This year, pancreatic cancer is expected to become the third leading cause of cancer related death in the EU. The outlook for the disease has not changed for the past forty years.
On World Pancreatic Cancer Day, Europe's leading pancreatic cancer experts answer key questions on pancreatic cancer and provide their insight into how we can turn the tide on the 'silent killer'.
Ali Stunt is the Founder and Chief Executive of Pancreatic Cancer Action and a member of Pancreatic Cancer Europe. Ali was diagnosed with pancreatic cancer in 2007 and, unlike 90% of patients diagnosed with pancreatic cancer, her illness was diagnosed early enough to allow a life-saving operation.
Matthias Löhr is a member of the UEG Public Affairs Committee and member of Pancreatic Cancer Europe. He is from the Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet in Stockholm, Sweden.
Sorin Barbu is a member of the UEG Public Affairs Committee, President of the Romanian Pancreatic Club and Councillor in the European Federation of the International Society for Digestive Surgery (EFISDS). He is currently a professor of surgery at the “Iuliu Hatieganu” University of Medicine and Pharmacy in Cluj.
1. Why is the survival rate for pancreatic cancer so low?
Ali Stunt: Most pancreatic cancer patients (80%) are diagnosed too late, when their disease has progressed and surgery – currently the only potential for a cure – is not possible.
Matthias Löhr: Survival rates are low due to late detection (and pancreatic cancer is often at a late stage at the point of diagnosis), no screening and poor chemotherapy response.
Sorin Barbu: Late diagnosis – only 20% of patients can have a treatment with curative intent (radical surgery and chemotherapy) at the time of diagnosis. Due to the aggressiveness of the tumour, only 20% of patients treated with curative intent then survive for five years (median survival time for patients treated with curative intent is 18 to 24 months). Pancreatic cancer is known as the ‘silent killer’ and late diagnosis is often due to a lack of specific symptoms, as well as late occurrence of these symptoms. There is also no efficient screening programme available for the disease.
2. Is the outlook for pancreatic cancer patients improving?
Ali Stunt: Sadly, the outlook for patients is very much the same as it was nearly 50 years ago. However, we are seeing very slight improvements in 5-year survival (1-2%) which is encouraging.
Matthias Löhr: There is no current breakthrough on the horizon. However, our hope is, that through therapy with personalised cancer medicine, things will slowly begin to improve in the future.
Sorin Barbu: We have witnessed a slow improvement in recent years with an increase of survival in the short term (less postoperative deaths) and medium survival (from 18 to 24 months for curative intent treatment). However, we haven’t seen any improvements for 5-year survival.
3. What are the main risk factors for pancreatic cancer?
Ali Stunt: The main risk factors for pancreatic cancer are smoking (attributable to 30% of cases), obesity (12%), age, a family history of pancreatic cancer (5-10%) and diabetes.
Matthias Löhr: There is often a lack of awareness and ignorance towards the disease from all parties involved, including physicians, grant agencies and policy makers. Smoking is also a huge risk factor for pancreatic cancer.
Sorin Barbu: Smoking, long last diabetes mellitus and obesity are factors that are predisposing and can be influenced by sporadic genetic mutations. Chronic pancreatitis and familial pancreatic cancer are other risk factors. Some known syndromes, with genetic mutations we can determine, can also lead to pancreatic cancer, but these unfortunately only represent around 10% of patients.
4. What are the main symptoms of pancreatic cancer?
Ali Stunt: The main symptoms are epigastric pain (discomfort below the ribs in the upper area of the abdomen), mid back pain, jaundice, resistant dyspepsia, unexplained weight loss, new-onset diabetes not associated with a metabolic condition and a change in bowel habits.
Matthias Löhr: Back pain, weight loss and loss of appetite are key symptoms. To find out more about the symptoms of pancreatic cancer, I would advise looking at Pancreatic Cancer Europe’s 10 warning signs of pancreatic cancer.
Sorin Barbu: Unfortunately, many symptoms of pancreatic cancer are non-specific to the disease. That’s why a diagnosis is often made after at least 2-3 medical visits which can frequently take over two months.
5. Someone in my family passed away from pancreatic cancer. Does that make me more at risk?
Ali Stunt: Your risk of developing pancreatic cancer increases to 50% above the normal population should you have two or more direct line relatives who have had pancreatic cancer. Just one relative affected doesn’t increase your risk, but it is worth mentioning to your GP any past family history of cancer.
Matthias Löhr: If only ‘someone’ (one person) then no. If there are two or more in direct line, then there is an increased risk.
Sorin Barbu: With one relative, you are not at a higher risk. However, you should avoid risk factors, such as smoking, and if you are undergoing abdominal imaging for any other diseases or symptoms, please ask the doctor to look carefully at your pancreas and ensure that they are aware of any family history of the disease.
6. Who should I approach when I’m worried about possible symptoms?
Ali Stunt: Approach your GP if you have symptoms that are not normal for you, if the symptoms are persisting and/or getting worse and ask about the possibility of pancreatic cancer. Keeping a diary of your symptoms for a 2-week period, noting the symptom severity and any changes is advisable unless you have severe pain or symptoms of jaundice (dark urine, yellowing of skin and whites of eyes and possibly itching), then you should seek help straight away.
Matthias Löhr: It is best to speak with your GP as soon as you are worried about your symptoms.
Sorin Barbu: The first approach should be your family physician.
7. Are there any new, exciting pieces of research that may help to improve survival rates?
Ali Stunt: There is lots of work being done on finding a diagnostic blood biomarker and one such is heading for clinical trials on a global scale. There is also work ongoing to identify the association between new-onset diabetes and pancreatic cancer.
Matthias Löhr: Novel approaches for blood-based markers and personalised cancer medicine with next-generation sequencing of tumour tissue are where the most promising research is currently situated.
8. Following diagnosis, how is pancreatic cancer usually treated?
Ali Stunt: If in time for surgery, then a patient will have a Whipple’s procedure followed up by adjuvant chemotherapy and sometimes chemo-radiotherapy. Locally advanced disease may be treated with neo-adjuvant chemotherapy with a view to shrinking the tumour to become operable. Advanced disease is treated with chemotherapy and sometimes surgical procedures and/or radiotherapy to manage symptoms of the disease.
Matthias Löhr: Surgery should be attempted in all cases suitable for resection. Downstaging chemotherapy may be used. After surgery, and in all other advanced/nonresectable cases, chemotherapy is the treatment of choice.
Sorin Barbu: When pancreatic cancer is diagnosed at an operable stage, the first line is surgery, which is the only chance for a cure. This is followed by adjuvant chemotherapy. If the cancer is locally advanced (with no distant metastasis), neoadjuvant chemotherapy will be undertaken to downstage the tumour to an operable stage. If there is no response to neoadjuvant chemotherapy, only palliative treatment is possible.
9. What can be done on an EU level to improve the outlook for pancreatic cancer patients?
Ali Stunt: FUNDING, FUNDING, FUNDING!
Matthias Löhr: Of upmost importance is more research, more awareness and a policy supporting the speedy diagnosis and treatment for these patients.
Sorin Barbu: We need a targeted EU policy for pancreatic cancer diagnosis and treatment and, also included within this targeted policy, more funding for pancreatic cancer research.