Pancreatic Cancer: From Diagnosis and the Whipple Procedure to Hospice Care

Pancreatic cancer is often called a 'silent' disease because its early signs are so easy to miss. This episode provides a comprehensive look at the diagnosis—from the complex Whipple procedure to hospice care—to help families move from fear toward understanding. https://bit.ly/4birjzs

In this episode, you will learn: 

• What the pancreas actually does (enzymes, insulin, and glucagon).
• The difference between modifiable and non-modifiable risk factors. 
• What a "pancreaticoduodenectomy" (Whipple procedure) involves and a brief history of the procedure. 
•  How hospice provides wraparound support to manage metastasis, ascites, and pain, ensuring comfort and dignity in the final stages 

Timestamps: 

• 00:00 - Intro: Roasted Jalapeño Dip, and Mel Brooks Documentary
• 03:14 - Jim Henson’s Legacy - It's Not Easy Bein' Green
• 06:33 - Pancreatic Cancer Statistics & The Pancreas Defined
• 06:33 - Cancer Risk Factors: Genetics vs. Lifestyle 
• 09:42 - The Whipple Procedure Explained 
• 16:42 - Late-Stage Realities & Hospice Support
• 29:19 - A Poem Honoring Alex Pretti by National Youth Poet Laureate Amanda Gorman 
• 30:56 - Outro

Related Episodes Mentioned:

• S5E45: Why Does Cancer Exist?
• S4E26: How Pain Medications for Cancer Improve Quality of Life
• S2E29: How to Decide When It is Time for Hospice
• S4E43: The Carters – Living Their Best Life to the End
  
  

#PancreaticCancer #CancerAwareness #HospiceCare #WhippleProcedure #EndOfLife #EveryoneDiesPodcast #JimHenson

Transcript

Hello and welcome to Everyone Dies. Relax and settle in for our podcast about serious illness, dying, death, and bereavement. Because even though everyone dies, no one must face it unprepared.

Today we're talking about pancreatic cancer, a common cancer that causes a disproportionate number of deaths, often because symptoms are subtle and the diagnosis comes later than anyone hopes. And as always, we'll also talk honestly about what happens if the disease progresses, because understanding the medical realities helps people make decisions that support comfort, dignity, and meaningful time together. I'm Marianne Matzo, a nurse practitioner, and I use my experience from working as a nurse for 47 years to help answer your questions about what happens at the end of life.

And I'm Charlie Navarrette, an actor in New York City, and here to offer an every person viewpoint to our podcast. We're both here because we believe that the more you know, the better prepared you are to make difficult decisions when a crisis hits. And remember that this podcast does not provide medical nor legal advice.

Please listen to the complete disclosure at the end of the recording. In the first half, Charlie has a story about Jim Henson's funeral and our recipe of the week. In the second half, we are continuing our cancer series with an exploration about pancreatic cancer, including what the pancreas does, how pancreatic cancer develops, and what risk factors matter, and what treatment, including the complex Whipple procedure, can look like.

In our third half, Charlie is reading the poem from National Youth Poet Laureate Amanda Gorman, composed for Alex Preddy. Hey, Charlie, have you seen the documentary on Mel Brooks? No, I have not. I've seen Little Cliffs, but no, I have not.

I imagine it's wonderful. Oh my god. Yeah.

It was just, it's two episodes, and it was really just delightful to, you know, hear his story and, you know, his relationship with Anne Bancroft, and just, oh, it was wonderful, wonderful. Okay, in our first half, our funeral lunch appetizer recipe is roasted garlic jalapeno dip. A simple yet delicious green party appetizer.

Combine cream cheese, jalapenos, roasted garlic, and Greek yogurt, and you'll get this creamy dip. Buono appetito! I'm multilingual, you know that, right, Marianne? No, I was doing piles of cocaine in the 80s, so I don't remember that. I remember that little white mustache you had for a while.

It was like little dust particles. It's like, Marianne, you have white on you. What is that? It's powder sugar from Krushiki.

There we are. A little plug there for Hamtramck Detroit. Very nice.

On May 16, 1990, Muppet creator Jim Henson died at the age of 53 from a bacterial infection. His death was ruled to be the result of toxic shock syndrome. Four years before his death, Henson had given very clear instructions about the services, requesting that no attendees wear black and that a jazz band be present.

