Variation In Pancreatic Cancer Treatment And Care
Depending on where someone diagnosed with pancreatic cancer receives care, their experience can be very different there can be different diagnostic pathways, different standards of care and different approaches to treatment.
Geographically, variation in treatment and care exists at all levels. There is international survival variation across developed countries, regional treatment variation across Cancer Alliances, and local variation in clinical practice between hospitals.
How Are Survival Rates Determined
In the United States, cancer survival rates are calculated with data collected by the National Cancer Institutes Surveillance, Epidemiology, and End Results program. SEER collects data on all types of cancers from different geographical locations and sources throughout the country. While it is not yet feasible to obtain data for every single patient in the U.S., SEER data covers large proportions of the countrys population and can be statistically analyzed to make reasonably accurate estimates of overall cancer survival rates.
The SEER program began collecting cancer data in 1973 in seven cancer registriessystems for collecting and managing cancer datarepresenting five states and two metropolitan areas. Since then, more registries representing different geographical locations have been added, and to date, 21 registries have collected cancer data through SEER. Different databases represent groups of these registries in different combinations used to analyze survival data and other statistics.
Sometimes survival rates vary slightly based on the SEER database used. For example, pancreatic cancer five-year survival is reported to be 10% when using the SEER 9 database which contains 9 registries and represents about 9% of the U.S. population, but it is reported to be 9% when using SEER 18, which contains 18 registries and represents about 28% of the population.
Relationship Between Prognosis And Treatment
Crino et al., reported that endoscopic ultrasound-guided fine-needle biopsy demonstrated high diagnostic accuracy in evaluating solid pancreatic lesion independently, meanwhile, in patients with unresectable PC, tissue biopsy samples are the only available histological material. In addition, repeated EUS-FNB after neoadjuvant chemotherapy may detect therapy-induced molecular changes, for example, mutation in KRAS . Therefore, high-quality histological samples obtained by EUS-FNB will provide the basis for individualized treatment of PC .
A POPF is considered one of the common complications after pancreatic surgery, with an incidence of 3%-45% . A retrospective analysis showed that pancreatic fistula was an independent risk factor for peritoneal recurrence . Pancreatic fistula was an independent prognostic factor after multivariate analysis . There is a significant correlation between the occurrence of POPF and higher postoperative mortality. The main reason is that the leaked pancreatic juice erodes the surrounding tissues, causing complications such as secondary intra-abdominal hemorrhage and infection . Our results also show that patients with POPF had a significantly shorter mOS than those without POPF. High-quality pancreaticojejunostomy performed by professional pancreatic surgeons and routine use of somatostatin after surgery are the key to reducing POPF and improving survival ..
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Potentially Curable If Caught Very Early
Despite the overall poor prognosis and the fact that the disease is mostly incurable, pancreatic cancer has the potential to be curable if caught very early. Up to 10 percent of patients who receive an early diagnosis become disease-free after treatment. For patients who are diagnosed before the tumor grows much or spreads, the average pancreatic cancer survival time is 3 to 3.5 years.
Why Is This Study Important
Experts predict that pancreatic cancer will be the second most common cause of cancer death in the United States by 2026. The 5-year survival rate for people diagnosed with pancreatic cancer is low, due in part to late-stage diagnoses.
Pancreatic ductal adenocarcinoma is the most common type of pancreatic cancer. It is seldom found at a treatable stage because people usually experience symptoms only with advanced disease. Few studies have been conducted to understand how pancreatic cancer screening affects diagnosis and survival outcomes for high-risk individuals the limited studies that have been done produced promising results.
This study confirms the findings of previous studies that show screening can lead to diagnosis of early- pancreatic cancer and increased survival. These results will likely change pancreatic cancer screening guidelines for high-risk people. The American Society for Gastrointestinal Endoscopy released a new guideline in early 2022 that recommends pancreatic cancer screening for high-risk people because screening was associated with earlier detection, better survival outcomes and fewer adverse events.
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What Are The Pancreatic Cancer Survival Rates
With that in mind, here are some of the most recent statistics regarding the survival rates of pancreatic cancer:
- The overall five-year survival rate for Pancreatic cancer is 7.2%
- Looking only at pancreatic cancers that have not spread beyond the pancreas , the survival rate is 27.1%.
- For cancers that have spread, but only to nearby areas , the survival rate is 10.7%.
- For cancers that have spread beyond that , the survival rate is 2.4%
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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Stage 4 Pancreatic Cancer Symptoms
One reason that pancreatic cancer gets diagnosed late is that it can be easy to miss the signs. A person may not know that they have cancer because they do not feel sick. Even if they do have symptoms, they might not bother them much.
The symptoms of pancreatic cancer usually do not start until the cancer cells have gotten into other organs. The intestines are often one of the first places cancer goes. It can also go to the liver, lungs, bones, and even the brain.
