Why Is Pancreatic Cancer Mortality So High
One can identify three main reasons for the dismal prognosis of pancreatic cancer.
A) Disease is diagnosed at a late stage
The only hope of long-term survival in pancreatic cancer is if curative resection can be undertaken. However, since pancreatic cancer patients seldom exhibit disease-specific symptoms until late in the course of the disease, very few patients have resectable disease by the time the diagnosis is made . A proportion of patients thought to be resectable by imaging studies will be found to have metastatic or locally unresectable disease at surgery the proportion varies from 15% to 50% depending on quality of pre-operative imaging . Finally, a subset of patients undergoing curative resection will have positive resection margins , reflecting incomplete resection. Thus, eventually < 10% of pancreatic cancer patients undergo a margin-negative resection.
B) Complete resection is not curative
If resectable disease were curable, the survival of pancreatic cancer could increase ~5-fold. Unfortunately surgery is only palliative in majority of patients undergoing resection the median survival of patients undergoing curative resection is only about 1218 months longer than that of patients with unresectable disease . Thus ineffectiveness of aggressive and apparently complete resection of pancreatic cancer to effect a cure is another contributor to the poor survival in pancreatic cancer.
C) Adjuvant therapy is only palliative
What Is This Study About
The Cancer of the Pancreas Screening program, which began in 1998, is an ongoing study looking at whether screening for pancreatic cancer in high-risk individuals can lead to the diagnosis of early-stage pancreatic cancer when it is most treatable. This study reported on the outcomes for the most recent group of participants in the study, which continues to enroll patients. This study also updated survival outcomes for previous CAPS participants.
What Happens If A Suspicious Lesion Or Cyst Is Present
The quality of abdominal imaging has significantly improved, allowing for better detection of small pancreatic cysts . Some people who have suspicious lesions may need surgery, because they may be precursors to pancreatic adenocarcinoma. Others may benefit from yearly follow-up appointments. The recommended care plan is determined by symptoms and the type, location and size of the lesion .If surgery is necessary, a general surgeon who specializes in pancreatic surgery will remove the lesions. Our general surgeons are highly experienced at performing the full range of pancreatic surgeries, from minimally invasive procedures to complex surgeries such as the Whipple procedure for treatment of pancreatic cancer.
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The Power Of Algorithms
One approach is to use what is called deep learning, a kind of subset of AI that uses algorithms to find patterns in massive amounts of data. Data doesnt just mean numbers, Rosenthal says. It can be anything that we can feed into a computer to help us find those important patterns and potential trends that might tip you off that something is going on with a patient that may be linked to the development or early diagnosis of pancreatic cancer.
At the Mayo Clinic, for example, researchers are building algorithms to systematically identify those at higher risk for pancreas cancer, such as those with a family history of the disease. Scientists at other sites will also look for genetic mutations as well as new onset diabetes. At Dana-Farber a research team is also developing risk assessment models by using deep learning analysis of clinical records and images gathered from large, diverse patient population datasets to identify individuals at highrisk for pancreatic cancer in the general population. These risk models will lead to a practical tool that can identify patients who are at elevated risk for pancreatic cancer and should be enrolled in screening programs for disease prevention and early detection.
All of that might not raise a flag when taken alone, but when taken together based on an algorithm were going to see an important pattern and say lets check this out more and see if theres something going on with the pancreas.
Definition Of Early Pancreatic Cancer
Early pancreatic cancer may be defined based on resectability, size or curability. Here are three definitions in order of decreasing prevalence and increasing survival .
Early Pancreatic Cancer- Definitions
A) Resectable pancreatic cancer
B) Small pancreatic cancer
According to the TNM classification, tumors 20 mm in size are classified as T1. Early pancreatic cancer defined as tumors 20 mm in size is also called small pancreatic cancer . To put this in perspective, the median size of resected pancreatic cancers is 30 mm . Small cancers constitute only ~ 20% of resected pancreatic cancers . In an unpublished series of 300 patients with pancreatic ductal adenocarcinomas who underwent margin-negative resection between 1987 and 2000 at our center, 54 were small . The 5 year survival after resection of small pancreatic cancers in case series and collective reviews has ranged from 30% to 60% , suggesting that detection of small pancreatic cancer will further enhance survival in pancreatic cancer.
