Tuesday, October 18, 2011

Invisible cancer that killed Steve Jobs

Now we can spot invisible cancer that killed Steve Jobs

Pancreatic cancer has no symptoms — but there are new tests to catch it early

By Pat Hagan

Last updated at 8:13 AM on 18th October 2011
When Jolie Dingle went for a routine scan 20 weeks into her pregnancy, she expected nothing more than images of her unborn baby. But the ultrasound also revealed something else — a large swelling on her spleen.

Within days, Jolie, 33, from Barnsley, South Yorkshire, had been diagnosed with cancer. Tests showed it had started in her pancreas and spread beyond the spleen to her stomach and kidneys.

Yet despite the shock of a cancer diagnosis, Jolie can count herself lucky. Cancer of the pancreas — a pear-shaped organ about 6 in long that lies deep inside the body between the stomach and the spine — is notoriously difficult to spot.

Medical developments came too late: Apple co-founder Steve Jobs died earlier this month aged 56 after a five-year battle with a pancreatic tumour
Medical developments came too late: Apple co-founder Steve Jobs died earlier this month aged 56 after a five-year battle with a pancreatic tumour

That’s because, in the majority of cases, it produces no symptoms until the malignant cells have migrated throughout the body and already caused irreversible damage to other organs, such as the liver or kidneys.

Despite being more than halfway through her pregnancy, Jolie had little choice but to undergo emergency surgery to remove a tumour which, it turned out, had grown almost as large as a football.

‘When they told me I had cancer, I thought my baby and I were both going to die,’ says Jolie, who has her own hairdressing business and is married to Jason, 43, who runs a decorating company.

‘I’d not heard of pancreatic cancer and, to be honest, I didn’t even know what the pancreas was or where it was in the body.’

Jolie and her now eight-month old son, Theo, both survived the surgery.
But had she not had a pregnancy scan, doctors said, the cancer would almost certainly have killed her and her baby too.

As a survivor of the disease, Jolie is a member of a very small club. It is widely regarded as one of the most lethal of all tumours, killing around 97 per cent of its victims within five years.

The profile of this deadly disease has been raised with the death of Apple co-founder Steve Jobs, who died earlier this month aged 56 after a five-year battle with a pancreatic tumour.

Every year, around 8,000 Britons are diagnosed with cancer of the pancreas. According to the Pancreatic Cancer Research Fund, while rapid progress has been made in boosting survival from cancers affecting the breast, a pancreatic cancer sufferer today is just as likely to die from it as someone 40 or 50 years ago.

Many sufferers discover a problem only when they experience considerable and unexpected weight loss (caused by the cancer eating away at their digestive system), back pain or severe abdominal cramps from the growing tumour.

But studies suggest that, if the disease is caught in the early stages, surgery to remove the tumour can transform survival rates from 3 per cent after five years to as much as 40 per cent.

Now research teams around the world are in a race to discover a simple way of checking otherwise healthy people for hidden signs of a pancreatic tumour.

Currently, most of those that get picked up early are spotted only because the patient happens to be undergoing an abdominal scan for some other, unrelated health matter — such as Jolie’s pregnancy scan. 

Survivors: Jolie Dingle and her baby Theo had a lucky escape when her tumour was spotted and treated when she was pregnant
Survivors: Jolie Dingle and her baby Theo had a lucky escape when her tumour was spotted and treated when she was pregnant

But in the U.S., efforts are under way to spot cancer victims as early as possible by scanning them for signs of pancreatic cysts, tiny growths that can become malignant.
These fluid-filled sacs on the pancreas usually have no known cause and, according to some estimates, affect up to one in eight people. In the vast majority of cases, they are harmless growths that never become malignant.

Those that do turn malignant account for about one in five cases of pancreatic cancer. At the moment, doctors usually only discover cysts by accident when a patient is having an ultrasound or MRI scan for something else.

But at the Johns Hopkins University Hospital in Baltimore, about ten patients a week are being screened as part of a trial to see if actively looking for cysts can cut the death toll.

Their efforts are being targeted at ‘high risk’ groups, such as those with a family history of pancreatic cancer, or those who have suffered a bout of pancreatitis — a persistent infection often brought on by gallstones, or frequent binge-drinking.

By targeting potential at-risk groups, it’s hoped doctors may pick up enough problematic cysts to make a significant difference to survival rates.

Another approach is being investigated by British researchers. Here, experts are pinning their hopes on research into the development of urine or blood tests that could detect pancreatic tumours before they get out of hand.

1 in 5
The number of people diagnosed with pancreatic cancer who are alive one year later
At the Institute of Cancer in London, scientists are hunting for ‘biomarkers’ that are released in high quantities into the urine when a tumour is developing. These biomarkers are proteins that a tumour produces, or chemicals that help with the breakdown of these proteins.

Within the next three to five years, it’s hoped that five to ten different ‘biomarkers’ will have been identified that will not only pinpoint pancreatic cancer but perhaps even identify a person’s risk of the disease, simply from their urine.

Dr Steve Pereira, consultant gastroenterologist and hepatologist at University College London, says: ‘Hopefully, in the next few years this will allow us to introduce a screening programme that is cheap and acceptable.

‘But it would have to be extremely accurate for us to test everybody. Instead, we will probably target those most at risk and concentrate on them.’

Jolie Dingle had no history of the disease in her family and had no other obvious risk factors when she complained to her midwife of feeling sick halfway through her pregnancy last year.

‘I felt terrible,’ she says. ‘It was only when I heard the doctor use the word tumour that I realised I had cancer. I had to break the news to Jason and my parents, who were all stunned.’

The surgery took place a few days later and doctors removed most of her pancreas, all of her spleen, a part of her stomach and about 15 per cent of one of her kidneys.

While mother and baby survived the operation, Theo was not out of the woods.
‘Doctors warned that in the first few days after surgery there was a high risk that I could go into premature labour or miscarry. At 22 weeks, Theo’s chances of survival would have been tiny. Every time the nurse put the monitor on me to try to pick up the baby’s heartbeat I was a bag of nerves.’

Now Jolie has regular three-monthly checks and so far the cancer has shown no sign of returning.

‘I can’t believe how lucky I am. When he was born, it was one of the best moments in my life. That’s why we called him Theo, which in Greek means God’s gift.’

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