Pancreatic Cancer Stage 4 Prognosis

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Stage 4 Pancreatic Cancer Life Expectancy

Stage IV Pancreatic Cancer

Pancreatic cancer is known as a type of cancer that originates within the pancreas. Much like other forms of cancer, pancreatic cancer progresses into several different stages, which often indicate the progression of the severity of the disease. In most cases, pancreatic cancer that has progressed past a certain stage becomes fatal.

Types Of Pancreatic Cancer

The most common type of pancreatic cancer is pancreatic adenocarcinoma. Most of the pancreas is made up of exocrine cells. Exocrine glands produce pancreatic enzymes to break down fats from food. Abnormal growth of exocrine cells causes a pancreatic exocrine tumor. Pancreatic Adenocarcinoma makes up 95% of pancreatic cancer cases.

Endocrine cells, on the other hand, are less common in the pancreas but have very important functions. It controls the sugar level in the blood by producing insulin and glucagon hormones. Uncontrolled growth of these cells causes a pancreatic neuroendocrine tumor. In addition to these two common pancreatic cancers, there are also less common types. These types are listed below:

  • Ampullary cancer
  • Undifferentiated carcinomas

What Is A 5

A relative survival rate compares people with the same type and stage of pancreatic cancer to people in the overall population. For example, if the 5-year relative survival rate for a specific stage of pancreatic cancer is 50%, it means that people who have that cancer are, on average, about 50% as likely as people who dont have that cancer to live for at least 5 years after being diagnosed.

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What Causes Pancreatic Cancer

Pancreatic cancer is believed to be caused by genetic changes , however, the exact cause for these mutations is unknown. Risk factors for developing pancreatic cancer include:

  • This is one of the most common causes of pancreatic cancer
  • About 25% of pancreatic cancers are thought to be caused by cigarettesmoking
  • The risk of developing pancreatic cancer is about twice as high among smokers compared to those who have never smoked
  • Being overweight or obese
  • People with a body mass index of 30 or more are about 20% more likely to develop pancreatic cancer
  • Gaining weight as an adult
  • Carrying extra weight around the waistline even in people who are not overweight
  • Workplace exposure to certain chemicals such as those used in the dry cleaning and metal working industries
  • About two-thirds of patients are at least 65 years old
  • The average age at diagnosis is 70
  • Gender: men are slightly more likely to develop pancreatic cancer than women
  • Race: African Americans are slightly more likely to develop pancreatic cancer than whites
  • Signs That Pancreatic Cancer Has Spread

    Chemotherapy For Pancreatic Cancer Stage 4

    If your pancreatic cancer has spread, you may notice new symptoms. Most often, pancreatic cancer spreads to the liver, but it can also move into the lymph nodes, abdomen, lungs and, sometimes, the bones.

    Advanced pancreatic cancer symptoms may include:

    • General feeling of being unwell
    • Swollen stomach caused by fluid buildup
    • Lack of appetite

    If you experience any of these symptoms, check with your doctor to determine a cause. Also, keep in mind that these symptoms may be due to other conditions.

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    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:

    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.

    Where Do These Numbers Come From

    The American Cancer Society relies on information from the SEER* database, maintained by the National Cancer Institute , to provide survival statistics for different types of cancer.

    The SEER database tracks 5-year relative survival rates for pancreatic cancer in the United States, based on how far the cancer has spread. The SEER database, however, does not group cancers by AJCC TNM stages . Instead, it groups cancers into localized, regional, and distant stages:

    • Localized: There is no sign that the cancer has spread outside of the pancreas.
    • Regional: The cancer has spread from the pancreas to nearby structures or lymph nodes.
    • Distant: The cancer has spread to distant parts of the body such as the lungs, liver or bones.

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    The Progression Of Stage 4 Pancreatic Cancer

    Stage 4 pancreatic cancer, in particular, is the stage of pancreatic cancer where the cancer has already spread to several distantly located places within the body. It may also affect organs that are close to one another. At this point, pancreatic cancer may affect the lungs and/or liver, in addition to the stomach, bowels and spleen, from the starting point at the pancreas.

    Patients with stage 4 pancreatic cancer are often classified into two groups, which both indicate how the pancreatic cancer has spread throughout the body.

    Group A Patients These patients often have pancreatic cancer thats spread to localized areas, such as nearby organs and blood vessels. This is often known as localized pancreatic cancer.

    Group B Patients These patients often have pancreatic cancer that had already spread to several distantly spaced organs within the body, in most cases, the lungs. This is often known as metastatic pancreatic cancer.

    Stage 4 pancreatic cancer is considered fatal, thanks to the very nature of the cancer spreading to adjacent organs. Many of the symptoms start once the pancreatic cancer starts spreading to the organs of the body.

    Common symptoms often include jaundice , abdominal pain and a loss of appetite/weight loss or vomiting .

    What Are The Stages Of Pancreatic Cancer

    Surviving Pancreatic Cancer

    Pancreatic cancer is categorized into five different stages. Your diagnosis depends on the size and location of the tumor and whether or not the cancer has spread:

    • Stage 0: Also known as carcinoma in situ, Stage 0 is characterized by abnormal cells in the lining of the pancreas. The cells could become cancerous and spread to nearby tissue.
    • Stage 1: The tumor is in the pancreas.
    • Stage 2: The tumor is in the pancreas and has either spread to nearby tissues, organs or lymph nodes.
    • Stage 3: The cancer has spread to major blood vessels near the pancreas. It may have also spread to nearby lymph nodes.
    • Stage 4: In stage 4 pancreatic cancer, the cancer has spread to distant areas in the body, such as the liver, lungs or abdominal cavity. It has possibly spread to organs, tissues or lymph nodes near the pancreas.

