Aggressive, Hard to Detect, Difficult to Treat: Why Pancreatic Cancer Is So Deadly
Pancreatic cancer isn’t selective. The disease can strike anyone and it’s often discovered at an advanced stage, making it one of the deadliest cancers. The American Cancer Society reports more than 48,000 people are expected to die of pancreatic cancer — the third leading cause of cancer-related deaths in the U.S. — this year.
In fact, pancreatic cancer has one of the lowest survival rates for cancer, with 20% of patients living to one year with the disease, on average, and 10% of patients living to 5 years. For patients with advanced disease, those numbers are lower.
Pancreatic Cancer is not Easy to Detect
Pancreatic cancer is aggressive and tends to spread silently. Because the pancreas is located deep inside the body and sits across the back of the abdomen behind the stomach, it can’t readily be felt or seen by health care providers during a checkup.
Additionally, there are usually no symptoms until the disease is at an advanced stage. And there’s no early detection method, such as regular screening, as with other cancers such as breast, colon or prostate.
Quite often, symptoms such as abdominal pain or jaundice, a yellowing of the skin, occur only once the disease is in its advanced stages. As the cancer spreads, it frequently goes to the liver causing jaundice.
Other symptoms of pancreatic cancer include:
- Dark urine
- Light colored or greasy stools
- Itchy skin
- Pain in the stomach or back
- Weight loss and poor appetite
- Nausea and vomiting
- Gallbladder or liver enlargement
- Diabetes — in rare instances, pancreatic cancer can lead to changes in blood sugar levels
Possible Causes of Pancreatic Cancer
To our knowledge, pancreatic cancer is sporadic in the majority of cases. In other words, it’s not gene-related. However, about 5% to 10% of individuals have a family history of the disease. There are multiple genes implicated with hereditary pancreatic cancer; the most well-known is the BRCA gene.
In familial pancreatic cancer, when we know there is a predisposing gene, screening is recommended and often performed. This is done with MRI imaging and endoscopic gastroenterology procedures that allow us to see the digestive anatomy and to investigate any abnormalities.
Besides a family connection, there are other known pancreatic cancer risk factors. Smoking increases risk and that alone accounts for 25% of all cases. Heavy alcohol drinkers are at higher risk, and numerous studies cite links between high body mass and lack of physical activity. Chronic inflammation of the pancreas, known as pancreatitis, is another risk factor.
One unusual implication involves blood type. The ABO blood group type may have a connection with this cancer. Compared with blood group O, individuals with non-O group — type A, AB or B — might be more likely to develop pancreatic cancer.
Treating Pancreatic Cancer
A pancreatic cancer diagnosis and the side effects sometimes caused by treatments can take an enormous toll on a person’s physical and emotional well-being. Patients should work closely with their health team to determine the best course of treatment, which can range from surgery to chemotherapy, but much depends on the type and stage of the cancer.
The mainstay of therapy is complete resection, or removal, of the tumor, which is the only curative intervention. However, the majority of patients present with advanced cancer and the tumor cannot be resected. In those cases, chemotherapy is frequently used to control the progression of the disease.
Patients with pancreatic cancer need much intensive care and support from both their physician and their family. While we want to treat the disease with all means possible, quality of life is just as important.
There is hope new treatments for pancreatic cancer will be developed, as immense research is currently evolving. Various new molecular therapies and immunotherapies are being tested. Until then, we eagerly await results of these studies, which could significantly change the outcomes for the better.
Dr. Igor Medic is a board-certified medical oncologist affiliated with Sharp Grossmont Hospital.