What Are The Risk Factors For Pancreatic Cancer
The average lifetime risk of developing pancreatic cancer is about 1 in 64. A risk factor is something that raises the chance that you will get a disease. There are risk factors that are a result of behavior and that can be changed. For pancreatic cancer, these types of risk factors include:
- Smoking cigarettes, cigars and using other forms of tobacco.
- Obesity is also a risk factor. Carrying weight around the waist is a risk factor even if you do not have obesity.
- Having diabetes, especially type 2 diabetes, which is linked to obesity. The new development of diabetes at an older age and in someone with a normal weight or body mass index could be a sign of pancreatic cancer.
- Being exposed to chemicals used by dry cleaners and metal workers.
- Having chronic pancreatitis, a permanent inflammation of the pancreas usually associated with smoking and drinking a lot of alcohol.
There are also risk factors that you cant change. These include:
- Hereditary chronic pancreatitis due to gene changes passed from parent to child.
- Hereditary syndromes with gene changes in genes such as BRCA genes passed from parent to child.
- Being older than 45.
- Being of Ashkenazi Jewish descent.
Your healthcare provider might suspect pancreatic cancer if you have certain symptoms or if youve recently developed diabetes or pancreatitis.
Pancreatic Cancer Stage 0
This is the earliest stage of pancreatic cancer, though it may not necessarily involve cancer. It just means that abnormal cells have been detected, and they could potentially become cancerous in the future. This stage doesnt involve any symptoms.
Treating pancreatic cancer involves two main goals: to kill cancerous cells and prevent the cancer from spreading. The most appropriate treatment option will depend on the stage of the cancer.
The main treatment options include:
- Surgery. Surgical treatment of pancreatic cancer involves removing portions of the pancreas . While this can eliminate the original tumor, it wont remove cancer thats spread to other areas. As a result, surgery usually isnt recommended for advanced-stage pancreatic cancer.
- Radiation therapy. X-rays and other high-energy beams are used to kill cancer cells.
- Chemotherapy. Anticancer drugs are used to kill cancer cells and help prevent their future growth.
- Targeted therapy. Medications and antibodies are used to individually target cancer cells without harming other cells, which can happen with chemotherapy and radiation therapy.
- Immunotherapy. Various methods are used to trigger your immune system to target the cancer.
In some cases, a doctor might recommend combining multiple treatment options. For example, chemotherapy might be done before surgery.
For advanced-stage pancreatic cancer, treatment options might focus more on pain relief and keeping symptoms as manageable as possible.
Comparisons Of The Survival Curves
PCSS was calculated to assess the survival of patients with PC. The median PCSS in each age group was 36.0, 10.0, 8.0, and 4.0 months, respectively. The five-year PCSS of patients aged 2040 years was about 1.5 times higher than that of patients aged 4060 years and 2 times higher than that of patients aged 6080 years , indicating that the frequency of PCSS reduced with increasing age. As is shown in Fig. 1B,C, race did not affect the trend of low PCSS with age. A prominent trend was that PCSS decreased with age in women, whereas male patients tended to show PCSS when they were aged > 40 years . The five-year PCSS in female patients was 54.4%, 20.7%, 13.4, and 7.5% in the four age groups, respectively, whereas in male patients, the PCSS was 34.6%, 14.1%, 14.1%, and 10.7%, respectively.
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How Can I Prevent Pancreatic Cancer
We dont know what actually causes pancreatic cancer, so its difficult to know how to prevent it. However, you can change your day-to-day behaviors to become healthier. These tips may help reduce the risk of getting pancreatic cancer:
- Dont smoke. If you do smoke or use tobacco in any form, try to quit.
- Try to reach and maintain a normal weight by eating healthy and exercising.
- Drink alcohol in moderation, or quit drinking altogether.
- Try to avoid getting diabetes. If you have it, control your blood sugar levels.
- Use safety equipment if your work exposes you to toxins.
Some People Want To Know How Long They May Have Left To Live This Is Called Your Prognosis Outlook Or Life Expectancy
The prognosis will be different for each person, and depends on several things. These include how far the cancer has spread, your general health, and what treatments you can have.
You may not want to know your prognosis. Its up to you whether you find out or not. But if you want to know, talk to your doctor or nurse. They wont be able to give you an exact timeframe, as everybody is different. But they should be able to give you an idea of what to expect.
There is a lot of information about pancreatic cancer online and not all of it is accurate or relevant to you. So its important to speak to your doctor about your own situation.
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What Are The Survival Rates For Advanced Pancreatic Cancer
The one year survival for stage 4 pancreatic cancer in England is 8%. This means 8 out of 100 people will be alive, one year after their diagnosis. Stage 4 cancer is known as advanced or metastatic cancer. This means the cancer has spread outside the pancreas to other parts of the body, and surgery to remove it isnt possible. Advanced cancer can sometimes grow and spread quickly.
If you are well enough, you may be offered chemotherapy. Chemotherapy will not cure the cancer, but it may help you to live longer. It may also help treat your symptoms. But it can cause side-effects, which can affect how you feel. You can also have other treatments to manage any symptoms.
