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.

Related posts:

1. Neuroblastoma – The Most Common Cancer in Infants
2. Acute Pancreatitis – A Dangerous Condition Which Can Be Caused by Drinking Alcohol
3. Pleural Mesothelioma – Cancer of The Lungs Caused by Exposure to Asbestos

Danger level: High

What is it?

Carcinoid tumor is a type of slow-growing cancer which can grow in several places in the body. It usually forms in the intestines, but can also appear in the lungs, in other places in the digestive system (such as the stomach) and in other organs.

Who gets it?

In the United States, about 1.5 people in 100,000 have a carcinoid tumor.

There are a few risk factors which can put you at risk of developing this tumor:

1. Smoking – As in many other tumors, smoking can also increase your risk of having a carcinoid tumor.
2. Family history – If you have someone in your family with a syndrome called Multiple Endocrine Neoplasia type 1 (or MEN1 for short) you might be at risk.
3. Certain medical conditions – These conditions affect the stomach’s ability to produce acid, which is produced by the stomach under normal conditions. Conditions here include atrophic gastritis, pernicious anemia and Zollinger-Ellison syndrome. They all put you at greater risk for developing a carcinoid tumor.

What causes it?

Most of us know that our digestive system (the stomach, intestines, etc.) helps us break down the food we eat and digest it. One of the less known abilities of this system is to produce hormones (these are chemicals which affect cells in other parts of the body). Our digestive tract is lined by cells which can produce hormones (as well as other cells). Carcinoid tumors arise from these cells (and that is why carcinoid tumors can sometimes produce hormones themselves, as you’ll see ahead).

In carcinoid, these cells multiply uncontrollably to form masses, which are the tumor.

A part of the small intestine with a round mass in it – this is the carcinoid tumor.

How does it feel?

There are 3 things that can be felt in a carcinoid tumor:

1. Nothing – Often these tumors don’t show any signs of existence in their early stages, and you can go about unaware you have them.
2. Things that occur when there are tumors in the intestines – Carcinoid isn’t the only tumor which can occur in the intestines. It and other tumors there usually can cause a set of symptoms due to their location. These include abdominal pain, obstruction of the intestines (which will cause vomiting and bloating, among other things), diarrhea and weight loss.
3. Things specific to carcinoid tumors – Above we mentioned that these tumors can produce hormones. In less than 10% of cases, this brings about a set of symptoms called the carcinoid syndrome. Things it can include:
   a. Flushing (redness) of the skin
   b. Diarrhea
   c. Enlargement of the liver
   d. Problems with the heart valves
   e. Asthma

How is it discovered?

There are a few ways in which these tumors can be discovered:

1. Accidentally – Since a lot of the time these tumors don’t produce any symptoms, sometimes they’d be found in surgery done for other reasons.
2. High levels of the hormones in the urine – As mentioned above, these tumors can produce chemicals. An example of this is 5-HIAA, which can be found in high levels in the urine. Blood tests can also be used to discover the tumor.
3. Body imaging – Using a CT scan, an MRI or some other form of imaging, will show the tumor itself.

How is it treated?

The main treatment for carcinoid is surgery to take out the tumor. If the tumor is detected early, it can be removed completely in surgery (depending on where it’s at in the body). Unfortunately, most of these tumors are at an advanced stage when they are finally discovered, so removing them completely is usually not an option.

These tumors tend to spread (send metastases) to the liver. In which case, a simple removal of the tumor in the intestines isn’t enough.  A liver surgery, a liver transplant or a procedure which will stop the blood supply to the tumor in the liver is performed. Chemotherapy may also be used.

This video tells the story of Ruth Gerdes, whose carcinoid tumor reached the liver, and how she was cured of it:

For people with the carcinoid syndrome, there are certain medications, which can help greatly.

What happens after treatment?

If a tumor is taken out completely about 100% of people will continue living cancer-free. If the tumor spreads, the chances are lower for survival, but are still high relative to other cancers.

Even if the tumor isn’t operable, people can still live for years, since it grows slowly.

The bottom line – How do I avoid it?

Preventing the risk factors mentioned above (smoking, the medical conditions mentioned) might prevent you from having a carcinoid tumor.

