In September 2009 actor Patrick Swayze passed away due to pancreatic cancer. This week Steve Jobs has lost the battle to the disease.

You can read about this horrible cancer in our original post.

Here are some updated statistics you should know about -

• Each year, more than 43,000 people are diagnosed with this cancer in the United States alone.
• 37,660 people have died of pancreatic cancer since the beginning of the year.
• Smoking is the most important risk factor for pancreatic cancer. Smokers are more likely to develop this cancer, while heavy smokers are at an even higher risk.
• Jaundice (yellowing of the skin, dark urine and pale stools) may be a sign of pancreatic cancer. Also abdominal pain may be one of the first signs.
• It’s usually discovered too late, which is one of the reasons so many people die of it
• If the cancer can’t be removed by surgery, survival may last for only 4-6 months.

Haiku by Andrew Forgrave

The Lustgarten foundation was established to advance the scientific and medical research related to the diagnosis, treatment, cure and prevention of pancreatic cancer. You can make a donation to help prevent further deaths from this disease.

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This is part of our House MD Project series.

Click here to read the connection to the episode (spoiler alert!)


On episode 4 of season 2, called “TB or Not TB”, a doctor named Sebastian Charles, who works with tuberculosis patients in Africa, collapses and is taken to the hospital. With tuberculosis being his specialty, the doctor is sure he has tuberculosis. Later on, during a press conference, he becomes disoriented and his heart fails. Turns out he has a small tumor called nesidioblastoma causing his symptoms.

Danger level: High

What is it?

Nesidioblastoma (also called “islet cell carcinoma”) is an uncommon cancer of the pancreas.

Who gets it?

Tumors of the endocrine pancreas (more about that word later) are pretty rare. In the US, they happen to 3-10 out of a million people per year.

They are slightly more common in women than in men.

In terms of age, they mostly present at ages 30-50.

What causes it?

The pancreas is a gland in our body. It has two types of cells:

1. Endocrine cells: Make hormones (chemicals that control actions of other cells or organs in the body), like insulin.
2. Exocrine cells: Make enzymes (proteins that have a function, like little machines) that are released into our intestines and help the body digest food.

Islet cell tumors, like nesidioblastoma, arise from the endocrine part of the pancreas. This means that they secrete hormones. They may be functional (causing symptoms) or non-functional.

An example would be a tumor that secretes insulin, like on the House episode. Insulin controls the amount of sugar in the blood. When insulin is high, sugar in the blood enters the cells, and there is less sugar in the blood.

How does it feel?

That depends on what the tumor secretes.

If it secretes insulin, like was shown on the House episode, it will lead to low sugar levels in the blood. This means the brain will not get enough sugar, necessary for it to function properly. This will lead to headaches, blurry vision, changes in thinking and concentration, weakness. Also sweating, changes in the heart rhythm, and body tremors.

Other hormones other than insulin can be secreted, and cause different symptoms.

How is it discovered?

There are different ways to discover different types of tumors arising from the pancreas.

For an insulin secreting tumor, for example, glucose (blood sugar) and insulin in the blood can be measured.

Another way of finding the tumor, which was shown on House, helps locate the tumor in the pancreas. In this method, calcium is injected into an artery that goes to one part of the pancreas. At the same time, a blood sample is taken from a blood vessel that comes out of the pancreas (a vein) to see if it secretes more hormones as a result. If there’s a tumor in the area the calcium reached, there will be an increase in the amount of hormone in the blood sample.

How is it treated?

Depending on the extent of the tumor, it can be removed from the body. Sometimes, other treatment measures are needed, if this is not enough.

What happens after treatment?

That depends on whether the tumor has spread to other areas of the body or not. If it has, chances of survival lower.

The bottom line – How do I avoid it?

There is currently no way to prevent nesidioblastomas or other tumors of the endocrine pancreas.

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Diabetes affects about 21 million people in the US, and much more around the world. It raises our risk for other diseases as well. Here you will learn what it is, and how to avoid it altogether.

Danger level: Medium

Health forums category: Diabetes

What is it?

Diabetes, or by its long medical name diabetes mellitus, is a condition in which there is an abnormally high level of sugar in the blood.

Sugar. You blood is rich in it when you have diabetes. Photo by Uwe Hermann.

