A SUDDEN TURN: Gene Upshaw was diagnosed with pancreatic cancer just four days before he succumbed to it.
Image: AP Photo/Morry Gash
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Gene Upshaw, the executive director of the National Football League Player's Association—the union for NFL players—died late Wednesday evening of pancreatic cancer while vacationing in California's Lake Tahoe. Doctors diagnosed the 63-year-old Hall of Fame offensive lineman with the disease just four days earlier.
Upshaw was a guard for the Oakland Raiders from 1967 to 1981. He played in seven Pro Bowls and three Super Bowls. He served as head of the NFL player's union for 25 years.
According to Bloomberg News, Upshaw's wife, Terri, took him to a hospital on Sunday, August 17th, because he was having trouble breathing. A biopsy revealed, much to everyone's surprise, that he had advanced pancreatic cancer.
In March, actor Patrick Swayze—star of the hit 1980s film Dirty Dancing—revealed he had been diagnosed with the illness in January. Doctors' reports indicated they had caught his cancer relatively early.
The pancreas secretes hormones and enzymes to digest our fats. One of those hormones is insulin, which prompts the body to use sugar in the blood rather than fat as energy. Its levels are low in diabetic patients, who suffer from abnormally high blood sugar.
Only one fifth of Americans diagnosed with pancreatic cancer survive for a full year, according to the American Cancer Society, and it is the fourth leading cause of cancer death in the country.
How does the disease develop without noticeable symptoms and then kill so quickly?
To find out, ScientificAmerican.com called Allyson Ocean, an oncologist at New York–Presbyterian Hospital/Weill Cornell Medical Center, who specializes in gastrointestinal cancers including pancreatic cancer. An edited transcript follows:
Why does pancreatic cancer kill so quickly?
Pancreatic cancer is typically diagnosed at a late stage because it doesn't cause symptoms until it's too late. Weight loss, abdominal pain, jaundice [a yellowing of the skin due to toxic buildup in the liver]—those are the most common symptoms. They usually start after the tumor is a significant size. By then, chances are, it has metastasized [that is, spread to other parts of the body].
Only about 10 to 15 percent of pancreatic cancers are diagnosed when they could be considered for surgery. And the prognosis is poor even in patients who do have surgery, because it comes back about 85 percent of the time. At best, 25 to 30 percent of patients are alive five years after surgery.
When doctors do pancreatic cancer surgery, they take out 95 percent of the pancreas, including the tumor, and then they leave a small remnant of the pancreas in there that serves [the insulin-producing] functions.
If a person can live without a fully functional pancreas, then what, ultimately, kills most pancreatic cancer patients?
When most patients die of pancreatic cancer, they die of liver failure from their liver being taken over by tumor.
What precludes doctors from performing surgery on late-stage patients like Upshaw?
We don't do surgery if the tumor has already spread outside the pancreas, because there's no survival benefit in removing the tumor. We also sometimes can't do surgery [when the tumor] involves the great blood vessels, the superior mesenteric vein and superior mesenteric artery. Those are the main vessels that come off of the aorta, the main artery in our body. If the tumor is wrapped around those blood vessels, then we can't take it out.
Why is this particular cancer so aggressive?
Because of the nature of the tumor cells. They escape the treatments, they hide out, and then they come back. And they grow again and they affect the liver and then they kill people.
What are the biggest risk factors for pancreatic cancer?
The biggest known risk factors are smoking and family history—it can be a hereditary disease. Then there are some other more obscure risk factors, such as defects in the anatomy of the pancreas, but that's very rare.
What factors affect how early a person gets diagnosed?
Depending on where the cancer is diagnosed in the pancreas, it can affect how soon it's diagnosed. For instance, if the cancer is in the head of the pancreas, which is close to the common bile duct, and it grows and it causes obstruction of the common bile duct, a patient can get jaundiced. And then they could [show symptoms] sooner than someone whose pancreatic cancer is in another part of the pancreas, like the tail. They would not present with jaundice, so we would not have a clue that there was necessarily anything wrong with them.
What are some of main symptoms as the cancer progresses?
Unexplained weight loss, abdominal pain, nausea, vomiting. Back pain is another one, because the pancreas is very posterior in the body. Back pain is also the most common complaint that patients go to an emergency room for, and most of the time it's just muscle pain—it's not pancreatic cancer.
The press reported that Upshaw's wife brought him to the hospital because he was having trouble breathing. What might have caused that?
It could be for a number of reasons, such as if the disease has spread to the lungs. If he was so run-down from having lost a significant amount of weight, and he was weak and fatigued, he could have had difficulty breathing, too. It's hard to say.
Another important thing with pancreatic cancer is that it's one of the cancers that is frequently associated with blood clots. He could have had a blood clot in the lung, called a pulmonary embolism. It's possible that that's what killed him.
What treatments are available if surgery isn't an option?