According to one account, Henson also reportedly wrote that, I'm not at all afraid of the thought of death and look forward to it. It would be lovely if there were a song or two and someone said some nice happy words about me. It was at London Memorial Service that Sesame Street legend Carol Spiney, the puppeteer behind Big Bird and Oscar the Grouch, paid tribute to his longtime collaborator with an overwhelmingly sad performance of It's Not Easy Being Green, a song made famous by Kermit the Frog, which he performed on both The Muppet Show and Sesame Street.

We have a link to the video of Big Bird at the funeral, so if you need a good cry, this video will get you there. And for those of you who are wondering if this is a good song for a funeral, have a listen to the words. It may change your mind.

It's not that easy being green, having to spend each day the color of the leaves, when I think it could be nicer being red, or yellow, or gold, or something much more colorful like that. It's not easy being green. It seems you blend in with so many other ordinary things, and people tend to pass you over because you're not standing out like flashy sparkles in the water, or stars in the sky.

But green is the color of spring, and green can be cool and friendly-like, and green can be big like an ocean, or important like a mountain, or tall like a tree. When green is all there is to be, it could make you wonder why. But why wonder why? Wonder.

I am green, and it'll do fine. It's beautiful, and I think it's what I want to be. Please go to our webpage for this week's recipe and additional resources for this program.

This is the part where we ask for your financial support. Your tax-deductible gift will go directly to supporting our non-profit journalism so that we can remain accessible to everyone. You can donate at www.everyonedies.org. That's every, the number one, dies.org. Or at our site on Patreon under Everyone Dies.

Marianne? Pancreatic cancer is the 10th most common cancer in the United States, making up 3% of all cancers, but causing 8.4% of cancer-related deaths, which comes out to about 67,530 diagnoses and 52,740 deaths each year. The average person's risk for pancreatic cancer is about one in every 64 people, so that comes out to about 185 people are diagnosed with pancreatic cancer every day. The pancreas is a large gland that helps the body digest food and is located deep in the abdomen between the stomach and the spine.

If you think about like where organs are, it's like in the middle of all the organs, so you have to really kind of dig in in order to find it. It's not something that you could like put your fingers on your belly and feel. So the pancreas makes enzymes that help digestion and hormones like insulin and glucagon that play an important role in maintaining the body's blood sugar levels.

Now if you've been following our cancer series, everything you wanted to know about cancer but didn't have anyone to ask, you know that different types of cancer are caused by different things, which are called risk factors. Some risk factors are modifiable, meaning that you can change them. If you've been following our cancer series, everything you always wanted to know about cancer but didn't have anyone to ask, you know that different types of cancer are caused by different things, which are called risk factors.

Some risk factors are modifiable, meaning that you can change them, and some are non-modifiable, meaning you can't change them. Non-modifiable risk factors for pancreatic cancer are age, so the average age at diagnosis is age 70. Gender, it's slightly more common in women.

Race, it's slightly more common in African Americans. Family history, it's more likely to run in families. We know from previous podcasts that cancer forms from changes in the cell when it reproduces.

There are also inherited gene changes called mutations that can be passed from parent to child and are known to cause about 10% of pancreatic cancer. The modifiable risk factors, meaning the things you can control to lower your risk of pancreatic cancer, are tobacco use. Risk of pancreatic cancer is twice as high in smokers compared to non-smokers, with 25% of pancreatic cancer caused by cigarette smoking.

And obesity, that's a BMI greater than 30, accounts for 20% higher risk of being diagnosed with pancreatic cancer. Pancreatic cancer is more common in people with diabetes as well as those with chronic pancreatitis. That's long-term inflammation of the pancreas, typically associated with heavy alcohol use and smoking.

People who are diagnosed with pancreatic cancer have vague symptoms that they may ignore. As a result, people are typically diagnosed with pancreatic cancer later in the disease. The symptoms that may motivate people to see their healthcare practitioner include abdominal pain, yellow tinge, which is called jaundice, skin color, having no appetite, feeling nauseated, light-colored stools, tea-colored urine, or pancreatitis.

Tests to diagnose pancreatic cancer are a CAT scan, MRI, or endoscopic ultrasound. Blood tests are ordered to look at liver function and cancer biomarkers. Treatment options depend on the type and stage of pancreatic cancer.

Studies have shown that removing only part of a pancreatic cancer doesn't help people live longer, so potentially curative surgery is only considered if the surgeon thinks that all the cancer can be removed. General surgery with the complex Whipple procedure is standard for resectable disease, meaning that looking at the scans, the surgeon feels that they could remove the cancer by surgery. The Whipple procedure is a very complicated operation that requires a surgeon with a lot of skill and experience.

