Although not among the most common types of cancer, cancer of the pancreas is one of the deadliest forms and is the fourth leading cause of cancer deaths.

The American Cancer Society estimates that about 37,000 new cases of pancreatic cancer will be diagnosed this year, and that the disease will be responsible for approximately 33,000 deaths.

One problem that makes pancreatic cancer so dangerous is that its early symptoms - moderate abdominal pain, loss of appetite, and weight loss — are too vague to allow an early diagnosis in most cases and, unless the cancer is diagnosed early, most patients die within seven months.

A second problem is that nearly half of those whose cancer is diagnosed early do not get an operation to remove the cancerous tissue. Although surgery for pancreatic surgery is complex and certainly does not guarantee long-term survival, about 30 percent of those who get early surgery survive for five years, compared to less than 5 percent who don't have the operation. And yet, a recent study found that surgery was offered to only 38 percent of 9,559 patients diagnosed with early pancreatic cancer.

The findings of this study suggest that many physicians don't refer patients to surgery because they believe that pancreatic cancer is essentially a death warrant and that the surgery is dangerous and is rarely effective.

In fact, the surgery for this cancer, called the Whipple procedure, is no walk in the park. It's a seven- to eight-hour operation that removes most or all of the pancreas along with the gallbladder and part of the intestine. And, unfortunately, surgeons who have expertise with this procedure are available at only a limited number of hospitals.

But at some medical centers that do many Whipple procedures, the death rate from the operation has fallen from about 25 percent in the 1960s to less than 3 percent.

Almost every day, it seems, I come across obituaries describing deaths due to pancreatic cancer or news stories about people with the illness — just recently, I read of the hospitalization of famed tenor Luciano Pavarotti, who had been operated on for pancreatic surgery a little more than a year ago.

Of course, I may be sensitized to any mention of this disease, having watched my brother-in-law's suffering during his final awful days with pancreatic cancer. An exploratory operation by one of the most experienced surgeons with the Whipple procedure found his cancer had already spread so far that the Whipple operation would be useless, and chemotherapy proved no more helpful.

In fact, several promising new chemotherapeutic drugs have turned out to be no more effective than the older ones in prolonging survival.
 
The upshot of all this is that if you or one of your family members is diagnosed with pancreatic cancer, I urge you to make every effort to have them referred to a surgeon who is experienced with the Whipple procedure. With luck, their life may be prolonged.

One of my patients felt perfectly well but was "lucky" enough to have his pancreatic cancer located so close to the bile duct that he developed early jaundice.

He was referred to me to treat elevated cholesterol levels, but it was immediately apparent that that was the least of his problems. His cancer was quickly found by imaging procedures, the cancer was removed before it had a chance to spread, and he has survived for more than 10 years.

About half of the people whose painless jaundice is found to be due to pancreatic cancer can be completely cured by surgery.