    Be sure to talk with your provider about your situation. Understanding your pancreatic cancer prognosis can help you make an informed decision about your treatment.

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    Pancreatic Cancer Stage 2

    Stage 2 pancreatic cancer is cancer that remains in the pancreas but may have spread to a few nearby lymph nodes or blood vessels.

    This stage is divided into two subcategories, depending on where the cancer is and the size of the tumor:

    • Stage 2A. The tumor is larger than 4 centimeters but hasnt spread to any lymph nodes or nearby tissue.
    • Stage 2B. The tumor has spread to nearby lymph nodes, but not to more than three of them.

    Symptoms of stage 2 pancreatic cancer tend to be very subtle and may include:

    • targeted drug therapies

    Your doctor may use a combination of these approaches to help shrink the tumor and prevent possible metastases.

    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.

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    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.

    What Are Some Reasons To Be Optimistic About The Future

    Treatment and survival rates of stage IV pancreatic cancer at VA ...

    There has been great progress in pancreatic cancer research and treatment. First, we are getting significantly better at giving standard treatments. Last year, a study showed that a combination of four chemotherapy drugs given after surgery could extend overall survival to nearly five years. This applies only to a particular group of patients, but it might be possible to replicate this success for other groups.

    We also are learning that targeted therapies could be helpful in subsets of people with pancreatic cancer. A class of drugs known as PARP inhibitors has shown promise in treating certain pancreatic tumors in people with inherited mutations in the BRCA genes. These are the same genes that have been linked to hereditary breast and ovarian cancer, and PARP inhibitors have shown they can be effective against these cancers.

    Overall, people today have many more options than they did ten years ago. Even if standard therapies stop working, there are more treatment choices and clinical trials available. For the first time in a long while, there is a real belief in the pancreatic cancer community that we can effectively treat this disease. But more research is needed to develop better treatments. Progress requires research.

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    How Long Do You Have To Live With Stage 4 Pancreatic Cancer

  • How Long Do You Have to Live with Stage 4 Pancreatic Cancer? Topic Guide
  • Life expectancy for pancreatic cancer is often expressed in 5-year survival rates, that is, how many people will be alive 5 years after diagnosis.

    Pancreatic cancer 5-year survival rates chart

    Pancreatic cancer stage
    Localized 37%
    Regional 12%
    Distant 3%

    The life expectancy for stage 4 pancreatic cancer is very low, estimated to be about three to five months. By stage 4, pancreatic cancer has spread to and damaged surrounding organs, which makes it difficult to treat.

    Is Stage 4 Cancer Terminal

    Terminal cancer cannot be cured or treated. A person with terminal cancer is actively dying and will usually not live for more than a few months.

    Stage 4 pancreatic cancer is not always called terminal. While the cancer is at an advance or late stage, some people do live longer than a few months with it.

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    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.

    Survival Rates By Stage

    Understanding stage IV pancreatic cancer

    If youve been diagnosed and your stage has been determined, you may be curious about your outlook. An outlook is based on information compiled from people who have a similar cancer.

    Although theyre useful, survival statistics arent definitive. Make sure you discuss your individual outlook with your doctor so you can better understand what it means for you.

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    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

    Stage Information For Pancreatic Cancer

    In This Section
    Enlarge
    T0 = No evidence of primary tumor.
    Tis = Carcinoma in situ. This includes high-grade pancreatic intraepithelial neoplasia , intraductal papillary mucinous neoplasm with high-grade dysplasia, intraductal tubulopapillary neoplasm with high-grade dysplasia, and mucinous cystic neoplasm with high-grade dysplasia.
    T1 = Tumor 2 cm in greatest dimension.
    T1a = Tumor 0.5 cm in greatest dimension.
    T1b = Tumor > 0.5 cm and < 1 cm in greatest dimension.
    T1c = Tumor 12 cm in greatest dimension.
    T2 = Tumor > 2 cm and 4 cm in greatest dimension.
    T3 = Tumor > 4 cm in greatest dimension.
    T4 = Tumor involves celiac axis, superior mesenteric artery, and/or common hepatic artery, regardless of size.
    NX = Regional lymph nodes cannot be assessed.
    N0 = No regional lymph node metastases.
    N1 = Metastasis in one to three regional lymph nodes.
    N2 = Metastasis in four or more regional lymph nodes.
    M1 = Distant metastasis.
    References
  • Kakar S, Pawlik TM, Allen PJ: Exocrine Pancreas. In: Amin MB, Edge SB, Greene FL, et al., eds.: AJCC Cancer Staging Manual. 8th ed. Springer 2017, pp. 33747.
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    Our Approach To Pancreatic Cancer

    Johns Hopkins pancreatic surgeons perform a variety of innovative techniques to treat pancreatic cancer, including operations using both traditional open methods and minimally invasive methods. During one appointment at our multidisciplinary clinic, patients will meet with experienced specialists who will care for them at every stage of the journey.

    How Is The Survival Rate Determined

    Pancreatic Cancer Treatment (Adult) (PDQ®)âPatient Version

    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.

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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:

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