Once cancer goes to other parts of the body, a person can start to feel very sick. They can also have serious medical conditions, such as:
The Effects Of Tumor Location Peripancreatic Invasion Lymph Node Metastasis Hepatic Metastasis And The Number Of Distal Organ Metastasis On Prognosis
Our study found that PHC accounted for 66.1% and PBTC accounted for 33.1%, which is similar to a study . They found that the vast majority of PC are in the head, while 20% to 25% are located in the body/tail. Some studies have suggested that the location of pancreatic tumors is a potential determinant of survival . A study found that the survival time of patients with PBTC is shorter than that of patients with PHC. In our study, we found that the mOS of the PHC subgroup was significantly longer than that of the PBTC subgroup . Generally, tumors in the body/tail are found later until they present significant clinical symptoms. At this point, the tumors often infiltrate adjacent organs or vascular structures and possibly metastasize to locoregional lymph nodes via lymphatic vessels or distant organs via hematogenous dissemination . However, tumors located in the head of the pancreas were more likely to compress the common bile duct, resulting in obstructive jaundice, which can be detected promptly .
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Why Is Early Detection Important
Patients whose disease is diagnosed in its earlier stages have better outcomes. This is due to a greater likelihood that they are eligible for surgery.
The Pancreatic Cancer Action Network and others are working to find pancreatic cancer earlier through:
- Awareness of symptoms
- Studies focused on biomarkers
- Efforts to improve imaging techniques
- Efforts to improve the identification and monitoring of people at higher risk for the disease
Survival For Pancreatic Cancer
Pancreatic cancer is often diagnosed at an advanced stage. Your outlook is better if your cancer hasn’t spread and you can have surgery to remove it.
Survival depends on many factors. No one can tell you exactly how long you will live.
Below are general statistics based on large groups of people. Remember, they cant tell you what will happen in your individual case.
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Pancreatic Cancer Screening In Caps Study
The CAPS study enrolled 1,461 people who were at high risk for pancreatic cancer. High-risk participants included individuals with inherited mutations in BRCA1). It is important to note that other than participants with inherited mutations in CDKN2A and STK11, all gene carriers also had a family history of pancreatic cancer PDAC in at least one first-degree relative and one-second degree relative .
Participants in the CAPS studies had yearly imaging of their pancreas with either an endoscopic ultrasound or MRI/MRCP. EUS involves passing an endoscope, a tube-like instrument with a light and a lens for viewing and an attached ultrasound probe down the esophagus to the stomach. This allows doctors to look closely at the pancreas . EUS is performed as an outpatient procedure under light anesthesia.
Participants also had a type of MRI imaging known as MRCP every two years. An MRCP is a special type of MRI that helps visualize the liver, gall bladder, pancreas and their ducts.
Although not used in this study, another type of screening, endoscopic retrograde cholangiopancreatography, or ERCP, can also be used. During an ECRP, an endoscope, is passed through the mouth and down into the first part of the small intestine. A smaller tube is then inserted through the endoscope into the bile and pancreatic ducts. A dye is injected through the catheter into the ducts, and images are taken.
Pancreatic Cancer Survival Rates
Pancreatic cancer survival rates are based on groups, but you are an individualand every patients situation is unique. The National Cancer Institutes Surveillance, Epidemiology, and End Results Program tracks five-year survival rates for all types of cancer based on data from previous patients and sometimes older treatments.
Based on people diagnosed with prostate cancer between 2011 and 2017, SEER data shows:
- Localized prostate cancer that is contained within the pancreas has a five-year relative survival rate of 41.6 percent.
- Regional cancer that has spread from the pancreas into nearby parts of the body, such as the lymph nodes, has a five-year relative survival rate of 14.4 percent.
- Distant cancer that has spread to farther parts of the body, such as the liver or lungs, has a five-year relative survival rate of 3 percent.
- The overall five-year relative survival rate for pancreatic cancer is 10.8 percent.
Its important to remember that survival rates are constantly improving, so patients diagnosed now typically have better outcomes than those diagnosed in the past.
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Pancreatic Cancer Survivor: Whipple Procedure Made Me Cancer
When I was diagnosed with stage III pancreatic cancer in January 2017, I was pretty shocked. Both of my parents died of heart disease in their 50s. So, Id grown up looking out for that, along with diabetes and hypertension, which also run in my family.
At the time of my diagnosis, I was 53, and I didnt know anything about pancreatic cancer. I just wanted it out of me. Today, I am cancer-free, thanks to a second opinion and a successful surgery at MD Anderson. Im very grateful to be alive, but I wish now that Id gone to MD Anderson first.