For more information, you can visit the Caring for Carcinoid Foundation’s blog.

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2. Cushing’s Syndrome – Could You Be Exercising and Dieting and Still Be Fat? (As Seen On House MD)
3. TTP – Thrombotic Thrombocytopenic Purpura – A Rare Disease That Could Kill You

A few days ago a court decision was made that ruled in favor of treating Daniel Hauser’s Hodgkin’s lymphoma, in spite of his parents’ objections. Since then, his mother took him and fled, putting the boy at risk.

We’ll explain the disease here, as well as the implications of treatment and of not treating it.

Danger level: High

What is it?

Hodgkin’s disease is a type of lymphoma – a cancer of the lymphatic system. The lymphatic system in our body is involved in draining fluid and waste products from the body, as well as producing white blood cells which protect the body from infections.

Who gets it?

In the US there are about 7,500 new cases of Hodgkin’s each year. It happens to about 3 out of 100,000 people. It’s more common in America and Europe than in Japan and China.

Hodgkin’s disease is more common in males than females, especially in children.

It tends to occur in two age groups: in people 15-35 years old and in those age 50 and more.

What causes it?

The white blood cells which are created in the lymphatic system are called lymphocytes. Their role is to fight infections. In lymphoma, these cells begin to multiply uncontrollably, which produces malignant cells. These cells can invade other tissues in the body.

A lymphocyte. These cells take over the body in lymphoma.

How does it feel?

Our lymphatic system contains organs called lymph nodes. They are found throughout the body, and act as “traps” for germs and other foreign things. When germs enter the body, some of them reach the lymph nodes. There they are presented to the lymphocytes, which learn that the body has an infection, and start multiplying in order to fight the infection in other places in the body. When they multiply, the lymph nodes enlarge. This is why, for example, when we have an inflammation in our throat, a lump can be felt in our neck – the white blood cells there multiply, which causes the lymph node to enlarge.

The lymphatic system. The green circles are the lymph nodes (you can click the picture for a bigger version).

Since in Hodgkin’s the lymphocytes multiply as well, the lymph nodes will get bigger. They are usually not painful, but one interesting feature is that they might hurt after you drink alcohol (for unknown reasons).

Other things which happen in the disease:

1. Enlargement of the spleen – As you can see in the picture above, the spleen is also part of our lymphatic system (in the picture it’s the oval shaped green mass on the right of the picture). It gets larger too in the disease. In some cases, the liver can enlarge as well.
2. “B symptoms” – This is a group of symptoms which characterize lymphomas. They include 3 things:
   a. Weight loss – Usually of more than 10% of the body weight over 6 months.
   b. Fever – Of more than 38 degrees Celsius (or 100.4 Fahrenheit).
   c. Night sweats – This doesn’t mean the sweat you usually experience on hot days. This sweating is profuse, often causing you to change sheets during the night.
   Sometimes an itchy skin may be present as well.
3. Cyclical fever – Some people will have fever that goes up for a few days, then goes down for several days or weeks, and then up again, in cycles. This phenomenon is called “Pel-Ebstein” Fever.

Since the lymphatic organs grow, they can press other organs in the body, which may cause:

1. Difficulty breathing – If the tumor presses the airways.
2. Back pain and even paralysis – When the tumor presses the spinal cord.

And others.

How is it discovered?

When one of the lymph nodes is enlarged and the doctor suspects you have Hodgkin’s disease, they will take a sample of that node, in a process called a biopsy. It can be done by cutting a piece of that node or taking the whole node out.

The sample of the node will be looked at under the microscope. One of the most characteristic things that can be seen under the microscope in Hodgkin’s are cells called Reed-Sternberg cells, which look like the eyes of an owl (if you have good enough imagination), as in this picture:

Once the microscope shows it’s Hodgkin’s, additional tests are done, including blood tests, and images of the body (X-rays, CT scans, etc.) to see where the tumor has spread to.

How is it treated?

Therapy for Hodgkin’s disease may include the following, depending on how severe the disease is:

1. Chemotherapy
2. Radiation therapy
3. Sometimes bone marrow transplantation

What happens after treatment?

