Information about Pancreatic Cancer and Scuba Diving

Pancreatic cancer is a malignant neoplasm of the pancreas. Sadly, 42,470 people are diagnosed each year in the United States, resulting in 35,240 individuals falling victim to the disease each year.

In light of Patrick Swayze‘s recent death from pancreatic cancer, Maldives Dive Travel investigates the signs and symptoms, diagnosis, treatment, prognosis and prevention of pancreatic cancer and how it affects your scuba diving:

Pancreatic Cancer Signs and Symptoms

Pancreatic Cancer is commonly referred to as a “silent killer” since symptoms are often undetctable during the disease’s early states. Furthermore, once the symptoms of pancreatic cancer manifest themselves, they are generally non-specfici and varied, causing individuals to attribute them to other causes. Therefore, the majority of pancreatic cancer cases are detected while the disease is in an advanced stage.

Common symptoms of pancreatic cancer include:

• Pain in the upper abdomen that typically radiates to the back (seen in carcinoma of the body or tail of the pancreas)
• Loss of appetite and/or nausea and vomiting
• Significant weight loss
• Painless jaundice (yellow skin/eyes, dark urine)
• Trousseau sign, in which blood clots form spontaneously in the portal blood vessels, the deep veins of the extremities, or the superficial veins anywhere on the body, is sometimes associated with pancreatic cancer.
• Diabetes mellitus, or elevated blood sugar levels. Many patients with pancreatic cancer develop diabetes months to even years before they are diagnosed with pancreatic cancer, suggesting that new onset diabetes in an elderly individual may be an early warning sign of pancreatic cancer.
• Clinical depression has been reported in association with pancreatic cancer, sometimes presenting before the cancer is diagnosed. However, the mechanism for this association is not known. (Source: Wikipedia)

Risk factors for pancreatic cancer include:

• Age (particularly over 60)
• Male gender
• African-American ethnicity
• Smoking. Cigarette smoking has a risk ratio of 1.74 with regard to pancreatic cancer; a decade of non-smoking after heavy smoking is associated with a risk ratio of 1.2
• Diets low in vegetables and fruits
• Diets high in red meat
• Obesity
• Diabetes mellitus is both risk factor for pancreatic cancer, and, as noted earlier, new onset diabetes can be an early sign of the disease.
• Chronic pancreatitis has been linked, but is not known to be causal. The risk of pancreatic cancer in individuals with familial pancreatitis is particularly high.
• Helicobacter pylori infection
• Family history, 5–10% of pancreatic cancer patients have a family history of pancreatic cancer. The genes responsible for most of this clustering in families have yet to be identified. Pancreatic cancer has been associated with the following syndromes; autosomal recessive ataxia-telangiectasia and autosomal dominantly inherited mutations in the BRCA2 gene and PALB2 gene, Peutz-Jeghers syndrome due to mutations in the STK11 tumor suppressor gene, hereditary non-polyposis colon cancer (Lynch syndrome), familial adenomatous polyposis, and the familial atypical multiple mole melanoma-pancreatic cancer syndrome (FAMMM-PC) due to mutations in the CDKN2A tumor suppressor gene.
• Gingivitis or periodontal disease (Source: Wikipedia)

Alcohol

It is disputed as to whether alcohol consumption is a risk factor for pancreatic cancer. Approximately 7 out of 10 cases of chronic pancreatitis result from long term heavy drinking, and chronic pancreatitis is a known risk factor for pancreas cancer. However, chronic pancreatitis that is caused by alcohol doesn’t increase risk as much as other types of chronic pancreatitis.  Therefore, if a link exists, it may be only very slight. (Source: Cancer Research UK)

Pancreatic Cancer Diagnosis

There are several different tests that can be used to diagnose pancreatic cancer:

Ultrasonography

This method uses high-frequency sound waves that are above the human audible range. An instrument sends sound waves into the patient’s abdomen, and the echoes that the sound waves produce as they bounce off internal organs creates a picture called a sonogram. Healthy tissues and tumors produce different echoes.

CT scanning (Computed Tomography)

This method of testing involves the use of an x-ray machine which is linked to a computer. The patient lies on a bed that passes through a hole, and the machine moves along the patient’s body, simultaneously taking multiple x-rays. The computer then pieces the x-rays together to produce detailed pictures.

