Much progress has been made in combating cancer, but pancreatic cancer still sticks its ruthless head up as an actually increasing and an equally deadly one. In 2016, The American Cancer Society estimates almost 55,000 new diagnoses of pancreatic cancer will be made and 42,000 deaths will ensue. Cancer of the pancreas has recently surpassed breast cancer as a cause of death in the United States and now ranks third behind lung cancer and colorectal cancer in the number of cancer related deaths. Globally the International Agency for Research on Cancer predicts 340,000 new diagnoses of cancer of the pancreas worldwide, with no decline in the mortality rate noted over the last decade.
Perhaps the biggest problem is that over four-fifths of pancreas cancers are detected too late—at advanced stages when they cannot be removed surgically and essentially are incurable. Even resectable cancers are not always fully cured. The non resectable ones are either metastatic already to the rest of the body or locally advanced—about a 50-50 ratio. The metastatic ones are generally treated with chemotherapy and then focused on palliation and end of life care. The biggest challenge is in the nearly one-third of cancers that are said to be in the intermediate zone—they are locally advanced but cannot be surgically excised due to local invasion. They have not yet spread beyond the pancreatic bed, and new treatments are focusing on this group of patients.
The most common type of pancreatic cancer is an adenocarcinoma—in about 85 percent of cases. They generally start in the area of the pancreas where digestive enzymes are made. One in every hundred cases or so are neuroendocrine tumors, arising from the hormone producing cells of the pancreas. These are generally less aggressive than the adenocarcinomas, but equally deadly—just taking more time to inflict their grim eventual prognosis. Signs and symptoms of pancreatic cancer are generally unexplained weight loss, yellow skin, abdominal pain, and a mild feeling of nausea. There are generally few symptoms in early disease and as such, unless discovered “accidentally” looking for something else at the time of diagnosis, the disease has spread to other parts of the body.
Pancreatic cancer is rare at younger ages; commonest over the age of 70. Diabetes, obesity and smoking are major risk factors. The cause is genetic inheritance in about 10 percent. Limited consumption of red meats and alcohol are also thought to lower the risk. Even with some of the leading treatments, the median survival for advanced pancreatic cancer is 9-11 months.
But how about when cancer of the pancreas appears to have been diagnosed “in time” and appropriate treatments have been given to hopefully affect a cure? Surgery is generally only possible in trying to affect a cure in about 20 percent of new cases, and there is always the worry that even in successful surgery, cancerous cells may be found at the margins of the tissue left behind and continue to grow and spread. Surgery is probably still the only possibility of cure—chemotherapy is used to extend life, and secondarily quality of life, but is generally not curative. Some forms of the neuroendocrine type are amenable to longer life spans but generally recur over a longer time horizon.
Underwriters look for information such as all the details of tumor type and staging, details of all treatment including surgery, radiation and/or chemotherapy, and continued follow-up including all imaging and tumor marker testing. Certain tumors such as islet cell tumors or gastrinomas may be eligible for consideration after two years with temporary flat extras, and standard after 6-8 years. The unfortunately more common adenocarcinomas are usually declined for a minimum of five years and then always carry a flat extra or table rating as there is late mortality risk that has to be accounted for. The hope is that some diagnostic testing can spot cancer of the pancreas earlier making it more amenable to cure, as no agents seem to be consistently effective once the cancer has begun its spread.
Robert Goldstone, MD, FACE, FLMI
MD, FACE, FLMI, board certified internist and endocrinologist, was most recently vice president and chief medical officer for Pacific Life and Pacific Life and Annuity. He has extensive brokerage and life insurance experience, having been medical director at both MetLife Brokerage and Transamerica Occidental Life. Goldstone is board certified in insurance medicine and the inaugural recipient of the W. John Elder Award for Insurance Medicine Journalism Excellence. He was also honored as a fellow of the prestigious American College of Endocrinology and has written monthly for Broker World since 1991. Goldstone does consulting full or part-time as well as on a fill-in basis for companies who need a medical director/physician. He can be reached by telephone at 949-943-2310. Emaill: firstname.lastname@example.org.