The reason is that the pancreas is very closely connected to the nearby organs in the abdomen. It can't just be removed on its own like the way a kidney or a lung can. The surgery carries a relatively high risk of complications that can be life-threatening.

The Whipple procedure is the most common surgery for pancreatic cancer, so I'll give you a little bit more detail about it just because I think it's interesting and because I like history and because if you're going to have it, you should know what happens. But there's also a link in the show notes for other surgery procedures that might be appropriate. The year was 1935, and Dr. Alan Oldfather Whipple, I did not make up that name, a wise and respected surgeon-in-chief at Columbia Presbyterian Hospital, prepared to demonstrate his operating skills to an audience of distinguished visitors.

And just as a side note, I had an opportunity when I was in Boston, I was at Boston General Hospital doing a research thing, and they took us into the original operating theater. And I'd never seen anything like this before, and so it was literally like a stage where they would wheel the patient onto, and the medical students or other physicians would come in and watch a surgeon operate. And they would sit in these chairs, and it was all open, and they would have the patient on the stage in this open-air room, and they would do surgery on them.

So, you know, as you could maybe guess, infection and things like that were sort of a problem, but I digress. So, Dr. Alan Oldfather Whipple, just because I like his name, was there, and he was going to, you know, do surgery and show how he did his thing. So, what he was doing that day is he would be removing a portion of the stomach from a patient with stomach cancer, a procedure Dr. Whipple had performed many times before.

But Dr. Whipple quickly realized that all was not as it seemed. His patient did not have stomach cancer. He had cancer of the pancreas, so Dr. Whipple had to improvise.

Whipple performed an elaborate operation that included removing not just the pancreas, but also the stomach, jejunum, duodenum, and the common bile duct. With that one bold move, Dr. Whipple opened the door to surgically curing patients with pancreatic cancer. His procedure technically called a pancreatic duodenectomy remains to this day the best surgical treatment option available for pancreatic cancer.

Now, don't try this at home, but here are the details of the Whipple procedure. During this operation, the surgeon removes the head of the pancreas. Now, the pancreas is sort of like a long kind of flattish, sort of looks like a fish, but maybe only to me.

So the surgery moves ahead of the pancreas and sometimes the body of the pancreas as well. Nearby structures such as part of the small intestine, part of the bile duct, the gallbladder, lymph nodes near the pancreas, and sometimes part of the stomach are also removed. The remaining bile duct and the pancreas are then attached to the small intestine so that the bile and digestive enzymes can still go to the small intestine.

The end piece of the small intestine or the stomach and small intestine are then reattached so that food can pass through the digestive tract. Usually, pancreatic cancer requires additional chemotherapy or radiation. Chemotherapy is a part of the treatment plan for pancreatic cancer in any stage and can be given after surgery or palliatively to help with symptom management.

Chemotherapy or radiation may also be given neoadjuvantly to improve surgical options for unresectable advanced disease. So adjuvant chemotherapy or radiation is chemo radiation that's given after surgery. Neoadjuvant is chemo or radiation that's given before surgery.

In this case, it's to help shrink the tumor to make it easier to go in later and do surgery. These treatments can cause a variety of physical and psychosocial effects. Side effects from surgery include post-operative and or chronic pain, tiredness, poor appetite, infection, bleeding, or weight loss.

Patients may have trouble digesting food and require pancreatic enzyme replacement to aid with malabsorption. Radiation may lead to skin irritation, nausea, vomiting, diarrhea, inflammation, fatigue, and other side effects. Chemotherapy can cause nausea, vomiting, myelosuppression, diarrhea, constipation, hair loss, numbness and tingling of hands, feet, or fatigue.

The five-year relative survival for someone with pancreatic cancer is 13.3%. This means that five years after diagnosis, 86.7% will have died. Understanding the final stage is essential to grasp the changes that occur and that can impact quality of life. In late-stage pancreatic cancer, the cancer cell starts to grow in other parts of the body.

This is called metastasis, and in pancreatic cancer, metastasis is common to the liver, lungs, and peritoneum. The peritoneum is the lining of the inside of your, like, abdomen area. These areas are particularly attractive to the cancer cells because they have a rich blood supply and the cancer's ability to spread through the bloodstream or lymphatic system.

The pattern of metastasis can vary among individuals but often involves multiple sites. The final months of pancreatic cancer are unique due to the disease's aggressive nature and its impact on the body. Compared to other late-stage cancers, pancreatic cancer is distinctly associated with severe pain, significant weight loss, and digestive issues.

