March 11, 2008 -- Legendary New York Times photojournalist Dith Pran, on whose story the award-winning movie The Killing Fields was based, survived the horrors of war and starvation in a labor camp in the time of the Khmer Rouge.
Now, the Cambodian national faces a different battle -- a fight against pancreatic cancer. And in most cases, it is an unwinnable fight.
Dith is the second celebrity with Hollywood connections in as many weeks who has been identified as a sufferer of the disease. And as the world watches Dith and actor Patrick Swayze fight the ravages of an illness that kills 95 percent of patients within five years, many may fear that they, too, could be at risk of this silent killer.
A short video posted Sunday evening on the site Jumpcut.com shows Dith discussing his illness with visitors to his hospital room.
"Some people say it is a killer disease," Dith says in the video. "I call it a sneaky disease, because it infiltrates into the bottom of your body so that nobody knows ahead of time."
In the video, Dith appears comfortable and alert. Diane McNulty, spokesperson for the New York Times, said Dith's colleagues have visited him at the hospital and "found him full of determination to beat the cancer, grateful for visits, cards, letters, e-mails and prayers, though not equally able at all times to receive them.
"Everyone who knows Pran at The Times knows that this is an extraordinary person, a survivor," McNulty said. "He survived the killing fields, and we hope he will survive this illness."
Dith was transferred to the Roosevelt Care Center in Edison, N.J. on Friday, and he is also having radiation treatments at Robert Wood Johnson Hospital. Dith has reportedly been battling the disease since his diagnosis in January.
McNulty said his disease is now in stage 4 -- the most severe form of the cancer for which there is no reliable curative treatment.
Actor Swayze's pancreatic cancer was revealed last Wednesday, when publicists released a statement following reports in the National Enquirer and other publications which said doctors had told the "Dirty Dancing" star he had only five weeks left to live.
"Patrick has a very limited amount of disease and he appears to be responding well to treatment thus far," George Fisher, Swayze's physician, said in the statement. "All of the reports stating the time frame of his prognosis and his physical side effects are absolutely untrue. We are considerably more optimistic."
But even though the five-week time frame trumpeted by tabloids may be false, cancer specialists say that pancreatic cancer more often than not comes with a daunting prognosis.
According to statistics from the National Cancer Institute, patients diagnosed with the disease have only a one-in-20 shot of being alive five years after the cancer is found. And the patient advocacy group Pancreatic Cancer Action Network pegs the average life expectancy for a patient diagnosed with pancreatic cancer that has spread at three to six months.
Part of the reason that this cancer is so deadly is that there is no reliable screening test for the disease. Adding to the problem is the fact that the symptoms that indicate the presence of the illness are easy to miss or misclassify -- abdominal pains, loss of appetite, weight loss and possible jaundice.
And once symptoms appear, it is often too late.
"Sixty [percent] to 70 percent of pancreatic cancers are diagnosed in the most advanced stage -- when it has spread to other organs -- and we have, at best, minimally effective therapies for advanced pancreatic cancer," said William Blackstock, professor of radiation oncology at the Wake Forest University Comprehensive Cancer Center in Winston-Salem, N.C.
"In most cases we don't even get a chance to cure it; at the time of presentation and the clinical manifestation of the symptoms, the cat's already out of the bag," said Andrew Warshaw, surgeon-in-chief at the Massachusetts General Hospital Cancer Center in Boston.
"For 80-plus percent, maybe even 90 percent of people at the time the diagnosis is first made, there is nothing beyond palliative care to help them," he says.
The numbers only get worse from there. Of the 20 percent of patients who are eligible for treatment, only about 20 percent are still alive after five years, Warshaw says, adding, "we're getting down to some small numbers."
Fighting an Impervious Foe
Oncologists say the usual treatment plan for the disease combines both chemotherapy and surgery.
"If the patient's medical status is good -- no liver or kidney abnormalities and a functional patient -- treatment would likely consist of chemotherapy," said Harold Frucht of the Pancreatic Cancer Prevention & Genetics Program at Columbia University in New York. "If there is a response, this would indicate a good short-term prognosis."
If the cancer has not already spread to other organs, Frucht says the best approach would be to try to use chemotherapy to shrink the tumor, allowing for a less dangerous surgery to remove the cancerous tissue. However, if the cancer has already spread, chemotherapy is the best bet for keeping it in check.
The best bet, however, is not always a great bet. Neither chemotherapy nor radiation has been reliably shown effective in dealing with pancreatic cancer, even in the best of circumstances.
And new experimental approaches to treat the disease are "unfortunately, not very promising," said David Patrick Ryan, clinical director of the Tucker Gosnell Center for Gastrointestinal Cancers at Massachusetts General Hospital. "The latest trials of [cancer drugs] Avastin and Cetuximab -- for which we had a lot of hope -- were negative."
Aditionally, surgery for pancreatic cancer is a risky proposal. Frucht says few surgeons in the country even possess the expertise needed to perform the operation.
Hope for the Future
Facing such odds, patients -- and even their doctors -- often view palliative care as the best course of action.
"There is a sense of nihilism among many treating physicians that says, 'why even subject these patients to surgery?'" Warshaw said. "Fifty percent of these patients don't get full treatment, which furthers this self-fulfilling prophecy."
This is bad news for the estimated 37,680 people the National Cancer Institute says will be diagnosed with the disease this year. And the institute projects that in 2008, 34,290 will die from the disease.
But trials on experimental treatments continue. And Mark Talamonti, division chief of surgical oncology at the Northwestern Medical Faculty Foundation in Chicago, says that with this research comes hope for many whose lives will be touched by this dreadful disease.
"[This is] promising in two senses," Talamonti said. "One, that clinically relevant research is being conducted in this disease, and two, that some differences in treatments is actually being demonstrated, considering the historically pessimistic outlook regarding treatment effectiveness for pancreatic cancer."
Dith and Swayze may even benefit from some of the strides that have been made in the treatment of the disease in the last two decades. And their continuing battle could bring more attention to a cancer that affects the lives of tens of thousands of Americans.
"It's a frightening disease ... but we are better right now at tailoring appropriate treatment to individuals," he said. "We're better able to provide the right treatment for the right patient.
"We've made a lot of progress in the past 20 years."