Chemotherapy and radiation therapy. Sometimes we do both together. We are also using biologic agents now, meaning antibody therapy. There's a drug called Tarceva, which is an antibody [or immune protein] against the growth factor that the tumor cell makes, and so it blocks that growth signal. It's given in combination with [a chemotherapy called] Gemcitabine. In a large randomized clinical trial, [the combination of the two drugs] was shown to improve upon Gemcitabine alone.
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13 Comments
Add CommentIt is the location and relation to vital structures like liver, blood vessels makes it difficult to detect in early stages along with symptoms which occur late in disease progression causing it to difficult to detect.
Reply | Report Abuse | Link to thisIs leaving small portion of pancreas enough for production of Insulin and Glucagon?
Reply | Report Abuse | Link to thisI think that people with a history of diabetes is linked to pancreatic cancer or people living with diabetes are at risk, also there is a high percentage today with a high sugar diet, personally, it's not good. Also it is also vital to understand that these treatments such as Chemotherapy and Radiation therapy are useless, it either makes the person sick again or causes more problems.
Reply | Report Abuse | Link to thisWhen I have an annual check-up, can my Dr check for PC? How?
Reply | Report Abuse | Link to thisI have a friend who has PC, islet cell type. She was diagnosed in 1988.
Reply | Report Abuse | Link to thiserratum: tarceva (aka erlotinib) is not an antibody, nor does it target a growth factor. it's a small molecule kinase inhibitor that binds to the receptor of a growth factor.
Reply | Report Abuse | Link to thisVery interesting article.y father,s mother died of diabetes complications: gangrene. Three of his sisters also died of diabetes complications; and he died in 1978 of PC.
Reply | Report Abuse | Link to thisThere is a very interesting new antibody therapy in a phase lb trial that could be a breakthrough product. It is radiolabeled antibody against the MUC1 antigen that is specific to pancreatic cancer.
Reply | Report Abuse | Link to thisWatch the 3 part presentation at www.hpam4.com . PC patients qualify for this trial only if they have not had CHEMO.
One of the sites is that is going to be treating PC patients is New YorkPresbyterian Hospital/Weill Cornell Medical Center.
Watch the presentation, there should be an update on the trial in January.
A new antibody therapy is very promising in PC cancer. See a 3 part presentation at www.hPAM4.com . One of the trial sites is New York–Presbyterian Hospital/Weill Cornell Medical Center that is mentioned in the article.
Reply | Report Abuse | Link to thisA PC patient can't qualify for the trail if they have been treated with a CHEMO. The presentations are worth watching, and there should be a trial update in January from the one in the website.
bobbybob you are an idiot, go find someplace else to spend you're time. Obviopusly this is way over your head.
Reply | Report Abuse | Link to thisI read that all these people that died of Pancreatic cancer caught this deadly disease. We injest too much sugar in our diets and too much fat and colesterol. Look at all these over weight problems over weight problems we have these days. I was born in Glendale, California, April, 09, 1945, with my twin sister Joan who now lives in Grants Pass, Oregon, with her husband joe and her many dogs, in the snow. She is into Amway and does not listen to me, since I use Shaklee products. I hope they make as good of products as we do. What I know they don't. She had acid reflux and I told her about our product: ez-gest (enzimes) and even sent her a bottle and she did not use it. Sad I ment well, but she is overweight and listens to the doctors. Not me. I got results listening to God and Shaklee. I wish I could convince people these are not what they preconcieve in their minds. Someone told me the other day that they only buy what is advertized on the TV. When I was born there was no TV around, in 1945. I had a friend who was realted to my friend Jack Ferra, who was in the U.S Coast Guard with me. His friend said she wrote down everything she saw advertized on TV so she would make sure she would not buy them. We thought she was crazy then. I think she was basicly right. You can't always believe what you here and watch. Beware what you let inter your mind. Shaklee products have made my life better, over 30 years of use. I still don't have cancer, and no heart discease, and no surgeries by the doctors who are really decieved by the drug companies wanting all your $. We are basicly lost sheed in need of a shephard, Jesus to show us the true way to living our lives and making the right choices in life. The Bible has all the answers to dietary ideas to help us live a long live glorifing our maker God. God knows how to heal your body. He made you! The Bible says a fool says there is no God. Just look around with the eyes God gave you to discover the truth and to be thankful in life. Learn to trust Him as I do. God allowed me to find out about these products He allows me to use on the $ he gives me to spend honoring Him. God bless you all in the New Year 2009. Love in Christ Dennis R. Miller 01-10-09, 10:21am, Pasadena, CA 91105. God loves you and that makes two of us! You don't have to suffer! Your Choice!
Reply | Report Abuse | Link to thislf a patient has a high blood sugar, why not do a biopsy on the pancreas tissue. Since it is so hard for the physician to detect panceatic cancer during a routine examination?
Reply | Report Abuse | Link to thisKnowing how much beer people consume crappy BEER at NFL games, I would like to conduct statistics on pancreatic cancer after consuming beer and/or coffee on daily/bi weekly base! Who cares about what genes are expressed? I care what causes their expression, FELLOWS!
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