One of the characteristic symptoms of advanced pancreatic cancer is significant weight loss and muscle wasting. This occurs due to the body's decreased ability to digest food properly and the cancer's metabolic demands. Maintaining adequate nutrition becomes increasingly difficult, leading to a frail condition.

Jaundice, characterized by yellowing of the skin and eyes, is another common symptom. This condition arises from the buildup of bilirubin in the blood, often due to the tumor obstructing the bile duct. Skin changes include itchiness and dryness, which are associated with the jaundice, can also occur.

Pain associated with pancreatic cancer is typically felt in the stomach area, the back, or other areas depending on the tumor's location and spread. The pain can be constant or intermittent and vary in intensity. Opioid medications are typically used to manage the pain.

Simple techniques like repositioning in the bed, using supportive pillows, and gentle massage can provide significant comfort. These methods can help alleviate pressure points and reduce discomfort, making it easier for people to rest and engage in activities that they enjoy. We have a few different podcasts about pain management that you can listen to so that you can learn more about that.

The digestive system's functioning is significantly impacted as pancreatic cancer advances. People often experience a decrease in appetite, which can be intensified by nausea and vomiting. These symptoms can result from the tumor itself or from the treatments such as chemotherapy.

Managing nausea and maintaining nutrition are critical aspects of care. Ascites, or the accumulation of fluid in the abdomen, can cause discomfort and difficulty breathing. This condition may require drainage to help with the symptoms and improve comfort.

If you're a watcher of the pit, there is a recurring patient with a huge abdomen that they drain the fluid from, which is the procedure to treat ascites. Hospice care offers a comprehensive range of services tailored to the needs of pancreatic cancer patients, including pain and symptom management, emotional support, and spiritual care. Navigating the final stages of pancreatic cancer can be challenging and emotional experience.

Understanding what to expect and how to manage symptoms can help make the end of life journey more bearable. By recognizing the physical, emotional, and psychological changes that occur during this time, families can better support their loved ones and create meaningful moments together. Effective pain management, nutritional support, and emotional care are crucial to ensuring comfort and dignity.

And I would also say, don't put off electing your hospice benefits. If treatment options have been exhausted, and you're exhausted, and your family's exhausted, elect hospice care and let them come in and help manage things, make things easier, and improve your quality of life. You'll be glad you did.

Pancreatic cancer is a difficult diagnosis to receive, but information helps us move from fear toward understanding. Knowing what symptoms may appear, how treatments work, and what support is available allows patients and their families to focus not only on managing illness, but on living intentionally through every stage. Charlie, you have any questions for me? Yes, you had mentioned that there are certain items or situations as practical markers of pancreatic cancer, but as you said, it doesn't seem that there are any real telltale signs until it's too late.

Do you see what I'm saying? Well, I think what we do is that, I think it's part of our human condition, is that when we have a new symptom, we say, oh, I must be getting older. Oh, that's probably that chili I ate last night. And we tell ourselves things, and it can go on for quite a long time.

And I've known people to do that, and I've known, you know, like I say, well, gee, you know, maybe you should go and get examined by your healthcare practitioner, you know, and they'll say, oh, it's not time for that. And what I would encourage people to do, I also had a friend who had symptoms of ovarian cancer, and as a nurse, like the first sort of weird symptom she had, she hightailed it to her doctor, and they diagnosed it very early, and she had treatment, and she continues to do really well. And so that makes a difference in terms of if you, you know, try to ignore it or wish it away, and it, you know, like I had a colleague who eventually was diagnosed with mouth cancer, and I had, you know, moved to an entire other job, and I get this call from her, and she says, no, actually, I got a message from a friend of hers who said that she's looking for me, and I said, oh, same phone number, she can just call me.

Well, she'd been having these symptoms that had been going on for over a year that she was ignoring. And people, I mean, you know, she's a smart woman, but chose for whatever reason to ignore it, and then when she finally went to the doctor, it was really advanced. And so then it's, you know, it's much harder to treat because it's, you know, been doing what it's been doing for a while.

So if anything that our listeners take from this is that if something changes, go to the doctor. You know, I've heard people say, oh, well, I don't want to bother them, they have more important things to do. It's like, no, what they have to do is take care of you.

