Pancreatic cancer, soda, and Randy Pausch

Randolph Frederick "Randy" Pausch (October 23, 1960 – July 25, 2008),
professor of computer science and human-computer interaction and
design at Carnegie Mellon University in Pittsburgh, Pennsylvania.
Author of "The Last Lecture: Really Achieving Your Childhood Dreams.”
Photo credit: Click here

The fourth leading cause of cancer death is pancreatic cancer. It is expected that this year 100% of the 32,000 Americans diagnosed with this deadly disease will also die from it. Pancreatic cancer has a high mortality rate but in spite of this, the federal government does not provide significant funding for the pancreatic research that could lead to effective treatment and possibly a cure for the disease.
 

The Pancreas [1]
The pancreas lies behind the stomach and extends horizontally across the abdomen. It is about 6 inches long and has a head, body, and tail. The head is on the right side of the abdomen, behind the area where the stomach meets the beginning of the small intestine (duodenum). The body is located behind the stomach and the tail is on the left side of the abdomen next to the spleen. The pancreas has 2 types of glands: exocrine (>95%) and endocrine. The exocrine glands make pancreatic juice, which contains enzymes that are released into ducts that merge together to form larger ducts that carry the juice to the small intestine. Pancreatic juice is released into the intestines when food passes through and aids in the digestion of fats, carbohydrates, and proteins. If it were not released, then food would just pass through without being absorbed.

Anatomy of the pancreas and pancreatic
and bile ducts—anterior view.
Illustration credit: Joyce E.M. Wall

A small percent of pancreatic cells have endocrine functions. These cells are arranged in small clusters or islets (islets of Langerhans), which release hormones, such as insulin and glucagon, into the blood. Insulin lowers the concentration of sugar in the blood and glucagon increases it.
 

Pancreatic tumors [1]
The exocrine cells and endocrine cells of the pancreas form different types of tumors.

Exocrine tumors-These are the most common type of pancreatic tumors. Benign (non-cancerous) cysts and tumors (cystadenomas) can occur, but most pancreatic exocrine tumors are malignant (cancerous). Approximately 95% of pancreatic exocrine cancers are adenocarcinomas. They begin in the ducts of the pancreas, and sometimes develop from cells that make the pancreatic enzymes (acinar cell carcinomas). Other types of ductal cancers are adenosquamous carcinomas, squamous cell carcinomas, and giant cell carcinomas. There are also ampullary cancers that occur at duct junctions. Treatment of an exocrine pancreatic cancer is based on the stage of the cancer (the size of the tumor and how far it has spread) but not the type.

Endocrine tumors-These types of pancreatic tumors are uncommon. They are called pancreatic neuroendocrine tumors (NETs) or islet cell tumors and can be benign or malignant. Pancreatic neuroendocrine cancers make up about 1% of all diagnosed pancreatic cancers. Treatment and prognosis depends on the tumor type and the stage but is typically better than that of pancreatic exocrine cancers. Islet cell tumors are named according to the type of hormone-making cell from which they originate:
•    Insulinomas-from cells that make insulin
•    Glucagonomas-from cells that make glucagon
•    Gastrinomas-from cells that make gastrin
•    Somatostatinomas-from cells that make somatostatin
•    VIPomas-from cells that make vasoactive intestinal peptide (VIP)
•    PPomas-from cells that make pancreatic polypeptide

There are distinct risk factors and causes that result in exocrine and endocrine cancers of the pancreas. Each type of cancer differs in signs and symptoms and they are diagnosed using different tests. In addition, each are treated in different ways and have different prognoses.
 

Sodas and soft drinks at a supermarket.
Photo credit: Click here

Soda: sweetened soft drinks and the risk of pancreatic cancer [2]
Researchers recently reported that people who drink two or more sweetened soft drinks a week have a considerably high risk of developing a deadly pancreatic cancer. A study conducted on 60,000 people in Singapore over the course of 14 years, linked the consumption of soft drinks to pancreatic cancer. Consumption of fruit juice instead of sodas did not carry the same risk. Although sugar is thought to be the culprit by increasing the level of insulin in the body and contributing to the growth of cancer cells in the pancreas, it is also suggested that people who drink sweetened sodas on a regular basis often have other poor health habits that may be a contributing factor. Recall that insulin is made from special pancreatic cells (beta cells) in the islets of Langerhans and it helps the body to metabolize sugar.

