As reported by the Danbury News-Times, March 10, 2008.

Doctors: Pancreatic Cancer Is 'Very Difficult' to Detect

By Robert Miller

Two years ago, Anthony Curcio Jr. was getting ready for hip replacement surgery.

But the surgery was stalled when preliminary tests showed the levels of some digestive enzymes in his body were higher than they should have been.

That led him to Danbury Hospital, where after several tests doctors found a cancerous mass on his pancreas was blocking his bile duct.

"They found it by accident," he said of the cancer. "I had no other symptoms."

Now, two years later, Curcio, 70, of Brewster, N.Y., is in the position an increasing number of cancer patients find themselves in today -- he is living with a disease that doctors can better manage, if not cure.

"I feel pretty good," he said. "When I got the diagnosis, I didn't think it was the end of the world. People ask me what I do. I tell them I just follow my doctor's orders."

Last week, actor Patrick Swayze -- the star of "Dirty Dancing," "Ghost" and "Road House" -- announced he had this form of cancer. Famed tenor Luciano Pavarotti died of the disease in fall 2007. Pavarotti's colleague of the opera stage, mezzo soprano Marilyn Horne, is also now living with the cancer.

In almost all cases of pancreatic cancer, the basic problem is this: There is no easy way to find the disease in its early stage, when it's best treated. Like lung cancer and ovarian cancer, its symptoms show up only after the cancer is fairly well established.

"It's a pretty aggressive cancer, and it's very difficult to detect," said Dr. Robert Kloss, medical director of inpatient oncology services at the Praxair Cancer Center at Danbury Hospital, and Curcio's oncologist.

"There's no set screening for it," said Dr. Bruce Brenner, a gastric surgeon at the University of Connecticut Medical Center in Farmington.

As a result, doctors often find the disease after it has spread. The American Cancer Society reports that the five-year survival rate for the disease is only 5 percent.

But both Kloss and Brenner said there are hopeful signs on the horizon for pancreatic cancer patients. Doctors have at least one new drug -- Tarceva, which Curcio takes -- to treat the disease. There are ongoing drug trials to find ways to improve treatment.

And a cancer vaccine being used in a some cancer centers boosts the body's ability to fight the disease after surgery.

As a result, the doctors said, patients with pancreatic cancer can expect to live longer and with a better quality of life.

"Patients who have pancreatic cancer that has metastasized used to live six months after diagnosis," Kloss said. "Now it's more like 18 months or longer."

The best-case scenario for pancreatic cancer patients is that doctors find the cancer early, before it has spread. Brenner said in those cases, surgeons can remove the tumor or only part of the pancreas, allowing it to function and provide the body with insulin and digestive enzymes.

In a minority of cases, doctors remove the entire pancreas. That gets rid of the cancer, but leaves the patients, in essence, as diabetics. They must get insulin shots and take medication that provides them with digestive enzymes.

For those patients -- who get a regimen of radiation and chemotherapy after surgery -- the five-year survival rate goes up to 25 percent.

But because doctors usually discover the cancer late, that's usually not an option. Often, as in Curcio's case, the cancer grows around the blood vessels that lead to the pancreas so removing the tumor is impossible. It can also spread to other organs, especially the liver.

But Kloss said doctors are now increasingly able to extend the lives of people with pancreatic cancer, if not cure them of the disease.

Curcio, for example, is taking Tarceva along with gemcitabine, the gold standard drug for pancreatic cancer treatment.

That's allowed him not just to live, but to enjoy life. In the midst of his treatment, he still went to Canada to hunt white-tailed deer. And he plans to go hunt there again.

"Some people get this news and curl up in a corner," Curcio said. "Me, I'm a fighter."

Pancreatic Cancer

  • The pancreas sits behind the stomach.
  • It produces digestive enzymes, insulin, and other hormones.

Risk factors

  • Cigarette smoking -- smoking in teen and college years has been associated with a two - to threefold increase in the risk of getting pancreatic cancer. (Patrick Swayze is reportedly a heavy smoker.)
  • Chronic pancreatitis.
  • Diabetes.
  • Diet high in meats, fats and fried foods.
  • Age -- 80 percent of cases occur in people between 60 and 80 years old.
  • Race -- more common in blacks than whites.
  • Gender -- more common in men than women.