揭祕喬布斯胰腺癌
When Jolie Dingle went for a routine scan 20 weeks into her pregnancy, she expected nothing more than images of her unborn baby. But the ultrasound also revealed something else — a large swelling on her spleen.
朱莉·丁格爾懷孕20周時查出肝脾腫大。
Within days, Jolie, 33, from Barnsley, South Yorkshire, had been diagnosed with cancer. Tests showed it had started in her pancreas and spread beyond the spleen to her stomach and kidneys.
約克郡巴恩斯利33歲的她隨即查出胰腺癌，已從脾臟擴到胃和腎。
Yet despite the shock of a cancer diagnosis, Jolie can count herself lucky. Cancer of the pancreas — a pear-shaped organ about 6?in long that lies deep inside the body between the stomach and the spine — is notoriously difficult to spot.
震驚之餘，她堪稱幸運。衆所周知，胰腺癌很難查出。
That’s because, in the majority of cases, it produces no symptoms until the malignant cells have migrated throughout the body and already caused irreversible damage to other organs, such as the liver or kidneys. Despite being more than halfway through her pregnancy, Jolie had little choice but to undergo emergency surgery to remove a tumour which, it turned out, had grown almost as large as a football.
總是直到惡性細胞擴散全身引起肝腎等器官的永久損傷，胰腺癌纔有症狀。朱莉只得切除足球般大小的腫瘤。
‘When they told me I had cancer, I thought my baby and I were both going to die,’ says Jolie, who has her own hairdressing business and is married to Jason, 43, who runs a decorating company.
朱莉經營美髮生意，嫁給43歲裝修公司老闆傑森。“得知患癌，我想到了孩子，我們就要死了”，她說：
‘I’d not heard of pancreatic cancer and, to be honest, I didn’t even know what the pancreas was or where it was in the body.’
“我甚至不知胰腺爲何物。”
Jolie and her now eight-month old son, Theo, both survived the surgery.
她和8個月的兒子西奧挺過手術。
But had she not had a pregnancy scan, doctors said, the cancer would almost certainly have killed her and her baby too.
醫生表示若朱莉沒做孕期檢查，母子可能已經病逝。
As a survivor of the disease, Jolie is a member of a very small club. It is widely regarded as one of the most lethal of all tumours, killing around 97 per cent of its victims within five years.
她的倖存破罕見。胰腺癌是公認絕症，約97%患者五年內發病離世。
The profile of this deadly disease has been raised with the death of Apple co-founder Steve Jobs, who died earlier this month aged 56 after a five-year battle with a pancreatic tumour.
此病因蘋果創始人之一喬布斯的病逝而被關注，他抗癌五年，本月初病逝，享年56歲。
Every year, around 8,000 Britons are diagnosed with cancer of the pancreas. According to the Pancreatic Cancer Research Fund, while rapid progress has been made in boosting survival from cancers affecting the breast, a pancreatic cancer sufferer today is just as likely to die from it as someone 40 or 50 years ago.
據胰臟癌症研究基金，每年約有八千英國人患胰腺絕症。
Many sufferers discover a problem only when they experience considerable and unexpected weight loss (caused by the cancer eating away at their digestive system), back pain or severe abdominal cramps from the growing tumour.
患者多在（消化系統受損）體重嚴重驟減、背部疼痛或由腫瘤引起的嚴重腹痛才確診患癌。
But studies suggest that, if the disease is caught in the early stages, surgery to remove the tumour can transform survival rates from 3 per cent after five years to as much as 40 per cent.
研究表明如切除早期腫瘤能使患者五年後存活率提高37%。
Now research teams around the world are in a race to discover a simple way of checking otherwise healthy people for hidden signs of a pancreatic tumour.
目前全球研究人員在競先發現儘早發現的方法。
Currently, most of those that get picked up early are spotted only because the patient happens to be undergoing an abdominal scan for some other, unrelated health matter — such as Jolie’s pregnancy scan.
多數患者在腹部掃描時查出，本爲他因，如朱莉。
But in the U.S., efforts are under way to spot cancer victims as early as possible by scanning them for signs of pancreatic cysts, tiny growths that can become malignant.
These fluid-filled sacs on the pancreas usually have no known cause and, according to some estimates, affect up to one in eight people. In the vast majority of cases, they are harmless growths that never become malignant.
