BY AMBER SMITH
One of the reasons pancreatic cancer is so deadly is because early symptoms are so vague. “The majority of cases are diagnosed at an advanced, incurable stage,” a team of Upstate doctors writes in the American Journal of Emergency Medicine. Oncologist Rahul Seth, DO, and colleagues go on to explain that controversy exists among medical professionals about a link between diabetes and pancreatic cancer.
They tell of a 59-year-old woman who was diagnosed with type 2 diabetes by her primary care doctor and prescribed insulin. Five days later, she came to the emergency room saying that she was confused and lethargic, with muscle aches and worsening abdominal pain. Those are symptoms of diabetic ketoacidosis, known in medical shorthand as DKA. It’s a life-threatening complication of diabetes that can be prompted by an infection, severe stress, inadequate insulin therapy or other reasons including, although rare, pancreatic cancer.
She was admitted to the intensive care unit of Upstate University Hospital for intravenous insulin therapy and hydration.
During her three-day stay, medical images of the woman’s abdomen revealed a tumor in her pancreas and some suspicious cells of her liver. Biopsies of both areas confirmed pancreatic ductal carcinoma. Like 85 percent of people diagnosed with this type of pancreatic cancer, her disease was at an advanced stage, and surgery was not a treatment option. When caught early, before it has spread, pancreatic cancer can be cured with surgery.
Seth indicates in the journal article that this woman’s pancreatic cancer probably prompted her DKA symptoms. His colleagues include physicians who are completing their residency training at Upstate: Danny Markabawi, Divya Kondapi and Vikrant Tambe.
The article references multiple medical studies. Some show that diabetes and hyperglycemia, which occurs when blood sugar levels are too high, are risk factors for the development of pancreatic cancer. Others suggest that hyperglycemia and diabetes might be caused by pancreatic cancer-associated pancreatic failure. It’s difficult to discern which happens first.
People who are newly diagnosed with diabetes have up to an eight times higher likelihood of being diagnosed with pancreatic cancer within three years, according to research that examined medical images and blood sugar values of people before they were diagnosed with cancer. Another study suggests that diabetes associated with pancreatic cancer occurs at a stage when surgery might still be an option.
That’s why Seth and colleagues propose “It might be worthwhile to consider screening patients with newly diagnosed diabetes mellitus for early-stage pancreatic cancer when other risk factors for diabetes mellitus are absent.”
They say it’s rare, but symptoms of diabetic ketoacidosis can be a clue to pancreatic cancer, especially when the most common causes of DKA are absent.
This article appears in the fall 2018 issue of Upstate Health magazine.