Remember that these statistics are general figures. Speak to your doctor about your own prognosis if you want to know this.
Remember that these statistics are general figures. Speak to your doctor about your own prognosis if you want to know this.
What Questions Should I Ask My Healthcare Provider
Develop an open and cooperative relationship with your healthcare provider. Take a list of questions with you so you remember to get the answers you need to live your best life. These questions might include:
- What stage is the cancer? What does this mean for me?
- What are my treatment options? Which do you recommend and why?
- What side effects might I develop as a result of treatment?
- Is genetic testing right for me?
- Am I able to be a part of a clinical trial?
- Will I be able to keep working and doing the things that I need or want to do every day?
- Are there situations in which I need to call you immediately or get emergency care?
- Can you tell me where to find financial support?
- Can you tell me where to find emotional support?
- What should I do to stay as healthy as I can?
Make sure to follow the plan that you and your provider agree on. Keep to the schedule of follow-up appointments and testing.
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How Is Pancreatic Cancer Treated
Pancreatic cancer treatment depends on certain things, including where the tumor is located, what stage it is in, how healthy you are and whether or not the cancer has spread beyond the pancreas. Treatment options include:
- Surgical removal: The cancerous part of the pancreas is removed. Lymph nodes near to the pancreas may also be removed. The surgery to remove the pancreas or part of the pancreas is called a pancreatectomy. If your tumor is located in the head of the pancreas, your provider may recommend the Whipple procedure. This surgical method removes the head of the pancreas, the duodenum , the gallbladder, a portion of the bile duct and nearby lymph nodes.
- Radiation therapy: High-speed energy used to kill the cancer cells.
- Chemotherapy: This method uses drugs that kill cancer cells.
- Immunotherapy: Treatment to help your body fight the cancer. Immunotherapy has largely been ineffective against pancreatic cancer, but about 1% of people with pancreatic cancer and a specific genetic change may benefit from it.
- Targeted therapy: Directed at certain genes or proteins that help cancer grow. Genetic testing is generally how we determine if a targeted therapy is right for you.
- Clinical trials: Talk to your healthcare provider about whether participating in a clinical trial might be an option.
Other things to know about treatment:
Anatomic Site Functional Performance Status
The anatomic distribution of all stages of pancreatic cancer and MPC are detailed in Figure 2. Of note, while the head of the pancreas constitutes 6,506 cases of all cancers identified, only 2,656 cases originated at this site among patients with MPC. The tail of the pancreas constituted 4.6% more cases of MPC compared to pancreatic cancer at all stages.
Figure 2
The functional performance status as calculated by the ECOG-PS score is shown in Figure 3 for all stages. The other established system of ranking performance status, the Karnofsky Performance Status was used in a negligible number of charts. The functional status appears to trend down as the stage at diagnosis advances. For example, 36.41% of stage I patients have a functional ECOG-PS score of 0 while only 20% of stage IV patients have an ECOG-PS of 0. For stage I patients, 7.04% of patients had an ECOG-PS score of 3, and 14.39% of patients diagnosed at stage IV had this ECOG-PS score.
Figure 3
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Questions You May Want To Ask Your Doctor Or Nurse
- Do I have any more treatment options?
- How long do I have left to live?
- How accurate is my prognosis?
- Should I get a second opinion?
- I dont want to know my prognosis, but can you tell me how my cancer will change?
- What symptoms will I have? How can symptoms be managed?
- What difference will it make to how well I feel if I decide to have chemotherapy? What happens if I dont have chemotherapy?
- What are the benefits of having treatment?
- Are there any risks from treatment?
- If I dont have chemotherapy, are there other treatment options?
- Is there anything I can do to help me live longer?
- Can you speak to my family about my future if I give my permission?
- If I dont want to know my prognosis but my family do, can you speak to them in confidence, if I give my permission?
Advances In Systemic Adjuvant Therapy: Chemotherapy And Targeted Therapy
Systemic therapy is treatment directed at destroying cancer cells throughout the body. Because patients with pancreatic cancer have small amounts of cancer that have spread away from the pancreas, an effective systemic treatment is needed to cleanse the body of micrometastases in order to improve a patients duration of survival and potential for cure.
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How Is Pancreatic Cancer Diagnosed
Its difficult to detect pancreatic cancer in the early stages. This is because healthcare providers cannot feel the pancreas in a routine exam. If your provider suspects that you may have pancreatic cancer, they may order imaging tests to take pictures of the internal organs. An endoscopic ultrasound can also be done.
An endoscopic ultrasound is a thin tube with a camera at the tip that is passed through the mouth and into the stomach. The ultrasound probe at the end of the endoscope allows imaging of the pancreas through the stomach wall. If necessary, an ultrasound-guided biopsy from the pancreas can be obtained during the procedure.
A blood test can find a substance called a tumor marker. For pancreatic cancer, high levels of carbohydrate antigen 19-9 a type of protein released by pancreatic cancer cells might indicate a tumor.