Who gets it?

That depends. There are 2 types of diabetes:

Type 2 diabetes:
Even though it’s number 2, this is actually the most common type. 90% of people with diabetes have type 2. This is an adult disease, as opposed to type 1 diabetes, although it is seen more and more in children. There are some risk factors which can put you at risk for diabetes type 2 -

1. Obesity – If you have a high BMI you’re at risk
2. Inactivity – The less exercise you do and the more sedentary you are, the greater your chances are of getting it
3. Family history – If someone in your close family has it, you are more likely to get diabetes
4. Race – People at higher risk include African Americans, Hispanics, American Indians and Asian Americans.
5. Age – As you get older your risk rises.

As Western society gets more sedentary and more fat, so is the disease spreading more rapidly. That is why more and more children get diabetes type 2.

Type 1 diabetes:

This is a disease which usually starts in childhood. No one knows the reasons behind why it develops, but it possibly runs in families (meaning it’s genetic), which means that if someone in your close family has it, your chances are probably higher than the rest of the population.

What causes it?

It all starts with insulin. This is a hormone produced by our pancreas, which is an organ that sits in our abdomen. When we eat, sugars from the food we ate are broken down into a molecule called glucose. Glucose fuels our body. Glucose gets into our bloodstream and then enters the cells in our body, fueling them. It can’t enter the cells, though, unless insulin is present in the blood.

In diabetes, little or no insulin is produced by the pancreas. This causes glucose to stay in the blood and not enter the cells, causing a high level of glucose in the blood (a situation which in medicine is called hyperglycemia).

This video shows it graphically:

Why it happens differs between the two types of diabetes:

Type 2 diabetes:

There are two things happening here:

The first is called insulin resistance, and it happens early in the disease. In this stage, the pancreas produces insulin, but the body is resistant to its effects, for an unknown reason. The pancreas, in turn, produces more and more insulin, until, with time, it produces less and less of it. This is the later stage of the disease.

Type 1 diabetes

In this type, the body attacks its own pancreas. Antibodies, the molecules the body usually uses to fight infections, are used against the body itself. Diseases in which antibodies attack the body are called autoimmune diseases. We covered several of those in the past, including lupus, celiac, Crohn’s disease, vitiligo and others.

The antibodies lead to the destruction of the pancreas, which can no longer produce insulin.

How does it feel?

There’s a groups of symptoms characteristic of diabetes:

1. Frequent urination and Increased thirst – In diabetes glucose builds up in the blood, and the kidneys want to get rid of it. To do this, they produce more urine. This is why people with diabetes urinate more, and as a result feel more thirsty.
2. Extreme hunger – Since sugar doesn’t enter the cells (since there is no insulin to help it do that), the body screams that it needs fuel, causing hunger.
3. Unexplained weight loss – Again, since sugars don’t get into the cells and are lost in urine, there is no weight gain.
4. Fatigue

How is it discovered?

Diabetes is discovered by simply taking a blood sample and watching the level of glucose in it. It can be done after fasting or without fasting. In both these circumstances, the level of sugar in the blood will be excessively high.

How is it treated?

That depends on the type and extent of the diabetes:

In type 2 diabetes, drugs are given which work in several ways to increase the amount of insulin produced by the pancreas, or  increase the body’s responsiveness to insulin. With time, though, the pancreas may stop producing insulin altogether, which may require the use of artificial insulin, which is injected by the patient.

In type 1 diabetes usually insulin, and not drugs, is given, since early in the disease the pancreas gets destroyed and not enough insulin exists in the body.

What happens after treatment?

Diabetes is a life-long disease. If it is discovered early and treated carefully, people can live with it a normal life.