Take care of you, exactly, yeah. So go, and rather, I'd rather them say, oh, that was last night's chili than for you to, you know, have those symptoms and be uncomfortable and lose a lot of weight, and then go to the healthcare practitioner and then find out that there's, you know, that it's already metastasized or whatever, and that treatment is, you know, not going to be effective or you're not going to get the outcome that you're looking for. So the cautionary tale is something changes, you're having pain, you know, if it goes on, I'd say give yourself a week.

Of course, this isn't medical advice, this is what I would do. It's like, give yourself a week. If it doesn't clear up, get yourself to the doctor.

Yeah, perfect. You pay a co-pay, but geez, that's better than letting it sit and stew. And you die.

Yes, exactly, yeah. Would you say something, okay, so you said something about hospice benefits. So when do you know it's time for hospice? Well, we have a podcast about that, that you can listen to.

The rule about hospice is that you have a less than six-month prognosis, but your healthcare practitioner, well, there's been plenty of research saying that healthcare practitioners are not particularly good at being able to tell when is that point. And so if you're waiting for them to say, you know what, why don't you think about hospice, it might come really late. So be proactive.

It's a benefit like any other benefit you have in your insurance policy. And it gives you a lot of great benefits. And there's not a patient that I've ever had in hospice who said, well, this was a dumb idea.

What I hear from people is I really should have done this sooner. It's like, yeah, you know, in my head I'm thinking, yeah, you should have, but you're here now. Yeah, I remember with President Carter, we talked about this on the show where he was in hospice, and he was in hospice for over a year.

And Mrs. Carter, he was in hospice and died three days later. So, yeah. And that's a more common scenario.

People being in hospice for over a year is far more unusual. Right. But, you know, they pay for your medicines, they bring them to the house.

I mean, it is an incredibly wonderful benefit. And it gives another layer of support for you and for your family and, you know, professional eyes on you to help manage things with your healthcare practitioner. It's, you know, it's just a really good benefit.

Yep. Thank you. Like if you could get a new pair of running shoes every six months because it was one of your benefits on your insurance, you'd probably get the new shoes, right? Yep.

I mean, I would. Oh, yeah, yeah. You know, so it's like that.

It's like, you know, you're going to, your end of life is going to come anyway if you're in hospice or not. So you might as well have that additional support and help and symptom management in a timely fashion and deliver to your house rather than trying to negotiate it all on your own. That's what I have to say about that.

And that's a good thing to say. Thank you. You're welcome.

For our third half, National Youth Poet Laureate Amanda Gorman composed a poem about the murder of Alex Pretty. It's titled, For Alex Jeffrey Pretty Murdered by Ice, January 24, 2026. We wake with no words, just woe and wound.

Our own country shooting us in the back. It's not just brutality. It's jarring betrayal.

Not enforcement, but execution. A message. Love your people and you will die.

Yet our greatest threat isn't the outsiders among us, but those among us who never look within. Fear not those without papers, but those without conscious. Know that to care intensively, united, is to carry both pain-dark horror for today and a profound daring hope for tomorrow.

We can feel we have nothing to give and still be loved this world waiting, trembling to change. If we cannot find words, may we find the will. If we ever lose hope, may we never lose our humanity.

The only undying thing is mercy. The courage to open ourselves like doors, hug our neighbor, and save one more bright, impossible life. Thank you, Amanda, for your powerful poem.

If this episode resonated with you, follow and subscribe to the show and share it with someone who might need clear, compassionate education about serious illness. You can find more episodes on Spotify, Apple Podcasts, or your favorite podcast app. This is Charlie Navarette, and from late night talk show host Stephen Colbert, who asked the most streamed music performer on the planet, what do you think happens when we die? Bad Buddy responded, they bury us.

And I'm Marianne Matzo, and we'll see you next week. Remember, every day is a gift, and understanding helps us use that time with greater purpose. This podcast does not provide medical advice.

All discussion on this podcast, such as treatments, dosages, outcomes, charts, patient profiles, advice, messages, and any other discussion are for informational purposes only and are not a substitute for professional medical advice or treatment. Always seek the advice of your primary care practitioner or other qualified health providers with any questions that you may have regarding your health. Never disregard professional medical advice or delay in seeking it because of something you have heard from this podcast.

If you think you may have a medical emergency, call your doctor or 911 immediately. Everyone Dies does not recommend or endorse any specific tests, practitioners, products, procedures, opinions, or other information that may be mentioned in this podcast. Reliance on any information provided in this podcast by persons appearing on this podcast at the invitation of Everyone Dies or by other members is solely at your own risk.