In patients in whom the disease is discovered early, more than 90% are cured as a result of treatment. Even in people with an advanced disease, more than 75% of them can live for years without the disease.

There is currently no known way to prevent the disease.

Related posts:

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2. Kawasaki Disease – A Childhood Disease That Can Endanger The Heart
3. TTP – Thrombotic Thrombocytopenic Purpura – A Rare Disease That Could Kill You

Anyone who watched last night’s season finale of Grey’s Anatomy has two different questions on their mind right now (and to not spoil it for anyone who didn’t, neither of them involves either IL-2 or anterograde amnesia). But tradition is tradition, and so you get to learn about two subjects for the price of one today.

IL-2

What is it?

IL-2 (or by its long name interleukin-2) is a chemotherapy used to treat melanomas and kidney cancer.

How does it work?

Interleukins are molecules in our immune system. They help in our body’s response to infections.

The cells that fight infections in our body are the white blood cells. The interleukins attach to these cells by connecting to a special receptor on them, and by this they activate them.

The good news is that the white blood cells can kill not only bacteria and viruses, but also cancer cells. IL-2 causes the body to make more of the immune system cells and makes the cells more effective.

The IL-2 molecule.

When is it used?

IL-2 is used to treat advanced stages of kidney cancer (called renal cell carcinoma) or melanoma, when these tumors metastasize (spread to other parts of the body).

How successful is it?

About 10-20% of people treated with IL-2 respond to the treatment. In a study done in 1999, 270 people with metastatic melanoma were given the treatment. 16% of them (43 people) improved with the treatment. Another study was done in 2000, in which again 16% of people improved.

It’s important to understand, though, that only 6% of these people were completely cured with this drug, while in the others it only helped partially.

Danger level: Medium

What is it?

Amnesia  is a Greek word which means forgetfulness or loss of memory. Anterograde amnesia is the inability to remember new facts.

Who gets it?

There are two types of things which can cause anterograde amnesia:

1. Drugs – No, not the ones that make you high. A group of drugs called benzodiazepines (which are usually used for anxiety or to induce sleep) can cause you to forget things. This can be seen in people receiving them before undergoing surgeries, who can’t recollect the minutes around taking the drug.
2. Physical damage to the brain – The damage can be the result of an injury (such as after an accident) or after a surgery to the brain. Such surgeries may be needed in some types of seizures, or when a tumor is in that part of the brain.

What causes it?

The area in our brain responsible for storing memories is called the hippocampus. Damage to the area of the hippocampus can cause a problem with learning new things and retaining them.

The hippocampus. Lose it and you’ll stop remembering new things.

How does it feel?

People with anterograde amnesia lose the ability to learn new facts. It’s important to understand, though, that they can learn how to do new things, such as talk on the phone. They won’t, whoever, remember who they talked to.

If the amnesia was caused by a drug, it usually goes away after a short time. If the amnesia is a result of damage to the brain, however, the chances of gaining the remembering ability back are much slimmer.

This video is a good example. It’s a part of a documentary about Clive Wearing, who suffers from anterograde amnesia:

You can see more examples by watching the (fictional) movies Memento and 50 First Dates.

How is it treated?

Unfortunately, once an area of the brain is damaged, there is currently no known way to recover that area.

Related posts:

1. As Seen on Grey’s Anatomy – Melanoma – You Can Avoid It if It’s Found on Time
2. As Seen on Grey’s Anatomy – Normal Pressure Hydrocephalus (NPH)
3. Superior Canal Dehiscence Syndrome – Hearing Sounds Inside Your Own Body (As Seen on Grey’s Anatomy)

Danger level: High

What is it?

Neuroblastoma is the most common cancer in infants. Cancer forms here in the adrenal gland, neck, chest or spinal cord.

Who gets it?

1 in 100,000 children will get neuroblastoma. Two thirds of cases of neuroblastoma occur in children younger than 5 years. After age 10 the disease is rare.

This cancer is a little more common in boys than girls, and more common in white people.

What causes it?

There is a part of our nervous system which is called the autonomic nervous system. This part controls functions of our bodies, such as the heart rate, breathing, blood pressure, digestion and other things.