If, on the other hand, treatment isn’t adequate, complications can develop, including:

1. Diabetic ketoacidosis – This is a condition that’s more common in type 1 diabetes. It’s a life-threatening condition in which the body breaks down fat since it is starved for energy. It then turns the fat into toxic acids known at ketones, which are dangerous for the body.
2. Blood vessel problems – Diabetes increases the risk for atherosclerosis, heart attacks and strokes.
3. Nerve damage – Excess sugar in the blood can damage the small arteries which supply oxygen to our nerves, especially the ones in the legs, causing them to get damaged. This can lead to anything from numbness and tingling, to a complete loss of feeling in the legs, which in turn can lead to dangerous infections. These sometimes necessitate amputation of the legs.
   Other nerves which can get damaged include those in our digestive system, which can lead to nausea, vomiting, diarrhea or constipation. In men, the nerves responsible for erection can get damaged as well.
4. Kidney damage – This can lead to failure of our kidneys, which may necessitate dialysis or a kidney transplant.
5. Eye damage – The blood vessels in our retina (a part of our eye) can get damaged, leading to blindness.

The bottom line – How do I avoid it?

If you have type 2 diabetes you can help to prevent it (this unfortunately doesn’t apply to type 1 diabetes, which no one knows yet how to prevent).

You can do this by taking the following steps:

1. Lose weight – If you’re overweight, losing the excess pounds can lower your risk of developing diabetes. You can start by reading our article about using the Internet to lose weight.
2. Get more physical activity – The American Diabetes Association recommends 30 minutes a day of moderate physical activity. They say that if you combine this with a 5-10% reduction in your body fat, you lower your chances of having diabetes by 60 percent. You can read their recommendations for exercise here.
3. Eat healthier – This means foods that are lower in fat and calories. You should instead opt for more fruits, vegetables and whole grains. Again, you can read the American Diabetes Association’s recommendations about diet here.

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1. Nesidioblastoma – A Tumor of the Pancreas That Can Secrete Hormones (As Seen on House MD)

Yesterday actor Patrick Swayze, known for his performance in such films as "Dirty Dancing" and "Ghost", died of pancreatic cancer. What is this cancer, and how can you avoid this deadly condition?

Danger level: High

What is it?

Pancreatic cancer is a disease in which malignant cells form in the pancreas. It is the 4th leading cause of cancer-related death.

Who gets it?

In the US, more than 37,000 people are diagnosed with pancreatic cancer each year. It happens to about 8-10 people out of 100,000 each year.

It’s most common in African Americans. It’s also more common in people of Native Hawaiian, Korean, Czech, Latvian, and New Zealand Maori origin. It’s quite rare in India, where there are about 2 cases per 100,000 people.

Pancreatic cancer is related to age – After age 50, the risk for it increases. Most people diagnosed with it are in their 70s and 80s.

There are some risk factors, which increase your risk of having pancreatic cancer:

1. Smoking
2. Being overweight
3. A history of chronic pancreatitis – In you or someone in your close family
4. A history of pancreatic cancer – In you or someone in your close family

Patrick Swayze, in 2006. Photo by MoonSoleil

What causes it?

The pancreas is a large gland in our abdomen. It’s responsible for making two things: insulin, which helps our body control the level of sugar in our blood; and pancreatic juices, which help our body digest the foods we eat.

The pancreas has three parts: The head, the body and the tail. Cancer can develop in any of these parts. Most cancers develop in the head of the pancreas (it is the part that’s leftmost in the drawing above).

Cancer is a condition which develops when cells in our body start dividing more than they should, causing a growth in an organ called a tumor. As with most other cancers, the reason for it is unknown, although it is known that a chronic inflammation in the pancreas increases the risk.

How does it feel?

As mentioned above, the cells in the pancreas grow, creating a tumor. This tumor often spreads further from the pancreas, through the blood, to reach other organs.

Unfortunately, this cancer doesn’t cause any symptoms most of the time, until the disease has spread. When symptoms do appear, they may include:

1. Abdominal pain – Usually in the upper or middle abdomen. It can radiate to the back.
2. Jaundice – This is a yellow color in your skin or the whites of your eyes.
3. Loss of appetite
4. Weight loss
5. Fatigue

How is it discovered?

Usually this cancer is detected late, a fact which is responsible for the high death rate involved with it.

Usually it is discovered by taking images of the body by an ultrasound, CT scan or an MRI, although there are other methods as well.

When the cancer is found, it is important to stage it. This term means deciding which stage the cancer is in, or how much it has spread. The higher the stage, the more advanced the cancer is, and the less likely it is that it can be cured. Staging can be done by surgery to open your abdomen and look at the pancreas and other organs, by imaging the body and by taking a blood test called CA 19-9, which helps the doctor follow the cancer and see if it is spreading.