Why I went to MD Anderson for pancreatic cancer treatment
I went to MD Anderson about a year after starting treatment near my home outside of Dallas. The surgeon there thought he could remove the tumor easily. But when he went in to take the cancer out, he took one look and sewed me right back up.
He said the tumor itself was fairly small, but it had tendrils wrapped around a critical artery. Those made it too dangerous to remove, in his opinion. So, I had seven months of chemotherapy and five weeks of radiation therapy, to try to shrink it instead.
I decided to seek a second opinion after finishing radiation, because my oncologist told me the new plan was to just keep giving me chemotherapy until I couldnt stand it anymore. By then, I already had neuropathy in my hands and feet so bad that I often needed a wheelchair to get around. So, that didnt sound very good to me.
My pancreatic cancer treatment
What Stage 4 Pancreatic Cancer Means
Doctors use stages when they talk about how cancer has grown or spread. Stage 4 is the last stage. It means that cancer cells have spread to other parts of the body. When this happens, cancer is called metastatic.
One way to stage cancer is called the TNM system. It has 3 parts:
- T : This part is based on how big a tumor is and where it has spread to. The T rating goes from T0 to T4. In stage 4 pancreatic cancer, the primary tumor can have any T rating.
- N : Lymph nodes help filter substances in the body. When cancer cells get to the lymph nodes, it’s easier for them to spread. Stage 4 pancreatic cancer can have an N rating of N1 or N2 .
- M : Metastasis means cancer has spread to other organs and lymph nodes. There are only two M stages: M0 or M1. Any pancreatic cancer with an M1 rating is at stage 4.
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How Is Pancreatic Cancer Staged
Pancreatic cancer is usually staged differently than other types of cancers. While many cancers are staged using the TNM system, which categorizes tumors based on diagnostic tests and classifications that happen during surgery, many patients with pancreatic cancer dont have surgery, so the TNM system isnt used as often to stage these diseases.
Instead, pancreatic cancer tumors are more often classified into one of four categories based on where they have spread and whether theyre able to be removed during surgery. The categories are as follows:
This type of cancer hasnt spread outside the pancreas or has only gone just past it. Resectable cancer can be removed by surgery.
With this type of pancreatic cancer, the tumor may, when first diagnosed, appear to be too difficult to remove surgically. However, surgery may still be an option if the tumor can be reduced in size through radiation therapy or chemotherapy treatment.
Locally advanced cancer has spread just beyond the pancreas and may have reached nearby arteries, veins or organswhich means surgery is not an option. However, it hasnt spread into more distant areas of the body.
Metastatic cancer has spread beyond the pancreas into distant areas of the body, such as the liver, abdomen or lungs. If youve been diagnosed with pancreatic cancer, your care team will let you know the stage of your cancer, along with what it means for your treatment plan.
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.
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Survival Analysis And Comparison Of Different Operation Procedures In Resectable Or Borderline Resectable Pc Patients With Hepatic Metastasis Only
Survival analysis was performed on 52 resectable or borderline resectable PC patients with hepatic metastasis only. The overall 1-, 3-, and 5-year survival rates of the 52 patients were 12.8%, 6.4%, and 0%, respectively, and the mOS was 5.2 months . The overall 1-, 3-, and 5-year survival rates of patients undergoing radical resection were 22.2%, 11.1%, and 0%, respectively, and the mOS was 4.4 months . The overall 1-, 3-, and 5-year survival rates of patients who did palliative bypass operation were 9.1%, 0%, and 0%, respectively, and the mOS was 6.0 months . The overall 1-, 3-, and 5-year survival rates of patients who did not undergo surgical were 5.6%, 0%, and 0%, respectively, and the mOS was 5.0 months . There was no statistically significant difference between the different operative procedures .
Results Of Univariate And Multivariate Analyses
In the univariate analysis, stratification factors, such as race, sex, year of diagnosis, pathological grade, AJCC stage, historic stage, tumour location, and age were used to evaluate PCSS and calculate the five-year PCSS. All of these factors, except sex, were significantly associated with PCSS .
In multivariate analysis, all significant stratification factors were included in the Cox model . Race and sex were not found to be prognostically important for assessing the survival of PC patients. Additionally, recent diagnosis of PC was found to be associated with a better survival than diagnosis in previous years. Undoubtedly, PC patients with tumours of higher grades had a higher risk of death than did those with tumours of pathological grade I/II. Likewise, advanced PC patients in stage III/IV or with distant organ involvement had a much poorer prognosis than did those outside this grouping. Compared with tumours in the head, tumours localized in the body and tail of the pancreas appeared to be associated with a favourable prognosis. Finally, the mortality risk of PC patients aged between 40 and 80 years was twice that of the patients aged below 40 years. However, patients aged > 80 years had a mortality risk three times higher than that of patients aged < 40 years. Therefore, age was an independent factor for predicting the prognosis of PC patients.
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