Learn more about the pancreas and cancer

Learn more about the pancreas and cancer

Steve Jobs, my idol, has died. Most of my gadgets are attributed to him and his company - my iPhone, my iPad, my MacBook Pro. I heard that he suffered a rare sort of pancreatic cancer. But seven years ago, he declared that he was cured of the disease. What happened?

Jobs had a rare form of pancreatic cancer called an islet cell neuroendocrine tumour.

The statements attributed to him about his cancer cure seven years ago is mere speculation from the press, as Jobs kept a very tight lid on his illness.

But it's possible that his cancer had either returned, or spread, which accounted for his liver transplant in 2009.

It is very likely that his cancer had further spread, or his new liver had failed. That is why he died. Perhaps more detail will emerge in time to come.

How did Jobs manage to live so long with pancreatic cancer, but Patrick Swayze didn't?

Jobs had cancer of the pancreatic islet cells. If treated, some people with this disease can live as long as 20 to 30 years.

Swayze had a more common type of pancreatic cancer called adenocarcinoma, one that involved the pancreatic duct cells. The survival for Swayze's type of cancer is only a few years at best.

Describe our pancreas. What does it do?

The pancreas is a pear-shaped organ located in our upper abdomen between our stomach and our spine. Pain from it usually radiates to our back.

It's only about six inches long, and divided into two main portions:

The exocrine: This is the part of our pancreas consisting of ducts and small glands called acini. They produce enzymes that help break down the proteins, carbohydrates and fats that we eat. The substances that are secreted via the pancreatic juice also neutralise our stomach's acids.

The endocrine: This is made out of the islets of Langerhans. These are the islet cells that we are talking about pertaining to Jobs. They secrete glucagon, which increases our blood sugar level, and insulin, which stores glucose, proteins and fat.

The islet cells are crucial to our blood sugar regulation. They are scattered throughout our pancreas.

Islet cell tumours

So tell me more about islet cell tumours.

These tumours are interesting and strange. An islet cell tumour can be either benign or cancerous (like Jobs').

It can either be functional or non-functional. Non-functioning islet cell tumours make up the majority of islet cell tumours.

A functioning islet cell tumour is one that produces hormones.

A non-functioning islet cell tumour does not produce hormones.

Jobs publicly declared he had a "hormonal" problem. So we can speculate that he might indeed have had a functioning islet cell tumour. Then again, maybe not.

There are five types of functioning islet cell tumours, which are based on the types of hormones the tumour makes. Note that some tumours may make two or three hormones simultaneously.

Gastrinoma: This one makes too much gastrin, a hormone that causes our stomach to produce too much acid. Needless to say, a patient who suffers from this will be having a lot of gastritis problems.

Insulinoma: This one makes too much insulin, which leads to really low blood sugars and can lead to a hypoglycaemic coma. An insulinoma is only 10 per cent cancerous.

Glucagonoma: This one makes too much glucagon, which causes the reverse result of an insulinoma. So now there's too much sugar in your blood.

Vipoma: This one makes too much VIP (vasoactive intestinal peptide), a hormone that helps move the water in your intestines. Naturally, when you move too much water, chronic and very watery diarrhoea ensues.

Somatostatinoma: This one makes too much somatostatin, a hormone which stops the secretion of other hormones like insulin, gastrin and the growth hormone.

How do you treat pancreatic cancer?

This will depend on whether your tumour is benign or malignant.

The trouble with most pancreatic cancers is that they present very late, especially in Malaysia.

They are difficult to diagnose most of the time because the symptoms the pancreas throws out are non-specific - like fatigue, malaise, loss of appetite, loss of weight.

And when you find out, it's usually very late.

In this aspect, it's usually better to have a functioning islet cell tumour that alerts you by throwing out hormones.

Then you will have symptoms according to the hormones that are excessively thrown out, and you will seek treatment much earlier.

Tumours are removed by surgery. If the cancer cells have spread to the liver, a portion of the liver has to be excised.

Chemotherapy and various targeted therapies are then used to shrink the rest of the tumour.

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