How is it treated?

There are a few types of treatment for this cancer. The one chosen depends on the stage of the disease, on your age, on your overall health and your personal preferences.

Treatment options include surgery, radiation therapy, chemotherapy and sometimes some drugs.

What happens after treatment?

Unfortunately, the death rates for this cancer are high. If the cancer can’t be removed by surgery, people usually survive for about 4-6 months. If the cancer can be operated on, about 20% of people can live for 5 years after the surgery.

This video from this morning’s CBS News sums it up:

The bottom line – How do I avoid it?

There are a few things you can do to lower your chances of having pancreatic cancer:

1. Quit smoking
2. Maintain a healthy weight
3. Eat a balanced diet – The American Cancer Society recommends eating more fruits, vegetables, and whole grains while eating less red meat, although none of this has been actually proven.

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Danger level: High

What is it?

Pancreatitis is a disease in which the pancreas gets inflamed.

Who gets it?

In the US, it happens to about 40 people out of 100,000 people. Over the world, acute pancreatitis is most common in the US and in Finland.

In terms of race, African Americans are more prone to acute pancreatitis. The risk for African Americans aged 35-64 is 10 times higher than for any other group.

What causes it?

The pancreas is an organ which is located next to our stomach and intestines. It has 2 roles:

1. It produces hormones: Such as insulin.
2. It secretes the pancreatic juice – It contains digestive enzymes (types of molecules in the body), which help with the breakdown of the food we eat in the intestines.

The pancreas. When it gets inflamed, pancreatitis happens.

Under normal conditions, the pancreatic juice is secreted into our intestines after we eat, helping with the breakdown of the food we ate. When that happens, the enzymes in the juice are activated, and start breaking the food molecules into smaller parts.

In acute pancreatitis, these enzymes are activated while still in the pancreas. Since their role is to break things down, instead of breaking down food, they break down the pancreas itself, causing it damage.

There are many causes for acute pancreatitis, with the first two being the most common:

1. Heavy alcohol use
2. Gallstones – These are stones in the gall bladder (you can see the gall bladder in the drawing above).
3. A high level of fats in the blood
4. After abdominal surgery
5. Certain medications
6. Smoking
7. Cystic fibrosis
8. Treating gallstones by a procedure called ERCP
9. Infections – Such as mumps.
10. Cancer in the pancreas
11. Injury to the abdomen or elsewhere in the body

How does it feel?

The main thing that’s felt in acute pancreatitis is an abdominal pain. It usually travels to the back. The pain may get worse by eating, especially fatty foods.

Other things that are felt during an episode of acute pancreatitis can include a swollen and tender abdomen, nausea and vomiting, and fever.

How is it discovered?

To determine if someone has acute pancreatitis, the blood level of the enzymes in the pancreas can be checked. These enzymes are released from the pancreas before due time, cause damage to the pancreas, and then reach blood vessels and can be found in the blood. These enzymes are called lipase and amylase and they will be high in blood tests in people with pancreatitis.

Other methods that can help include an ultrasound or a CT scan, as well as other techniques.

How is it treated?

The main treatment is fluids and pain killers, both given directly to the vein. Also, not eating for a couple of days helps the pancreas rest and recover. Acute pancreatitis usually requires hospitalization, and the treatment is given in the hospital.

Acute pancreatitis is a severe condition, and in up to 20% of people it may require hospitalization in an intensive care unit. There, the person with pancreatitis will be closely monitored, since the disease can cause damage to other organs in the body as well.

What happens after treatment?

Usually an attack of acute pancreatitis lasts a few days, unless there are complications. Even when treated properly, acute pancreatitis is a serious condition, which can sometimes also lead to death.

After recovery, the cause for the pancreatitis has to be discovered and treated, in order to avoid future attacks.

Sometimes, the simple treatment above doesn’t help, and the situation requires a surgery to fix the condition.

The bottom line – How do I avoid it?

Since many cases of acute pancreatitis are caused by excessive alcohol drinking, you should limit your alcohol drinking. If you abuse alcohol, you should see a doctor about a referral to an alcohol treatment center.

This video shows the personal story of someone with pancreatitis caused by heavy alcohol drinking:

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