The Importance of Understanding the Links Between Diabetes and Pancreatic Cancer

The article, "Why Is She Getting Thinner?" by Douglas G. Adler, from the May 2006 issue of Discover magazine, is about how the author, assistant professor of medicine at the University of Texas Medical School at Houston, had a certain patient whose strange medical case illuminated some of the linkages between stomach pain, diabetes, and weight loss, and how the illumination of those linkages saved his patient's life.

This patient was an elderly woman, almost 70-years-old, who came to see him about recurring abdominal pains. All of the basic tests with other physicians had shown nothing, so the patient was referred to Adler for further examination. At first he was stumped as to what her condition might be, having a few vague ideas, all of which seemed realistically unfeasible. But then he noticed the patient was fairly thin for her height, and when he compared her current appearance with her driver's license photo he noticed that she had indeed lost weight.

Armed with this new information, and also with the discovery that the woman was a diabetic, Adler began to question her as to her medical history, finding that the diabetes diagnosis had surprised her because she'd never had any problematic indications of it before and because the disease did not run in her family. Finding out that she had new-onset diabetes, according to Adler, "raised a red flag for me, especially because she was so thin." This is because diabetes that doesn't develop until later in life, according to Adler, is often a "disease of overweight people." New-onset diabetes being so uncommon in thin people, Adler pursued his questions further, finally deciding that the problems this woman was having with her stomach might actually be problems that she was having with her pancreas, which turned out to be correct.

He goes on in the article into a semi-complicated (to me anyway) spiel about how the pancreas is a "woefully misunderstood organ," and how it's actually the pancreas, small intestine, and colon, and not the stomach, that actually do most of our digestive work for us. According to Adler, most people are pretty much ignorant of the pancreas until it starts having problems, and since his patient was having abdominal pains in the presence of new-onset diabetes, Adler determined it was fast becoming time for her to become aware of her pancreas and it's situation, as she could have pancreatic cancer.

Adler goes on to discuss the mysterious relationship between diabetes and pancreatic cancer, where there are many correlations but few answers as to why those correlations should exist. One example is that though "many patients with pancreatic cancer develop high blood sugar...which can progress to full-fledged diabetes...the reasons for this are unknown." He then goes on to talk about how some physicians wish to do research on certain new-onset diabetes patients to eke out some answers to some of the questions that plague the topic, but concludes that due to the research being too large-scale it would probably be prohibitively costly to conduct.

Apparently most patients with pancreatic cancer die within six months of their diagnosis, the cancer having been diagnosed only when it has also become too far along to be curable. So I can see why Adler would be a proponent of research that could lead to an earlier diagnosis of cancer by seeing the signs in other diseases, such as new-onset diabetes. This is what happened with Adler's elderly female patient. Because Adler saw the signs and followed them from her stomach pains and new-onset diabetes, he was able to sniff out a trail that led him to the pancreas. Once at that point, a CT scan showed inflammation in the patient's pancreas that could be a tumor, and following further tests concluding that it was in fact cancer the tumor was removed the next week.

So this particular patient was a lucky one. According to Adler, "If she had waited a few more months to get medical attention, she might have died from inoperable pancreatic cancer." Adler concludes his article with a brief summation that though the relationships between diabetes and pancreatic cancer are still being "explored," the fact that they exist at all is a sign of hope that moves us closer toward new ways to identify potentially curable patients.

I thought this article was entertaining and informative, though some parts (particularly the paragraphs on digestion and the pancreas) were a little much, and others (the paragraph about research with the statistics) were a little dry. For the brevity of the article there really was quite a bit of information to digest, and though there were those somewhat complicated and dry parts, the information was necessary. I don't believe the article could have been written noticeably better or in such a way as to be more easily understood by the general public.

Source:

http://discovermagazine.com/2006/may/vital-signs