Michael Landon's good humor last week as he announced to the press in California that he has advanced pancreatic cancer was an exhibition of extraordinary grace in a difficult situation.
In fact, the prognosis in most cases of cancer of the pancreas is not encouraging: The vast majority of pancreatic tumors are known as adenocarcinomas, which rarely cause symptoms until they have passed the point of no return.
Cure is rare, and survival time is more often measured in months than in years, according to Dr. Richard Kaplan, associate professor of oncology and medicine at the University of Maryland Oncology Center.
However, he added, "There's a small percentage of patients with adenocarinomas who are curable with a combination of surgery, radiation and chemotherapy."
One of his patients appears to be in that lucky group: Terri Shnipper was 72 and living in Florida five years ago when itchiness, nausea, yellowish skin and amber-colored urine sent her into the hospital for diagnosis. At first, her doctor suspected hepatitis, but a CAT scan revealed a small pancreatic tumor that had blocked her bile duct and caused her symptoms.
Mrs. Shnipper came to Baltimore, where her daughter lives, had surgery at Johns Hopkins Hospital, and then transferred to the Oncology Center at University Hospital for six weeks of radiation and a year of chemotherapy.
Checkups every two months since then have shown no recurrence. Today, Mrs. Shnipper's happy, healthy lifestyle includes art classes four days a week and regular visits to other Oncology Center in-patients, "to encourage them and show them you can get well," she said.
"She's the only patient I know who's done that well with that kind of carcinoma," Dr. Kaplan said.
More often, adenocarcinomas have already grown considerably before they block the bile duct. Or they've spread into the web of nerves behind the pancreas, causing pain. Or they've sent malignant colonies to the liver. In those situations, surgery is of no use.
Mr. Landon, in pain for six weeks before his diagnosis, is also reported to have cancer in his liver. It is not clear from reports whether this is a different tumor or a metastasis from the pancreatic tumor, though the latter is more likely, said Dr. Kaplan.
According to the American Cancer Society, pancreatic cancer has been increasing in recent years. Smokers are more likely to get it than non-smokers, blacks more than whites, men more than women.