noted at all. The early symptoms are of subtle and ignored. Once the tumor grows to a point where it is in conatct with other organs we start to see symptoms. Pain when it pushes against nerves, Nausea or vomiting as it pushes against intestines, jaundice as it pushes against the ducts that drain bile.

 

Why is it advanced by the time the diagnosis is made? The problem is that the symptoms are not specific and there is no blood test to make the diagnosis. Symptoms like abdominal pain, nausea and vomiting can be caused by many other illnesses some as simple as a stomach virus. Often patients can’t fully describe the symptoms and thus they tolerate them. In some cases the patient will have jaundice or yellowing of the skin but it comes on slowly and is often not noted by the patient.

 

The tests that helps make the diagnosis are a CT scan of the abdomen, or ultrasound it is with these tests that a mass may be noted in the pancreas and thus signal there is cancer present. For some patients the CT scan is done for another reason and the mass in the Pancreas is noted, in some cases before symptoms. For these individuals it is like winning the lottery as surgery can often be done before the cancer has a chance to spread. These are the patients that have much longer survival rates. This is really the only chance for a cure is when it is found early and surgery is successful. Many patients will have surgery and chemotherapy in the hopes to slow the growth and extend life but it is very rarely curative as by the time of diagnosis the cancer cells have already spread to other parts of the body thru the blood stream and extension.

 

Looking at the health records of Ms Franklin that have been shared, one has to wonder if her surgery in 2010 was just that, pancreatic cancer surgery. The reason for the surgery was never shared but the surgery along with weight loss may lead one to believe that she may have had surgery for pancreatic cancer at that time.

 

The pancreas is very important organ for us as it is the organ that makes insulin to help us control our blood sugar levels in the body, it also makes enzymes that the body needs to absorb and digest food. Pancreatic cancers can be of either type with the symptoms being similar

 

Pancreatic cancer is  described in stages with Stage 4 being the worst, at this point the cancer has spread and has  often eliminated surgery as an option. The symptoms patients in this stage notice are, jaundice or yellow skin or eyes, weight loss, itching skin, stomach pain or back pain, nausea and vomiting.

 

There is a lot of research going on now with pancreatic cancer, clinical trials with new drugs, new combination of drugs as well as trying to find a way for earlier diagnosis with a blood marker

 

 

Measles-  This word for most of us is just a word in a vaccine, MMR or Measles , Mumps, Rubella. If you were born after 1957 chances are that you received the vaccine MMR as a present for your first birthday and then as a welcoming gift as we entered school. The vaccine requires 2 doses for the best coverage, the first dose at 12 months and the booster at age 5-6. That vaccine gives us each around 95 % coverage against each of the 3 viruses.

 

We have not eradicated these vaccines from the US and in fact outbreaks are still very common around the world. The US has kept these pretty much under control with the exception of 2014 when we noted over 600 cases of measles in the US. However, 400 of those cases came from a single Amish community in Ohio. Last year we had 116 cases, this year appears to be on a big increase as we have seen 107 cases in 21 states as of mid-July. In Illinois we have had 4 cases, which is close to our norm for the entire year.

 

The concern is that we have had a bunch of recent cases and couple that with children returning to school. Measles is highly contagious, it is caused by a virus that is shared by being exposed to coughing and sneezing. The virus can live in air and on surfaces for up to 2 hours. As we discussed last year the world is getting smaller and we have many countries where measles is common and rampant, so the spread is much easier as travel has allowed this. One can be contagious with the virus prior to having the rash, they may have cough, sneezing and fever often followed by the rash 10-14 days later.

 

Measles symptoms include runny nose, conjunctivitis, cough, sneezing, fever and a body rash. The individuals feel miserable and can for a week or 2, the bad thing is the rash does not start until 3-5 days after the symptoms start. This is bad as the individual is spreading the illness before they know they have it. Only a small number of individuals will go on to have the more serious complications like a brain infection or pneumonia.

 

Although many may feel, “so what, it is a little rash and cough?’ before this vaccine it had a huge impact on the health of our children. Think about a classroom of non-vaccinated kids, when one child comes in with a highly contagious illness and spreads it to the entire class in one day, and then to the entire school.  The impact it had on schools, parents, families and the local economies was major.

 

Many may question the value of vaccines, what they have to realize is all we are doing is teaching the immune system how it should work in a more controlled environment while eliminating the bad outcomes a virus may cause if left alone. Remember before vaccines, patients would have an illness and then be protected from future exposure as their immune system would now block any future chance of illness. Unfortunately going thru that natural process was painful, disruptive and in some cases deadly.

 

It is unfortunate that we had a fake study that was published by Dr Andrew Wakefield in 1998 that falsely touted a link between autism and vaccines. What is worse is we have some celebrities that continue to tout this, it is sad that we will listen to Jenny McCarthy or Jake Cutlers wife instead of the 100’s of true studies that show no link between autism and vaccines. I feel sorry for the parent who does not vaccinate their child thinking they are protecting them from autism yet end up with a life-threatening illness that exposes many others.