ERCP (Endoscopic retrograde cholangiopancretography)

A method for taking x-rays of the common bile duct and the pancreatic ducts. The doctor passes a long, flexible tube called an endoscope down the throat, through the stomach, and into the small intestine. The doctor then injects dye into the ducts and takes x-rays.

EUS (Endoscopic Ultrasound)

This is a test that combines ultrasound(sound waves) with an endoscope. The doctor places the tube (endoscope) into the stomach and the ultrasound machine (which is on the endoscope) is used to direct sound waves to the pancreas. This test is especially useful for detecting small tumors of the pancreas.

MRI (Magnetic Resonance Imaging)

This method of testing involves the use of an x-ray machine which is linked to a computer. The patient lies on a bed that passes through a hole, and the machine moves along the patient’s body, simultaneously taking multiple x-rays. The computer then pieces the x-rays together to produce detailed pictures.

PTC (Cholangiogram, Percutaneous Transhepatic)

A thin needle is put into the liver through the skin on the right side of the abdomen. Dye is injected in to the bile ducts in the liver so that blockages in the ducts can be seen on x-rays.

Pancreatic Cancer Treatment

Conventional Pancreatic Cancer Treatments

Pancreatic Cancer Surgery

• Whipple Procedure
• Palliative Procedures

Pancreatic Cancer Radiation Therapy

• 3D Conformal Radiation
• External Beam Radiation
• IMRT
• TomoTherapy®
• TheraSphere®
• TrilogyTM

Pancreatic Cancer Chemotherapy

• Metronomic Chemotherapy
• Intra-Arterial Chemotherapy
• Chemoembolization

Pancreatic Cancer Biotherapy/Immunotherapy

Supportive Pancreatic Cancer Therapies

• Nutrition Therapy
• Naturopathic Medicine
• Pain Management
• Mind-Body Medicine
• Oncology Rehabilitation
• Spiritual Support
• Image Enhancement

Pancreatic Cancer Prognosis

While pancreatic cancer survival rates have been improving from decade to decade, the disease is still considered largely incurable.

Survival Rates

According to the American Cancer Society, for all stages of pancreatic cancer combined, the one-year relative survival rate is 20%, and the five-year rate is 4%. These low survival rates are attributable to the fact that fewer than 10% of patients’ tumors are confined to the pancreas at the time of diagnosis; in most cases, the malignancy has already progressed to the point where surgical removal is impossible.

In those cases where resection can be performed, the average survival rate is 18 to 20 months. The overall five-year survival rate is about 10%, although this can rise as high as 20% to 25% if the tumor is removed completely and when cancer has not spread to lymph nodes.

Tumor Size

Tumor size does appear to impact survival rates. The larger the tumor, the less likely it is to be cured by resection.

Progression

In patients where a cure is not possible, progression of the disease may be accompanied by progressive weakness, weight loss, and pain.

Pancreatic Cancer Prevention

Sadly, currently no medically backed methods exist for preventing pancreatic cancer. The best defence is to avoid the risk factors.

Pancreatic Cancer and Scuba Diving

There is no steadfast rule as to when, and even if, cancer patients can safely return to scuba diving. Cancer treatments, symptoms, surgery, radiation therapy, chemotherapy and medication all possess their own unique set of risks, which can greatly alter a person’s normal bodily functions.

Doctors recommend that patients should wait until they’re done with all therapy and fully recuperated before scuba diving. Chemo and radiation therapy can take a huge toll on energy levels and stamina, often taking a full year before fully recovering your previous fitness level.

Certain chemotherapy drugs can increase the risk for cardiac and pulmonary toxicity should you need hyperbaric oxygen therapy while taking them, and chemotherapy suppresses the body’s immune system, leaving you vulnerable to infection. The ocean is home to an array of pathogens, so one’s immune system should be in full force prior taking the plunge.

Furthermore, radiation treatment and certain chemotherapy drugs can also cause pulmonary fibrosis, an inflammation of the lungs that causes scarring and stiffening of the lung tissue. So, once you’re fully healed, you should have a lung assessment to be sure that you don’t have residual damage that may predispose you to lung injuries. Pulmonary fibrosis can also cause shortness of breath and pulmonary hypertension. What’s more, it may develop months after completing chemo and radiation therapy, which is why it’s important to give yourself plenty of time before scuba diving once again.

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