The 68-year-old Franklin, who lives in Bloomfield Hills, Mich., was hospitalized in October at Sinai-Grace Hospital in the Motor City, and was ordered by her doctors to cancel appearances for six months. She has several known risk factors for pancreatic cancer, including being obese, African American, over 55 (the median age in many pancreatic cancer studies is 65) and diabetic, although it's unclear whether she has Type 1 or Type 2 diabetes. (Doctors don't know whether it's the elevated blood sugar levels or the impaired function of the insulin-secreting pancreas itself that accounts for the pancreatic cancer risk among diabetics). Other known risk factors for pancreatic cancer include smoking, which doubles or triples risk; family history; chronic inflammation of the pancreas, cirrhosis of the liver and workplace exposures to pesticides, dyes and chemicals. About 10 percent of cases are linked to genetic mutations associated with certain cancers of the breast and ovaries, skin, and some colorectal cancers. Researchers also suspect there may be associations with ulcer-causing Helicobacter pylori infections and high-fat diets.
Ranked No. 1 on Rolling Stone magazine's list of the 100 greatest singers of all time, Franklin has kept her illness largely private, although a cousin reportedly told the National Enquirer that she was suffering from pancreatic cancer, which in 2009 claimed the life of actor Patrick Swayze. However, other high-profile patients, like Supreme Court Justice Ruth Bader Ginsburg and Apple CEO Steve Jobs, have survived.
Pancreatic cancer occurs in an oblong organ about 6 inches long lying deep in the abdomen, behind the stomach, small intestine, liver, and bile ducts. It contains the islet cells that secrete the important hormone insulin, which breaks down sugar to fuel the brain and body. The pancreas contains other cells that release enzymes that digest food.
Pancreatic cancer is the No. 4 cause of cancer in this country. In 2010, more than 43,000 people will be diagnosed with it and more than 36,000 will die from it, the American Cancer Society estimates. It is one of the most dreaded cancers because by the time it's found, it's most often advanced. Plus, there are no reliable ways to screen for it.
Some blood tests can detect chemicals made by pancreatic tumor cells, such as CA 19-9, but the tests have limited value and largely are used to help doctors determine if treatment is working, or to detect recurrence. Pipas and his colleagues at Dartmouth have submitted for publication a study that looked at CA 19-9 levels in close relatives of pancreatic cancer patients, and sent those family members with high levels for endoscopic ultrasound exams to look for tumors. Pipas said the findings were "not conclusive, but suggestive." He said endoscopic ultrasound has allowed Dartmouth cancer specialists to pick up tumors when they are just 10 to 15 millimeters in size.
Tests for another protein, carcinoembryonic antigen (CEA) can be used to identify advanced pancreatic cancer.