LTD / ERISA Disability Lawyers: Orange, Riverside & San Bernardino Counties
The pancreas is an organ in the body that produces insulin. It is located deep in the abdomen. It is only about six inches long. If the pancreas fails to produce enough insulin, that leads to type-1 diabetes, whereas type-2 diabetes develops when the insulin it produces is relatively ineffective because of obesity or other metabolic factors.
The pancreas also helps in the digestion of food.
There are two types of pancreatic cells. They are called “endocrine” and “exocrine” cells. The endocrine cells are sometimes called “islet cells.” They are the ones that produce insulin. The exocrine cells produce pancreatic enzymes that aid in digestion.
Pancreatic cancer (< 200,000 cases per year in the United States) is an unregulated growth of either the endocrine or exocrine cells in the pancreas. Cancer arising out of the endocrine cells comprises only about 5% of pancreatic cancers. The rest are in the exocrine cells. No one knows exactly what causes pancreatic cancer, but there are known risk factors that increase a person's susceptibility to developing pancreatic cancer.
Risk Factors for Pancreatic Cancer
Smoking: Chronic cigarette smoking is estimated to cause 20-30% of pancreatic cancers.
Obesity: As with other cancers, obesity increases the risk of developing pancreatic cancer.
Age: Most pancreatic cancers occur in persons > 45 years of age. Men, particularly African Americans, have a higher incidence of pancreatic cancer.
Genes: Some families have higher rates of pancreatic cancer due to genetic factors. There are two relatively rare familial disorders, such as Lynch, Peutz-Jeghers and Von Hippel-Lindau, that are associated with pancreatic cancer.
Genetic abnormalities in BRCA1 or BRCA2 genes, that can be passed down from parent to child, also increase the risk of developing pancreatic cancer.
Illnesses: Other illnesses increase the risk of developing pancreatic cancer. They include diabetes, chronic pancreatitis, and cirrhosis of the liver.
Signs and Symptoms of Pancreatic Cancer
Unfortunately, there may not be any “early signs” of pancreatic cancer. That is one reason why pancreatic cancer may be deadly. By the time symptoms appear, the cancer has already metastasized. However, the following are “red flags” that may indicate the presence of pancreatic cancer.
- Jaundice (yellow coloration to the skin and eyes)
- Dark-colored urine
- Unexplained weight loss
- Pruritis (itching)
- Abdominal and back pain
- Thrombophlebitis (blood clots)
- Nausea and vomiting
- Anorexia (loss of appetite)
The diagnosis of pancreatic cancer is typically made by a combination of imaging studies and tissue biopsy. Imaging studies include CT, MRI and ultrasound scans of the abdomen, ERCP (in which a thin, flexible catheter with a camera is inserted into the mouth, stomach and into the bile duct to visualize the pancreas), and PET scans, although if the cancer cells are not consuming glucose faster than non-cancerous cells, the PET scan may produce a “false negative” result. A tissue biopsy may be performed by endoscopy or laparoscopy.
If caught early enough, pancreatic cancer may be cured by surgery.
Whipple Procedure: The best-known surgery for pancreatic cancer is the “Whipple Procedure,” which is named after the Columbia University surgeon who first developed it many years ago. It involves removing the “head” of the pancreas, the duodenum (the initial part of the small intestine), part of the bile duct, surrounding lymph nodes, the gallbladder, and a part of the stomach. The Whipple surgery is complex and difficult, but in skilled hands, it can be effective.
Distal Pancreatectomy is performed when the cancer is in the bottom half or “tail” of the pancreas, which is removed with the spleen.
Total Pancreatectomy: Removing the entire pancreas, along with bile duct, gallbladder, nearby lymph nodes and parts of the stomach and small intestine, may be required to remove the entire tumor.
Laparoscopic and Robotic Surgery, where appropriate, allow the surgeon to remove tumors with miniaturized instruments that require smaller incisions and result in faster recovery times.
Chemotherapy and Radiation Therapy
Chemotherapy, radiation therapy, or a combination of both may be used instead of surgery or in conjunction with surgery, depending on the nature of the cancer.
To prevent the immune system from attacking normal cells in the body, the immune system uses “checkpoint” proteins on immune cells, which act like on/off switches to start or shut-down an immune response. Cancer cells can use “checkpoints” to “hide” from the immune system.
However, drugs have been developed, called “checkpoint inhibitors,” that can be used effectively to treat pancreatic cancer, when the cancer cells have specific genetic abnormalities such as a high level of microsatellite instability (MSI-H) or changes in one of the mismatch repair (MMR) genes. Patients with pancreatic cancer, whose cells have MSI or in MMR (or both) genetic abnormalities, may benefit from “checkpoint inhibitor” immunotherapy.
The FDA has approved Keytruda (pembrolizumab), an immunotherapy drug that works as a checkpoint inhibitor, to treat pancreatic cancer, whose cells contain certain genetic mutations. Keytruda inhibits PD-1, a checkpoint protein on T cells, that unblocks the immune system and allows it to attack pancreatic cancer cells. It is given as an intravenous (IV) infusion every 2 or 3 weeks.
Side effects can include fatigue, cough, nausea, itching, skin rash, decreased appetite, constipation, joint pain (arthritis), and diarrhea. Serious complications may (rarely) occur in other organs, such as the lungs, intestines, liver, endocrine glands, and kidneys from the immune system attacking those organs.
The long-term prognosis for pancreatic cancer remains poor. The overall 5-year survival rate is 7.2%. For “localized” prostate cancer (meaning it has not spread outside the pancreas) the survival rate is 27.1%. For “regional” pancreatic cancer (meaning nearby spread), the survival rate is 10.7%.
Disability Benefits for Pancreatic Cancer
Under an ERISA-regulated long-term disability (LTD) group policy, there are usually no similar provisions to expedite approval. However, if you have been diagnosed with pancreatic cancer and are unable to perform your job because of the effects of the cancer and/or the side effects related to its treatment (with surgery, chemotherapy, radiation therapy, or immunotherapy), you may be eligible for LTD benefits, with proper documentation in the medical records.