C) Curable pancreatic cancer
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Why Is Pancreatic Cancer Hard To Find Early
- The pancreas is deep in the abdomen. Doctors usually cannot see or feel the tumor during a physical exam.
- Pancreatic cancer symptoms are not always obvious and usually develop over time.
- Tests used to diagnose pancreatic cancer do not always detect small lesions, pre-cancers or early-stage cancers well.
- Researchers have had a hard time figuring out which people to screen. Broad screening can cause medical, emotional and financial challenges.
- Doctors use several tests to diagnose pancreatic cancer, but there is no standard, single test.
Progression Of Pancreatic Cancer From Pre
The now famous Vogelgram of pancreatic cancer proposed by Hruban and colleagues plots the histologic and molecular progression of preinvasive stages of pancreatic cancer. However, not much is known about progression of invasive pancreatic cancer. We have tried to recreate, based on published literature, the natural history of pancreatic cancer from its preinvasive stage to its diagnosis and correlate it with symptoms and changes on cross-sectional imaging .
Model of Histologic and Radiologic Progression of Pancreatic Cancer
A) Pancreatic intraepithelial neoplasia I and II
Pancreatic cancer is thought to develop from pre-cancerous precursor lesions called pancreatic intraepithelial neoplasia or PanINs . PanIN lesions do not cause symptoms and are not visible on cross-sectional imaging. In patients with familial pancreatic cancer markedly abnormal pancreatograms with dilated, cystic side branches have been described in patients with dysplasia without invasive cancer , findings that are not seen in sporadic pancreatic cancer.
B) Pancreatic intraductal carcinoma
Also called intraductal carcinoma or carcinoma in situ, progresses to invasive cancer . Only a few cases of resected intraductal carcinoma have been described in literature . These are generally asymptomatic and not visible on conventional imaging studies. However, pancreatic ductal dilation and cutoff may be a radiologic sign of intraductal carcinoma .
C) Minute pancreatic cancer
D) Small pancreatic cancer
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What Kind Of Pancreatic Screening Services Are Available
No universal screening tests for pancreatic cancer in the general population exist yet.
But researchers across the country are studying people who have a high chance of getting pancreatic cancer. Methods to detect cancer in people at increased risk are especially important.
Experts do not know yet when, how or how often high-risk people should be tested. They recommend taking part in studies looking at groups at high risk for pancreatic cancer.
Surveillance studies throughout the country enroll people at high risk. In these programs, doctors check participants for changes in the pancreas.
People at high risk who cannot take part in a surveillance program may get regular imaging scans from a gastroenterologist who specializes in pancreatic cancer. Your doctor can also order a blood test for you that may be able to detect the presence of pancreatic cancer before symptoms arise.
How Do You Detect Pancreatic Cancer Early
Early-stage pancreatic cancer can be difficult to detect for several reasons. First, small tumors may not be seen or felt because the pancreas is located deep within the body. Second, pancreatic cancer usually does not produce noticeable symptoms until it spreads to other organs. Finally, no pancreatic cancer screening test has proven to be effective enough for use in people of average risk. Therefore, the best way to detect pancreatic cancer early is to know the symptoms, such as jaundice and dark-colored urine, and to promptly report anything unusual to a physician.
If youd like to review your pancreatic cancer risks with an oncologist in Moffitt Cancer Centers renowned Gastrointestinal Oncology Program, you can request an appointment with or without a referral. Call or complete our new patient registration form online.
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Pancreatic Cancer Blood Test
Researchers are working on creating an effective screening blood test for early detection of tumor markers associated with pancreatic cancer. The protein CA 19-9 is a tumor marker that can be detected by a blood test however, levels of this protein do not reliably reflect the presence of pancreatic cancer. Doctors may use the test for patients who have symptoms or require assessment while undergoing treatment.
