Pancreatic cancer has taken another life. The prognosis for pancreatic cancer is dismal. The overall five year survival rate is less than two percent, the worst of any cancer. Only 20 percent of the patients will be diagnosed at a stage where surgery may offer hope.
Last time I wrote about pancreatic cancer was in 1996. That was the year my sister, Gulshan, age 60, passed away within three months of diagnosis of pancreatic cancer. Steve Jobs was 56. He lived for four years after having had a diagnosis of pancreatic cancer. He also received a liver transplant.
It has been 15 years since my sister died. Has anything changed to improve the prognosis of patients diagnosed with pancreatic cancer?
Before we look into that, let us look at some numbers. The Canadian Cancer Society’s document “Canadian Cancer Statistics 2010” says that in 2010, Canada will continue to see an increase in the number of individuals diagnosed with and dying from cancer. Every hour of every day, an average of 20 people will be diagnosed with some type of cancer and eight people will die from cancer.
Fifty per cent of the newly diagnosed cancer patients will be suffering from lung, colorectal, prostate and breast cancers. Cancer of the pancreas is 12th on the list of estimated number of new cases. About 4,000 new cases will be diagnosed – this will be equally divided amongst males and females. Almost the same number of people will die of pancreatic cancer each year. Death from pancreatic cancer is fifth on the list after lung, colorectal, breast and prostate.
An article in the Scientific American (January 2011) says that one of the reasons why the prognosis is so dismal in pancreatic cancer is that the disease is not typically diagnosed until 15 years after the first cancer-causing mutations appear, by which point the cancer has spread and become highly aggressive.
What does that mean? That means there may be plenty of time for doctors to intervene before pancreatic cancer becomes lethal. Then the tumour can be successfully removed and the prognosis can be improved with appropriate chemotherapy and radiotherapy, if indicated.
The article says researchers from John Hopkins found that cancer cells appear 10 years after the first cancer-causing mutation arises and that another five years pass before the cancer cells spread and become deadly. Research like this and many others gives hope for the future. In the last two years scientists have brought screening techniques for pancreatic cancer closer to reality.
The article says that these technologies are not available commercially but progress is expected to increase in the next decade. In the meantime, doctors should consider using CT and MRI scans to screen patients who are at high risk because of family history of the disease. Is that practical or economically feasible? There is no defined protocol for this and there are advantages and disadvantages of using CT or MRI scans as a screening tool in otherwise healthy individuals.
What causes pancreatic cancer? The precise cause is unknown. Smoking and chronic inflammation are suspected in the causation of the disease. An estimated 5-10 percent of pancreatic cancers are inherited and additional 10-20 percent may have other significant genetic influence. Most patients present with jaundice, abdominal pain, weight loss, or no appetite. By that time it is too late.
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