When it comes to the organs you know you’re supposed to monitor, your heart, brain, and colon probably jump to the top of your mind. Your pancreas? Not so much.
But the late Jeopardy! host Alex Trebek brought some much needed attention to the overlooked organ after announcing he had stage 4 pancreatic cancer in 2019. Trebek, who hosted Jeopardy! since 1984, died Sunday morning at the age of 80.
Although pancreatic cancer rarer than other forms of the disease, it’s also among the most deadly. And the Stage 4 pancreatic cancer survival rate is particularly low. According to the American Cancer Society, an estimated 55,440 people will be diagnosed with pancreatic cancer in 2018, and 44,330 will die from it. Only about eight percent of all people with pancreatic cancer survive five years after the initial diagnosis, according to the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program (SEER). The five-year survival rate for patients diagnosed with metastatic, or stage 4, pancreatic cancer is three percent. Once patients are in this stage, the cancer has spread to other organs, like the liver or lung.
What’s even more frightening? Pancreatic cancer is hard to detect, and it’s not subject to routine screenings. Plus, it can also spread to other organs early on, explains Daniel M. Labow, M.D., F.A.C.S., chair of the department of surgery for Mount Sinai West and Mount Sinai St. Luke’s, and chief of surgical oncology and hepatobiliary surgery at the Icahn School of Medicine at Mount Sinai.
While not everyone with pancreatic cancer will exhibit early symptoms, knowing what to look out for can help doctors treat it as soon as possible, which significantly raises your chances of survival. Here are eight possible signs of pancreatic cancer — including some that your doctor probably never told you about.
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Your skin and eyes turn yellow.
Jaundice is the result of a buildup of bilirubin, or bile, in your bloodstream. The bile duct passes through the pancreas, so when cancer cells are growing near the head of the pancreas, the tumor can compress the bile duct, which causes the bile to back up into the bloodstream.
When your skin and the whites of your eyes turn yellow, the actual color pigment of the bile running through your blood, which is deposited in skin and fat, says Dr. Labow. Other symptoms associated with jaundice are dark, Coca-Cola colored urine and light, clay-colored stool, he adds. “Bilirubin in the intestine is what makes bowel movements brown, and so when it backs up and gets into the bloodstream, it can’t get into the intestine,” he explains.
The pancreas plays an important role in digesting fats, says Dr. Labow. If bile and pancreatic enzymes aren’t making their way to the intestines because of a blockage — say, a tumor — undigested fat will elevate the fat content of stool, causing it to look greasy. It might even float on the top of your toilet’s water.
Nagging back or stomach pain.
“The pancreas sits deep within the abdomen, so sometimes, there’s an irritation of the nerves around the spine [because of] the cancer being there,” says Dr. Labow. “That can cause a nagging pain in the upper-middle back.”
Most of the time, this won’t be a five-alarm, excruciating pain. “Sometimes people feel like they pulled their back, and they think it’ll get better after a few days and it never quite does,” he adds.
Pancreatic cancer can also cause pancreatitis, which is inflammation of the pancreas that can cause abdominal pain. You don’t have to have both back pain and abdominal pain — it could be either, says Dr. Labow.
Rapid, unexplained weight loss.
“Certain cancers secrete [compounds] into the blood that can lead to the body breaking itself down,” says Dr. Labow. This can lead to rapid weight loss due to the breakdown of both fat tissue and skeletal muscle. “Even if you ate non-stop, you would never be able to gain or maintain weight,” says Dr. Labow.
While this applies to many different types of cancer, there’s another reason why pancreatic cancer in particular can lead to rapid weight loss. “You’re not absorbing fats and proteins the way you normally would, and so even if you’re eating well, you don’t necessarily absorb all the calories you’re eating,” says Dr. Labow.
Nausea and vomiting.
Cancer in general can be linked to nausea and vomiting, but it’s especially common with pancreatic cancer because of the important role the pancreas plays in digestion.
“The pancreas sits right near the stomach and the duodenum, which is the first part of the small intestine,” says Dr. Labow. “A large mass could be pushing on it, which can affect the way food leaves the stomach and goes into the GI tract. So your stomach may not empty the way it normally does.”
A lump under the right side of your ribcage.
In some cases, you may actually be able to feel your gallbladder in the upper right quadrant of your abdomen, poking out from underneath your rib cage.
“Gallbladder enlargement can happen because of how the bile drains at the bile duct,” explains Dr. Labow. “If the bile duct and the gallbladder are blocked [as a result of pancreatic cancer], then it can sometimes cause the gallbladder to be quite large and distended, and you can feel it.”
A swelling, throbbing leg.
If one of your legs is swollen and in pain, that can be a sign of deep vein thrombosis (DVT), which is a blood clot that forms in a vein that’s deep in your body, usually in the leg.
“Cancer in general is known to increase patient’s risk of blood clots, because cancer can [induce a hypercoagulable state], or something that causes you to form clots abnormally,” says Dr. Labow.
This becomes especially dangerous if a blood clot breaks off and goes to the lung, which is known as a pulmonary embolism, says Dr. Labow. “[Look for] any sudden shortness of breath for no good reason, or a prolonged rapid heart rate for no reason,” he says. A pulmonary embolism can be fatal, but it’s treatable if you catch it, so get these symptoms checked out immediately.
While most of the above symptoms usually aren’t caused by pancreatic cancer, the old saying “better safe than sorry” still applies. “Any symptom that does not have a good explanation or persists more than a few days should be investigated in some way,” says Dr. Labow, even if that’s just a call to your doctor.
A diabetes diagnosis
Although rare, pancreatic cancer can cause diabetes, according to the American Cancer Society. This is because the cancer destroys insulin-making cells. When this occurs, people may feel more thirsty or hungry than normal. Some patients could be symptomless but have blood sugar level changes are detectable through blood tests.
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