Family History Of Pancreatic Cancer
Patients with a strong family historyan immediate family member or multiple second-degree relativesshould discuss early screening with their doctor, even if there are no symptoms present.
There are certain inherited abnormalities and syndromes that can raise your risk of developing pancreatic cancer. These include mutations in the BRCA2 gene, Lynch syndrome and familial pancreatitis. Once you complete genetic blood testing to identify these abnormalities, you can work with your doctor to plan for additional screening if necessary.
If you believe you have a genetic predisposition to pancreatic cancer, consider asking your doctor to put you in touch with a genetic counselor. A genetic counselor can interpret test results, help you understand your true level of risk and discuss possible next steps.
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Whats The Outlook For Pancreatic Cancer
The outlook for pancreatic cancer depends on factors such as the stage at diagnosis, how well you respond to treatment, and your overall health.
As of 2018, the overall 5-year survival rate for pancreatic cancer was 11% . However, its important to remember that survival statistics are always based on past data.
The 11% statistic is based on people diagnosed with pancreatic cancer between 2011 and 2017. Advances in cancer treatment have been made in the past several years, and its likely that current survival rates are higher.
Is It Hard To Catch Pancreatic Cancer Early
Pancreatic cancer is difficult to diagnose early. Pancreatic cancer very rarely causes early symptoms, and people without an elevated risk for pancreatic risk arent typically screened for cancer.
Often, pancreatic cancer isnt found until symptoms appear unless its found during testing for another, unrelated, condition. As more early-detection tests are developed and become available, this might change, and screening for pancreatic cancer could become standard.
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Blood Tests For Tumor Markers
Tumor markers are substances that are either made by cancer cells or made by your body in response to cancer. Some types of tumor markers can be found in the blood and could indicate the presence of cancer.
The two tumor markers most commonly used to help detect pancreatic cancer are called CA19-9 and CEA. These are proteins that, at higher levels, can be detected in the blood of some people with pancreatic cancer.
However, not everyone with pancreatic cancer has high levels of these proteins. Also, other health conditions can also cause high levels of these proteins.
Clinical Manifestations Of Pc And Impediments Regarding Early Diagnosis
The initial presentation of patients with PC varies depending on the location of the tumor. In about 6070% of cases, the tumor is located in the head of the pancreas, whereas in 2025% of cases it is in the body/tail of the pancreas, and in 5 to 20% of the cases the tumor includes the whole pancreatic body . A study of 185 patients with PC reported the signs and symptoms that these patients have at the time of diagnosis . Table 2 summarizes the main signs and symptoms in pancreatic cancer patients provided by literature data .
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Diagnosis Of Pc In Early Stages
The initial evaluation of a patient with suspicion of PC includes serological evaluation and abdominal imaging. Subsequently, depending on the patients risk factors, clinical presentation, and initial test results, additional laboratory investigations are performed. Among imaging methods used in the diagnosis and staging of PC are ultrasound, endoscopic ultrasound , endoscopic retrograde cholangiopancreatography , CT, MRI, and PET. These techniques allow for the detection of the pancreatic tumor and the assessment of local or remote dissemination of this malignant disease. They can also help estimate the possibility of surgical resection of the tumor. Another use of these techniques is to monitor the post-operative or post-chemotherapy evolution of the patients and as screening methods for PC in high-risk families .
Currently, the most efficient method for certain and early diagnosis of PC is an endoscopic ultrasound . This is used to detect and delineate the extent of pancreatic lesions. It also permits us to obtain a biological sample by an FNA biopsy and microscopic examination. Some of the advantages of using EUS in the diagnosis of PC are:
With the development of new EUS techniques like contrast-upgraded EUS and EUS elastography, the combined use of two or more imaging techniques can contribute to establishing a certain diagnosis .
