Aretha Franklin’s Death Highlights Vicious Path of Pancreatic Cancer

Aretha Franklin’s death from pancreatic cancer highlights the viciousness with which the disease attacks, killing tens of thousands of Americans a year.

It’s not clear when the Queen of Soul was diagnosed. She had what she called a health scare in 2010, then finally stopped performing in November, and by last week celebrities were coming to pay their last respects.

Pancreatic cancer is among the nation’s deadliest diseases. Here’s why:

The Pancreas

Unless you’re a diabetic, you probably don’t give much thought to your pancreas. It’s a wallflower among bigger, flashier organs. but is one of the most important body parts, essential to the control of blood sugar levels. Long and flat, it’s nestled deep within the abdomen, next to the stomach and the spine and puzzle-pieced in with the duodenum, the initial pipeline into the small intestine.

The Hidden Danger

Because the pancreas is located deep in the body it is rarely tested in non-diabetics, tumors have the opportunity to grow and thrive before they can be felt—by which time it’s often too late. The tumors can bulge out and interfere with the function of neighboring organs like the stomach, gallbladder, and the liver. According to the Mayo Clinic, symptoms include pain in the abdomen, extreme weight loss, a new case of diabetes, and jaundice, which can also be symptoms of other diseases.

Who is at risk?

The American Cancer Society says that 55,440 people will be diagnosed with pancreatic cancer this year and more than 44,000 of them will die. While it accounts for 3 percent of all cancer cases in the U.S., it covers 7 percent of cancer deaths.

It’s more commonly found in African-Americans and people in lower socioeconomic classes, although high-profile deaths—Apple founder Steve Jobs and Los Angeles Times food critic Jonathan Gold—shows it does not discriminate.

The Risk Factors

Pancreatic cancer has dietary and lifestyle roots. Cigarette smoking is linked to one in five cases—the connection is so powerful that smokers who quit almost immediately reduced their risk rates to those of non-smokers, according to Johns Hopkins University. Diets heavy in meat, fat, and cholesterol can contribute. Because men smoke more and have less healthy diets than women, they are diagnosed more often. Some studies have shown a link between high alcohol consumption and the disease but that may be the result of other booze-fueled conditions like pancreatitis and cirrhosis.

Aretha’s History

Franklin struggled with obesity for much of her life, with her weight yo-yoing. There are reports that she struggle with alcohol. She was a chainsmoker, finally quitting in 1992, when she said her weight “ballooned.”

Some of her health history is a mystery. In 2010, Franklin had surgery for an undisclosed tumor, sparking rumors of pancreatic cancer. She denied it and was back on the stage by 2011, telling Access Hollywood, she had recovered but providing few details.

“I went through a number of procedures before I knew what was wrong,” she said at the time.

By May 2013, however, Franklin was back in the hospital for undisclosed treatment; in an interview with the Associated Press later that summer, Franklin called her recovery “miraculous” and said she had rebounded,

In 2017, Franklin began looked more frail and appeared to have lost a significant amount of weight. By November, she’d canceled the remainder of her concerts.

Dismal Survival Rates

The speed and rate with which pancreatic cancer kills—Gold died within weeks of diagnosis—make it one of the most dreaded disease. Jobs survived for eight years but he had a form of the cancer, called a neuroendocrine tumor, that grows more slowly.

But one thing is clear: Most people who get pancreatic cancer will die from it —74 percent of patients within a year of diagnosis, according to the Hirshberg Foundation for Pancreatic Cancer Research. Five year-survival rates hover around seven percent. With the United States in the throes of an obesity crisis, pancreatic cancer is set to be the second leading cause of cancer by 2020 after lung cancer, another lifestyle-associated disease.

Hard to Treat

Detecting pancreatic cancer and removing it before it spreads is rare. Once found, chemotherapy can extend life, but is usually too little too late, adding just a few weeks of survival.

Whipple procedures—a catchier name for a pancreaticoduodenectomy, in which surgeons remove a tumor at the head of the pancreas—have shown promise but they have to be done early in the disease progression.

Researchers also racing to figure out how to detect pancreatic cancer earlier and new ways to treat it. Some biotech startups are studying proteins that can use the immune system to help fight the beginnings of pancreatic cancer. There are 178 active clinical trials, many studying proteins while others look at genetic engineering alternatives that could help target the otherwise hard-to-reach space.