英國正致力掃描出囊腫徵兆儘早確診，輕微囊腫也可爲惡性。
Those that do turn malignant account for about one in five cases of pancreatic cancer. At the moment, doctors usually only discover cysts by accident when a patient is having an ultrasound or MRI scan for something else.
五分之一胰腺癌由惡性囊腫引發。目前醫生多在超聲波或磁核共振掃描其他疾病時偶然發現。
But at the Johns Hopkins University Hospital in Baltimore, about ten patients a week are being screened as part of a trial to see if actively looking for cysts can cut the death toll.
巴爾的摩約翰霍普金斯大學醫院，每週約有十位患者被測試囊腫檢查觀察是否減少死亡人數。
Their efforts are being targeted at ‘high risk’ groups, such as those with a family history of pancreatic cancer, or those who have suffered a bout of pancreatitis — a persistent infection often brought on by gallstones, or frequent binge-drinking.
該院針對“高危”病患，如有家族病史或曾患過胰腺炎---膽結石或頻繁暴飲暴食常引起持續感染。
By targeting potential at-risk groups, it’s hoped doctors may pick up enough problematic cysts to make a significant difference to survival rates.
醫生有望查出病異囊腫來大幅提升存活率。
Another approach is being investigated by British researchers. Here, experts are pinning their hopes on research into the development of urine or blood tests that could detect pancreatic tumours before they get out of hand.
或是從尿檢血檢入手，在腫瘤惡化前查出。
At the Institute of Cancer in London, scientists are hunting for ‘biomarkers’ that are released in high quantities into the urine when a tumour is developing. These biomarkers are proteins that a tumour produces, or chemicals that help with the breakdown of these proteins.
倫敦癌症協會正在尿液中找病變“生物指標”。該指標是腫瘤產生的蛋白質或能分解蛋白質的化學物質。
Within the next three to five years, it’s hoped that five to ten different ‘biomarkers’ will have been identified that will not only pinpoint pancreatic cancer but perhaps even identify a person’s risk of the disease, simply from their urine.
有望三五年內鑑定出五到十個“指標”，確診胰腺癌及其他疾病。
Dr Steve Pereira, consultant gastroenterologist and hepatologist at University College London, says: ‘Hopefully, in the next few years this will allow us to introduce a screening programme that is cheap and acceptable.
“便宜有效的檢查有望面世”，
‘But it would have to be extremely accurate for us to test everybody. Instead, we will probably target those most at risk and concentrate on them.’
倫敦大學學院胃腸和肝臟病顧問史蒂夫·佩雷拉博士表示：“本是大衆精檢，可能以高危人羣爲主。
Jolie Dingle had no history of the disease in her family and had no other obvious risk factors when she complained to her midwife of feeling sick halfway through her pregnancy last year.
朱莉有孕期不適，但無家族病史和明顯病因。
‘I felt terrible,’ she says. ‘It was only when I heard the doctor use the word tumour that I realised I had cancer. I had to break the news to Jason and my parents, who were all stunned.’
“很糟，”她說：“醫生說是癌症。我告訴家人，他們嚇壞了。”
The surgery took place a few days later and doctors removed most of her pancreas, all of her spleen, a part of her stomach and about 15 per cent of one of her kidneys.
幾天後手術切除了她大部分胰腺、整個脾臟、部分胃和一個肝臟的15%。
While mother and baby survived the operation, Theo was not out of the woods.
母子平安，西奧仍可能患癌。
‘Doctors warned that in the first few days after surgery there was a high risk that I could go into premature labour or miscarry. At 22 weeks, Theo’s chances of survival would have been tiny. Every time the nurse put the monitor on me to try to pick up the baby’s heartbeat I was a bag of nerves.’
“醫生警告術後幾天可能早產或流產，第22周西奧活着的可能性很小。測他的心跳時我好緊張。”
Now Jolie has regular three-monthly checks and so far the cancer has shown no sign of returning.
之後她三個月檢查一次，尚無復發跡象。
‘I can’t believe how lucky I am. When he was born, it was one of the best moments in my life. That’s why we called him Theo, which in Greek means God’s gift.’
“我真幸運。兒子出生是我人生最美時刻。他叫西奧，希臘語是上帝恩賜。”