In the Singapore study, 140 of the 60,000 subjects developed pancreatic cancer. Those who drank two or more soft drinks a week had an 87 percent higher risk of being among those who developed pancreatic cancer. Researchers believe that the results of this study could readily apply elsewhere since many of the same habits exist among the population like in western countries. The similarities include wealth, excellent healthcare, eating, drinking, and shopping.

There is some skepticism about the findings of the study, however, because the number of cases of pancreatic cancer is relatively small and it is unclear whether there is a causal association. Factors that need to be controlled for are other adverse health behaviors such as consumption of red meat and smoking, which are associated behaviors relative to soft drink consumption in Singapore. Previous studies have linked pancreatic cancer with the consumption of red meat but some researchers support the idea that high sugar intake fuels cancer cells and that tumors use more glucose than other cells. A 12-oz (355 ml) can of regular (sweetened) soda contains about 130 calories and almost all of those calories come from sugar.

Randy Pausch (October 23, 1960 – July 25, 2008) [3][4]
Randy Pausch was a professor of computer science and human-computer interaction and design at Carnegie Mellon University in Pittsburgh, Pennsylvania. He was diagnosed with a terminal case of pancreatic cancer in September 2006. He delivered a lecture entitled "The Last Lecture: Really Achieving Your Childhood Dreams" on September 18, 2007 at Carnegie Mellon, which became extremely popular in the media. He co-authored a book, The Last Lecture, which became a New York Times best-seller. Pausch died of complications from pancreatic cancer on July 25, 2008.

Excerpts from the website of Randy Pausch:

-------- CONTEXT:  MAIL SENT IN EARLY SEPTEMBER (2006) -------------
Dear Friends and Colleagues,
I apologize for this mass email, but I know in situations like this that rumors and misinformation spread quickly and a mass email is the best way to ensure correct information for everyone. I have recently been diagnosed with pancreatic cancer (adenocarcinoma).The good news is that I'm one of the 20% of pancreatic cancer patients who are viable for surgical removal of the tumor, and I'm scheduled for surgery on Tuesday, Sept 19th at UPMC Shadyside. It's a major surgery, where they will remove the tumor (which is about 3mm in diameter), my gallbladder, part of my pancreas, part of my small intestine, and possibly part of my stomach. I will be in the hospital 2-3 weeks, and then another 4 weeks of bed rest at home. At that point, I'll be physically 100% again. If the surgery removes every last cancer cell, I win. Otherwise, eventually the cancer will recur. Statistically, the long-term prognosis is not rosy; only 10-20% of people who have the surgery survive to five years. Needless to say, I intend to be one of the lucky ones who sticks around! The median age for this disease is 66 and so there is some reason to believe my odds will be better than the typical patient's (I'm 45 and in good physical shape), so they can hit me with more aggressive chemo and/or radiation after the surgery. My wife Jai and I are focusing right now on the logistics of taking care of our children (Dylan, 4; Logan, 2; and Chloe, 4 months) during the 2 months that I am sidelined. This is obviously not good news, but I wanted people to hear this from me, and to have accurate information. I have only 6 days remaining to do a ton of logistics before the surgery, so please understand if I'm unable to respond to email or phone in the short term. Please feel free to share this message with anyone you see fit.
-- Randy

Nov 28 (2007): Leveraging Fame for Good  
Jai & I have been trying to see how we can use my D-list celebrity (apologies to Kathy Griffin) for good. I'm working with both the Pancreatic Cancer Action Network (PanCAN) and the Lustgarten Foundation, doing things like videotaping public service announcements and meeting with lawmakers up in Washington, DC. One reason pancreatic cancer is such an "orphan" disease is that we don't have many long-term survivors to lead marches on Washington. So I'm trying to sort of become the "Michael J. Fox of pancreatic cancer."

July 24th, 2008: The cancer is progressing
A biopsy last week revealed that the cancer has progressed further than we had thought from recent PET scans. Since last week, Randy has also taken a step down and is much sicker than he had been. He's now enrolled in hospice. He's no longer able to post here so I'm a friend posting on his behalf because we know that many folks are watching this space for updates.

July 25th, 2008
Randy died this morning of complications from pancreatic cancer.