Pancreas : Pancreatitis, Pancreatic Cancer

by Food and Drug Administration (FDA)

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Pancreatitis

Another common disease associated with the exocrine function of the pancreas is pancreatitis (inflammation of the pancreas), which can be either acute or chronic.

The most common cause of acute pancreatitis is blockage by a gallstone of the main secretory duct from the pancreas as well as the common bile duct. When this happens, large quantities of pancreatic secretions pool in the pancreas and can digest the entire pancreas within a few hours. But because the islets of Langerhans are not adversely affected, the pancreas can continue secreting insulin. Acute pancreatitis is a condition demanding immediate medical attention. It is characterized by abdominal pain, vomiting, abdominal swelling and gas, fever, muscle aches, and a drop in blood pressure. When appropriately treated, the effects of acute pancreatitis usually calm down within five to seven days. Treatment includes stopping oral consumption and providing nourishment only with intravenous fluids.

Chronic pancreatitis occurs when acute pancreatitis continues until pancreatic function is greatly diminished. Symptoms include persistent pain in the upper abdomen which can radiate to the back and last for days or weeks, with mild jaundice (yellow skin and eyes) and rapid weight loss. A person can have recurrent attacks over several years. This may result in secondary bacterial infections of the pancreas, calcium deficiencies, and Type II diabetes.

Pancreatic Cancer

Pancreatic cancer is the fourth leading cause of cancer deaths in the United States, affecting about 27,000 persons yearly. It is second only to colon cancer as a cause of death from gastrointestinal malignancy. It affects men twice as frequently as women and is more likely to develop after the age of 40. Pancreatic cancer risks increase with chronic pancreatitis, diabetes mellitus, genetic factors (more common in blacks than whites), smoking, excess alcohol consumption, high-fat diets, and exposure to industrial chemicals such as urea, naphthalene or benzidine. Symptoms include weight loss, abdominal pain, nausea, loss of appetite, itching, jaundice, and constipation. Abdominal stress may improve or worsen after eating, and the pain may increase after lying down. Because its symptoms mimic many other common health problems, it often goes undetected until it is too late to treat effectively.

When early diagnosis and early treatment are possible, however, survival chances increase. Imaging with endoscopic ultrasound may aid early diagnosis. Researchers are also rapidly building a library of potential genetic markers that indicate the onset of pancreatic cancer. Treatment includes chemotherapeutic drugs and traditional surgical techniques.

The most commonly used chemotherapeutic agents are 5-Fluorouracil (5-FU) and the recently approved Gemzar (gemcitabine), a nucleoside analog that mimics DNA building blocks. FDA's approval of Gemzar last May was based on two clinical studies in patients with cancer that was locally advanced or had spread beyond the pancreas. These studies found improvement with Gemzar in what is termed "clinical benefit response" — a measure including changes in patients' use of painkillers, pain intensity, and body weight.

The first study, conducted with patients who had never before received chemotherapy, showed that when compared to patients receiving 5-FU therapy, patients treated with Gemzar had a statistically significant improvement in clinical benefit (23.8 percent versus 4.8 percent) and in median survival (5.6 months versus 4.2 months).

A second study conducted in 63 patients previously treated with 5-FU therapy and then given Gemzar showed a clinical benefit response of 27 percent and a median survival of 3.8 months.

Before its approval, FDA authorized Gemzar's manufacturer, Eli Lilly and Company, to make the drug available through a Treatment IND (investigational new drug) program. More than 2,800 patients received the drug under this program between February 1995 and May 1996. Treatment INDs allow drug developers to give patients access to drugs before they are approved for marketing in cases of immediately life-threatening or otherwise serious diseases.

Cryosurgery, a type of surgery in which extremely low temperatures are employed either locally or generally to destroy tissue, is also being investigated for use in pancreatic cancer. The technique involves specific time length and time interval applications by a probe containing liquid nitrogen to freeze the cancer cells to death. The advantages of cryosurgery are that it is inexpensive, requires shorter hospital stays, and causes less blood loss.

Pancreatic diseases are among the most common and most deadly diseases that affect Americans today. Due to genetics and the pancreas' inability to cope with disease, having one pancreatic disease primes the body to contract or develop a second pancreatic disease. Although scientists have made considerable progress in the treatment of diabetes, early detection and treatments for cystic fibrosis and pancreatic cancer don't always guarantee the patient will live a long normal life. However, researchers are constantly searching for new and improved methods to complement or replace current therapies in an attempt to at least improve the patient's quality of life.

About the Author

www.fda.gov
FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.