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Januvia Pancreatic Cancer

The type 2 diabetes medication Januvia (generic: sitagliptin) has recently been linked to chronic pancreatitis, a known risk factor for pancreatic cancer. A recent study published in the journal Gastroenterology found that patients who took Januvia had a nearly 3-fold increased risk of developing pancreatic cancer compared to patients who took other diabetes drugs.

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What’s the Problem?

Diabetes patients who take Januvia may have an increased risk of developing acute pancreatitis, necrotizing pancreatitis, or hemorrhagic pancreatitis, conditions that can lead to pancreatic cancer. A 2011 study published in the journal Gastroenterology found a 6-fold increase in reported cases of pancreatitis (inflammation of the pancreas), as well as a 2.7-fold increase in pancreatic cancer, in patients who took Januvia. These findings added to previous research published in the journal Diabetes in 2009 which found an increase in pancreatitis in rats whose GLP-1 levels were raised.

Pancreatic Cancer Overview

Pancreatic cancer (also known as pancreatic carcinoma) is a cancer of the pancreas, a large organ located behind the stomach. The pancreas makes and releases enzymes into the intestines that help the body absorb foods, especially fats. Pancreatic cancer occurs when uncontrolled cell growth occurs in the pancreas. Rather than developing into healthy, normal pancreas tissue, these abnormal cells continue dividing and form lumps or masses called tumors. Tumors then interfere with the main functions of the pancreas.

Pancreatic Cancer Symptoms

In its early stages, pancreatic cancer often grows with no identifiable symptoms. By the time the patient experiences symptoms, the cancer has usually traveled to other parts of the body. At this point, signs and symptoms depend on the tumor’s location inside the pancreas. Pancreatic cancer symptoms in the head of the pancreas include:

  • weight loss
  • jaundice (yellow skin)
  • dark urine
  • light stool color
  • itching
  • nausea
  • vomiting
  • abdominal pain
  • enlarged lymph nodes in the neck

In patients whose tumor is located in the body or tail of the pancreas, pancreatic cancer symptoms may include:

  • belly pain
  • back pain
  • weight loss

Gastrointestinal Symptoms of Pancreatic Cancer

Because pancreatic cancer grows around the digestive system, the patient may experience the following gastrointestinal symptoms:

  • abdominal pain – As the tumor grows, it tends to cause a dull ache in the upper abdomen radiating to the back. The pain may be constant or intermittent.
  • bloating – pancreatic cancer may cause an early sense of fullness with meals (satiety), or an unusual swelling of the abdomen.
  • nausea
  • diarrhea
  • dark urine
  • pale-colored stools – If Januvia pancreatic cancer causes a blocked bile duct leading into the intestine, the patient may experience pale or clay-colored stools.

Constitutional (Whole Body) Symptoms of Pancreatic Cancer

As pancreatic cancer grows, it causes symptoms in the patient’s entire body. Constitutional symptoms of pancreatic cancer may include:

  • weight loss
  • malaise
  • loss of appetite
  • elevated blood sugar levels – Januvia pancreatic cancer may cause diabetes by impairing the pancreas’ ability to produce insulin.

Pancreatic Cancer Skin Symptoms

Pancreatic cancer may cause the following skin symptoms:

  • jaundice – As tumors block the common bile duct, bile accumulates in the bloodstream, giving the skin and eyes a yellowish hue.
  • itching – Januvia pancreatic cancer can cause intense itching all over the patient’s body, a condition thought to be caused by blockage of the bile ducts.

Diagnosis

Pancreatic cancer is difficult to diagnose in its early stages, and is often not recognized until the disease is terminal. Early diagnosis of pancreatic cancer is critical to the patient’s long-term prognosis. People who have experienced pancreatic cancer symptoms should contact their doctor immediately to determine whether they have the disease.

Treatment & Outlook (Prognosis)

Treatment for individuals diagnosed with pancreatic cancer depends on the stage and location of the disease, as well as on the patient’s age, overall health and personal preferences. The primary goal of pancreatic cancer treatment is to eliminate the cancer, if possible. When this is not an option, the focus shifts to preventing the cancer from growing or causing more harm. In advanced cases where treatments aren’t likely to offer a benefit, the doctor may suggest ways to relieve symptoms and make the patient as comfortable as possible.

Each year in the United States, more than 30,000 people are diagnosed with pancreatic cancer. In Europe, over 60,000 diagnoses of the disease are made each year. Because pancreatic cancer is usually diagnosed late in its development, the five-year survival rate after diagnosis is less than 5%.

Treatment

Pancreatic Cancer Surgery

If pancreatic cancer is confined to the pancreas, surgery may be an option. Operations used on patients diagnosed with early stage pancreatic cancer include:

  • Whipple procedure (pancreatoduodenectomy) – Procedure that involves surgically removing the pancreas’ head, a section of the small intestine, gallbladder, and a segment of the bile duct. Once complete, the remaining parts of the pancreas, stomach and intestines are reconnected to allow the patient to digest food.
  • Pancreatectomy – Surgery that removes the tail of the pancreas. Unfortunately, pancreatectomies carry a high risk of internal bleeding and infection.
Pancreatic Cancer Radiation Therapy

In pancreatic cancer radiation therapy, high-energy beams are used to destroy cancerous cells. Patients may receive this type of treatment before or after surgery, or in combination with with other kinds of therapy. External radiation therapy is accomplished by a machine that moves around the patient, directing high-energy beams at specific locations on the body. Specialized medical centers may deliver radiation therapy during surgery (intraoperative radiation).

Chemotherapy & Chemoradiation Treatment

Pancreatic cancer chemotherapy involves using drugs to help kill cancerous cells. These drugs may be injected through an IV or taken orally, and may be used alone or with other prescription drugs. Chemoradiation, a type of therapy that involves both chemotherapy and radiation therapy, is often used when pancreatic cancer has spread beyond the pancreas. Chemoradiation may also be used after surgery to reduce the likelihood that pancreatic cancer returns.

Targeted Therapy

A prescription medication called Tarceva (generic: erlotinib) may be used to attack specific properties within cancer cells. Specifically, the drug blocks chemicals that make cancer cells grow and multiply. Targeted therapy for pancreatic cancer is typically combined with chemotherapy for use in patients in the later stages of the disease.

Complications

Possible complications of pancreatic cancer include:

  • Jaundice – Cancerous tumors that block the bile duct can lead to jaundice, whose symptoms include yellow skin and eyes, dark urine, and pale stools. To treat jaundice caused by pancreatic cancer, a stent may be placed in the bile duct to hold it open. When this is not possible, bypass surgery may be necessary to create a new route for bile to flow from the liver to the intestines.
  • Pain – Pancreatic cancer tumors may press on nerves in the patient’s abdomen, causing severe pain that may require prescription drugs or radiation therapy. In severe cases of the disease, doctors may inject alcohol into the nerves that control pain in the abdomen. This stops the nerves from sending pain signals to the brain.
  • Bowel obstruction – If tumor cells travel into or press against the small intestine, it can block digestion. A stent can be placed in the small intestine to hold it open, or, in cases where this is not possible, a bypass may be required to connect the stomach to a lower point in the intestines that isn’t blocked.
  • Weight loss – Complication caused by nausea, vomiting, loss of appetite, or a tumor pressing against the stomach making it hard to eat. Weight loss from pancreatic cancer may also occur because the patient’s body is having difficulty processing nutrients. If this is the case, pancreatic enzyme supplements may be taken to aid in the digestive process. Patients with pancreatic cancer can help maintain their weight by adding extra calories to their meals, and by making mealtime as enjoyable as possible.

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