The autonomic nervous system is divided in to the sympathetic system and parasympathetic system. Neuroblastoma arises from the sympathetic system. The sympathetic system includes -

1. Nerves that run alongside our spinal cord
2. Clusters of nerves along nerve fibers in our bodies, called ganglia
3. Nerve-like cells in our adrenal glands (small glands that sit on top of our kidneys).

Since neuroblastoma develops from the sympathetic system, it can be found anywhere along this system. About 40% start in the adrenal glands. Another 25% in ganglia in the abdomen, and the rest in ganglia in the chest, neck or pelvis.

The autonomic nervous system. You can see it controls many organs in our body – The heart, eyes, intestines and others. Neuroblastomas arise from the sympathetic system.

The cause for the rise of tumor from these types of cells isn’t known.

How does it feel?

Neuroblastoma may begin with symptoms that are not specific, such as loss of energy, loss of appetite, fever. Other symptoms depend on where the tumor is located:

1. If it’s in the abdomen – It may cause a swollen belly, abdominal pain or constipation.
2. If it’s in the chest – It may cause breathing problems.
3. If it’s in the vicinity of the spinal cord – It may press it, causing weakness.

The tumor may also spread to the rest of the body and cause different symptoms, such as bone pain if it reaches the bones, or bulging eyes/dark circles around the eyes if it reaches behind them. About 50-60% of children already have metastases in other areas of the body by the time it is discovered.

Neuroblastoma can also release hormones, which cause different things in the body. Examples of these things:

1. Fever
2. Diarrhea
3. High blood pressure
4. Rapid heartbeat
5. Red skin
6. Sweating

How is it discovered?

There are several things that can be done to discover it:

1. Blood test – A high amount of the substances dopamine and norepinephrine are higher in this tumor. These substances are produced by the sympathetic system, and so are higher here.
2. Urine test – The substances found in the blood are broken down by the body into other substances, which are then passed out in the urine. They are called homovanillic acid (HMA) and vanillyl mandelic acid (VMA), and will be higher if a tumor exists.
3. X-rays, CT scan, MRI, ultrasound – They can discover the origin of the tumor in the body. A special scan called MIBG can discover the tumor areas in the body.
4. Biopsy – It’s the only way to be certain that all the hints we got from the other detection methods are really arising from a neuroblastoma. A piece of the tumor is taken out and viewed under a microscope.

How is it treated?

There are many options for treating neuroblastoma. Choosing a certain option depends on the age of the child, the level to which the cancer has advanced before discovery, the location of the cancer in the body, and the way it looks under the microscope.

The treatment can include surgery, chemotherapy, radiation, stem cell transplantation or other types of therapy.

What happens after treatment?

There are many things that can affect the survival of the child with a neuroblastoma, including age, the advancement of the tumor, the way the tumor looks under the microscope. Tumors which are less advanced respond better to treatment.

There is no known way to prevent neuroblastoma. In rare cases, the tumor can be found before birth during an ultrasound. It can also be found accidentally in children during tests to find other diseases. Such early discovery might improve survival (but there are currently no recommendations to search for the tumor in every infant, since this wasn’t found to be helpful).

You can learn more about neuroblastoma by reading the personal story of Paris, at The Strickland Family Blog.

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1. In The News – Pancreatic Cancer – The 4th Leading Cause of Death
2. Pleural Mesothelioma – Cancer of The Lungs Caused by Exposure to Asbestos
3. Waldenström’s macroglobulinemia – A Rare Blood Cancer That Can Lead To Strokes

Each week we’ll tackle here a disease featured in that week’s episode of Grey’s Anatomy. Last night’s episode (Stand By Me, season 5, episode 18) dealt with Dr. Stevens’ Stage IV melanoma. We’ll try to explain what melanoma is, what the various stages mean, and what you can do to discover it on time.

Danger level: High

What is it?

Melanoma is a malignant tumor of the skin. It’s responsible for the majority of skin cancer deaths. While skin is where it usually arises, it can also start in the eyes, ears, gastrointestinal tract, the brain coverings, and around the mouth or genitalia.

Who gets it?

About 60,000 cases occur each year in the US, causing more than 8,000 deaths. It occurs mainly in white people. It’s much less common in people of African American origin and Hispanics, but when they do get the disease, it might be deadlier.