Everyone who is newly diagnosed with pancreatic cancer should talk to their doctor about doing genetic counseling and testing to see if there is a hereditary reason they developed pancreatic cancer. This is based on recommendations from two of the largest cancer organizations, the National Comprehensive Cancer Network and the American Society of Clinical Oncology .
Borderline Resectable Pancreatic Cancer
Depending on the location of stage 2A, stage 2B and stage 3 pancreatic cancers, treatment often involves resection in combination with neoadjuvant treatment to shrink the tumor before surgery takes place. Borderline resectable pancreatic cancer has grown into nearby tissues, organs or a major blood vessel. Although it may be possible to remove the tumor, surgeons may not be able to extract all of the cancer via surgery. Adjuvant treatment via chemotherapy or radiation may be performed after surgery to help destroy remaining cancer cells.
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Survival Rates For Pancreatic Cancer
Survival rates can give you an idea of what percentage of people with the same type and stage of cancer are still alive a certain amount of time after they were diagnosed. They cant tell you how long you will live, but they may help give you a better understanding of how likely it is that your treatment will be successful.
Keep in mind that survival rates are estimates and are often based on previous outcomes of large numbers of people who had a specific cancer, but they cant predict what will happen in any particular persons case. These statistics can be confusing and may lead you to have more questions. Your doctor is familiar with your situation ask how these numbers may apply to you.
Study Subjects In Taiwan As The Identification Set
The flowchart in Fig. 1a illustrates the inclusionexclusion criteria in this study. First, only patients with PDAC were retained, resulting in 578 patients being excluded due to different histological types. These were 457 patients with pancreatic neuroendocrine tumor and 121 patients with histological types other than PDAC. Only ICD codes C25.03 and C25.79 were included in this study. Second, we excluded patients with palliative bypass surgery or diagnostic surgery and patients who were not stage 3 disease . Third, patients receiving other treatments before the surgery, such as neoadjuvant radiation therapy and neoadjuvant chemotherapy, were removed to reduce the heterogeneity . Lastly, only 701 patients with definite surgery information and clear clinical variables, including tumor size and stage information, were analyzed . This study has been approved by the institutional review boards of National Taiwan University Hospital .
Fig. 1
Patient selection and exclusion criteria utilized for datasets: a Taiwan Cancer Registry database, and b SEER database
The authors thank Melissa Stauffer, PhD, for editing the manuscript.
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Factors May Extend Survival In Advanced Pancreatic Cancer
A new Mayo Clinic study suggests that some patients with pancreatic cancer could increase survival with adjustments to their chemotherapy regimen before surgery.
Historically, most patients with pancreatic cancer whose tumors grow outside the pancreas to encompass veins and arteries have been told the cancer is inoperable and they should prepare for an average survival time of 12 to 18 months.
However, a newly published Mayo Clinic study finds that a presurgery treatment plan focused on three chemotherapy-related factors can extend life years beyond that average. The findings were published in the Annals of Surgery, the journal of the American Surgical Association and the European Surgical Association.
The study followed 194 Mayo Clinic patients who received chemotherapy followed by radiation and surgery. An average survival time of 58.8 months, or just under five years, was achieved.
The researchers found that patients who had three factors experienced significantly longer survival times than those who didn’t have these factors:
- Extended chemotherapy before surgery the more cycles they had, the longer the survival
- A CA 19-9 tumor marker that fell to a normal level after chemotherapy
- A tumor that, when surgically removed, was found to be completely or mostly dead due to chemotherapy
The Mayo Clinic study refutes that conventional wisdom.
Pancreatic Cancer Stage 4
Stage 4 pancreatic cancer has spread beyond the original site to distant sites, like other organs, the brain, or bones.
Pancreatic cancer is often diagnosed at this late stage because it rarely causes symptoms until it has spread to other sites.
Symptoms you might experience at this stage include:
- pain in the upper abdomen
- pain in the back
Stage 3 pancreatic cancer is difficult to cure, but treatments can help prevent the spread of the cancer and ease symptoms. These treatments may include:
- surgery to remove a portion of the pancreas
- anticancer drugs
- radiation therapy
The majority of people with this stage of the cancer will have a recurrence. Thats likely due to the fact that micrometastases, or small areas of undetectable cancer growth, have spread beyond the pancreas as the time of detection and arent removed during surgery.
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How Is The Survival Rate Determined
For the five-year survival rate, SEER uses data from different areas throughout the country. When SEER was first developed, there were nine places that data were gathered from, making up the SEER-9 database.
SEERs database has grown to 18 regions now, called SEER-18. But, they continue to use the SEER-9 data as the benchmark to compare survival rate trends over time.
To get the five-year survival rate, numbers must be analyzed over a range of time. This means that the patients included in the analysis received treatment and care that may be different from today. Knowledge and treatment have improved in recent years.
There are many other ways to look at survival. Besides the five-year survival rate, people also measure:
- Overall survival: the length of time from diagnosis to a patients death
- Progression-free survival: how long a person stays on a treatment without their disease getting worse
- Disease-free survival: the amount of time a person is believed to be cancer-free, also known as no evidence of disease
These other survival measurements are often used to judge success of clinical trials.