Gallbladder Or Liver Enlargement
If the cancer blocks the bile duct, bile can build up in the gallbladder, making it larger. Sometimes a doctor can feel this during a physical exam. It can also be seen on imaging tests.
Pancreatic cancer can also sometimes enlarge the liver, especially if the cancer has spread there. The doctor might be able to feel the edge of the liver below the right ribcage on an exam, or the large liver might be seen on imaging tests.
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Am I At Higher Risk Of Pancreatic Cancer
Known risk factors
are anything that increases your chance of getting a disease. Having one or several risk factors does not necessarily mean that you will get pancreatic cancer, and people with pancreatic cancer may not have any of the below risk factors.
- Family history of pancreatic cancer
- Family history of other cancers
- Inherited genetic conditions
Use this risk assessment tool to help you determine your risk.
Worried youre at higher risk? Heres what to do next.
Contact your GP to discuss the risk factors you are concerned about. You can take along a copy of these web pages to help you describe your risk factors.
If you are concerned you are at a higher risk of pancreatic cancer due to genetic factors, including if a first-degree relative has recently been diagnosed with pancreatic cancer, please contact your GP.
It can also be a good idea to speak with a genetic counsellor. Find a genetic counsellor near you through the Human Genetics Society of Australasia website.
Watch our webinar with Genetic Counsellor Tanya Dwarte.
Should people who dont have symptoms get tested?
Screening tests help detect cancer in people who do not have any symptoms. Screening cannot stop you getting cancer, but it can help to find it early when it is much easier to treat. There are useful screening tests for certain types of cancer, such as breast cancer and bowel cancer.
Our Early Detection Initiatives
Since our inception, PanKind has been committed to funding impactful research that furthers the understanding of pancreatic cancer, including projects to detect the cancer earlier and provide better treatment options to improve survival outcomes.
Read more our early detection projects below and click on the links to find out more.
The APGI’s ongoing mission is to further develop the existing world-class resource comprising biological samples and comprehensive information on pancreatic cancer patients from diagnosis onwards, including clinical, genomic and outcome data and to use this resource to improve pancreatic cancer care in the era of personalised medicine. Biospecimens are materials taken from the human body, such as tissue or blood, that can be used for cancer diagnosis and analysis. When patients have a biopsy or surgery often a small amount of the specimen removed can be stored and used for research. Biospecimens contain an extraordinary amount of biological information, written in the language of cells, genes and proteins. Researchers can then frame questions that will be answered by looking at these biospecimens, for example, they often use the biospecimen to identify the biological characteristics of cancer cells over time, and then correlate those patterns with the clinical picture – and investigate how different patients experience progression of the disease.
A novel agent for imaging and treatment of pancreatic cancer
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How Is Pancreatic Cancer Typically Diagnosed
In addition to blood tests, other tests play an important role in diagnosing pancreatic cancer.
Imaging tests help your doctor look for signs of cancer in your body. A variety of imaging tests may be used, including:
- CT scan:CT scans use X-rays to make cross-sectional images of your body. When pancreatic cancer is suspected, a special type of CT scan called a multiphase CT scan is often used.
- MRI scan: An MRI scan makes an image using strong magnets and radio waves. While CT scans are typically the standard imaging for pancreatic cancer, MRI scans may sometimes also be used.
- PET scan:PET scans use a special radioactive marker that localizes to cancer cells. These cells are then detected using a specialized camera. It can be combined with a CT scan to better understand how far the cancer has spread.
- Ultrasound:Ultrasound uses sound waves to make images of the inside of your body. A type of ultrasound called an endoscopic ultrasound can help diagnose pancreatic cancer.
- Cholangiopancreatography: A cholangiopancreatography is a type of imaging procedure that can help your doctor find tumors that may be blocking ducts in and around the pancreas.
Another important test for pancreatic cancer is a tissue sample, or biopsy, thats collected from the affected area and is checked for cancer cells. If cancer is present, further tests can help better characterize the cancer.
- blood clots, which often affect the large veins in the leg
- new-onset diabetes or worsening of existing diabetes