Until age 39 women are about twice as much likely to get melanoma, but after the age of 40 it’s more common in men.

Usually this cancer appears around age 50, but in women aged 25-29 it’s the most common cancer.

There are a few factors that can put you at risk for melanoma:

1. Fair skin, red or blond hair, blue eyes, freckles or if you tan poorly and sunburn easily.
2. Sun exposure
3. Family history or a personal history of melanoma
4. Increased number of skin moles (nevi)

What causes it?

Our skin is composed of several layers. In these layers are scattered cells of many types. One of those cell types are melanocytes – they produce a material called a pigment, which gives our skin color. That pigment is named melanin. When exposed to the sun, that pigment is created, which is why we get a tan: That pigment causes our skin to get darker.

On the left you can see a cut from the skin showing the layers. On the right is a magnification of the layer where melanocytes exist, producing melanin.

In melanoma, in a process which is not understood completely, melanocytes turn into malignant cells. These cells divide without dying, like normal cells would, and in this way spread in the area, enter blood vessels and send metastases (areas of tumor far from the original area) throughout the body.

About 50% of melanomas develop from moles on the skin, The rest can arise in any place where melanocytes exist: The skin, eye, ear, brain coverings, and so on.

How does it feel?

Melanoma starts on the skin. It looks like a dark spot. Below we will tell you how you can differentiate a normal mole and a melanoma. Here’s a picture of one -

Melanoma

Like mentioned above, it may start on the skin, but can spread throughout the body if not taken care of on time. Each level of spread is called a stage, and there are 4 of them:

• Stage 1 and 2: The melanoma is still on the skin area.
• Stage 3: The melanoma started spreading, and it exists in lymph nodes around the area it started. (A lymph node is an organ of our immune system. Many tumors find it easy to spread using them).
• Stage 4: The tumor sent metastases to far off places in the body.

How is it discovered?

If you have moles, or any of the risk factors listed above, you should get your skin examined at least once a year by a doctor. If a lesion on the skin looks like a melanoma, the only way to make sure about its true nature is to take a biopsy out of it (a biopsy is a cut made through the lesion, after which that piece will be looked at under the microscope).

How is it treated?

The main treatment is taking off the skin lesion surgically. The surgeon will take it off along with a margin around it, to make sure everything is taken out.

What happens if the tumor metastasized? Usually operation is not possible in these stages. There are cases when you can take out the metastasis itself. Chemotherapy and drugs called “biological therapy” might also be involved in treatment.

What happens after treatment?

The survival in cancers is usually counted for 5 years after the treatment, meaning how many people survive for 5 years after being treated, and is called the 5-year survival. In Stages 1-2, the 5 year survival is between 70-99%. In stage 4 it’s around 18%, but can go down according to the place the tumor has spread to.

1. Protect yourself from the sun: The best way is to avoid sun exposure between 10am-4pm, when it’s the most intense.
2. Wear protective clothing when out in the sun: A hat with a brim, a shirt with sleeves and pants.
3. Use sunscreen with an SPF of at least 15, and it should protect against both UVA and UVB sun rays. But please don’t think that this gives you full protection – you should always try to stay clear from the sun.
4. Examine your skin regularly:

Performing a skin self-exam -

• Stand in front of a mirror and examine your body: front and back, right and left. Don’t neglect any areas, like the feet and even the space between your toes.
• Check for the ABCD’s:

A. Asymmetrical skin lesion: The lesion should be equal from all sides. If it isn’t, it is suspicious.

B. Border: The border of the lesion should be regular, without any notches. Any irregularities in the border are suspicious.

C. Color: It shouldn’t have more than 2 colors. More than that, and the lesion is suspicious.

D. Diameter: It shouldn’t be greater than 6 millimeters (0.24 inches).

Do you know of anyone with melanoma, or have you experienced it yourself? Share in the comments.

Related posts:

1. Vitiligo, or Why Michael Jackson Has Turned White
2. As Seen on Grey’s Anatomy – Acute Porphyria
3. As Seen on Grey’s Anatomy – Normal Pressure Hydrocephalus (NPH)