New Clue to Pancreatic Cancer

Study finds changes after ulcer surgery may increase risk of disease

MONDAY, April 29, 2002 (HealthDayNews) -- Doctors may soon have another clue about the development of pancreatic cancer.

That's the promise of a new study that seeks to explain how and why 39 people who had surgery for peptic ulcers had a higher rate of pancreatic cancer over the course of some 59 years.

Reporting in the May issue of the Journal of Clinical Pathology, Dutch researchers contend that physiological changes that occurred after ulcer surgery may have increased the risk for pancreatic cancer.

"What this study suggests is that certain events which occur in the body as a result of surgery for peptic ulcer appear to increase the risk of pancreatic cancer some 20 to 30 years or more later," says Dr. Roger Keresztes, a pancreatic cancer specialist at Weill Cornell Medical Center in New York City.

Because most peptic ulcers today are treated with medication, the type of surgery featured in this study -- a partial gasterectomy -- is rarely, if ever, performed. So there is little for ulcer patients to fear, Keresztes says.

Even for those who had this surgery in the past, the risks remain small.

"We are talking about 39 people out of thousands who had the surgery -- this is not a major threat for ulcer patients," Keresztes says.

While the risks for developing cancer may be small, the information gleaned from the study could play a role in furthering the understanding of how and why pancreatic cancer occurs.

"I think what we can take away from this study is a better understanding of some of the events that may be involved in the development of pancreatic cancer, and in that way the study has value in terms of better understanding this disease," Keresztes says.

The study was a retrospective look back at 2,633 patients who had ulcer surgery between 1931 and 1960 in the Netherlands.

Of that group, 39 patients died of pancreatic cancer, with more than 35 developing the disease at least five years after their ulcer surgery.

More specifically, anywhere from 5 to 59 years following surgery, ulcer surgery patients were at least two times more likely to develop pancreatic cancer than the general population. Ironically, the more time that passed after the surgery, the greater the cancer risk became -- gradually increasing to more than three times that of the general population beginning 35 years after the surgery.

Clearly, the number of people affected was dramatically small - of the original 2,633 patients, 39 deaths were attributed to pancreatic cancer during the course of 60 years.

However, researchers say those 39 people may hold the clue as to how some forms of pancreatic cancer occur.

Researchers at the University of Amsterdam, The Netherlands, say the ulcer surgery deprives the stomach of acid. This, in turn, creates an environment where certain bacteria can thrive.

The presence of this bacteria may then increase the production of cancer-causing compounds, chemicals such as nitrosamines, which have been linked to increased risk of pancreatic cancer in animals.

Many of these same patients also saw an increase in lung cancer. Most were smokers, which is also a risk factor for pancreatic cancer. Further, the data on smoking was considered incomplete.

While the researchers say it's likely smoking played some role in the development of pancreatic cancer, the lung cancer patterns were different from those of pancreatic cancer, so they believe the surgery exacerbated the development of pancreatic cancer.

However, Keresztes points out that if the surgery played a role, the exacerbation was slow in coming, because most people did not experience an increased risk until at least 35 years had passed after their ulcer surgery.

What To Do

To learn about the latest treatments for peptic ulcers, visit The National Digestive Diseases Information Clearinghouse.

For more information on the risk factors for pancreatic cancer, check out Johns Hopkins Medical Institutions.

SOURCES: Roger Keresztes, M.D., pancreatic/gastric specialist, and assistant professor, clinical medicine, Weill Cornell Medical Center, New York City; May 2002 Journal of Clinical Pathology
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