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Dr. Praveen Kammar

MS, MRCS, MCH

Surgical Oncologist

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Pancreatic Cancer Blogs | 24 January 2022, Monday

Is Pancreatic Cancer Curable?

Pancreatic cancer is the development of cancer cells in the ducts of the pancreas. People are often worried about the treatment of it. To know if pancreatic cancer is curable or not, it is crucial to understand a few basics about its spread and causes.

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What is the most common cause of pancreatic cancer?

Some of the common causes of pancreatic cancer include:

  • Increasing age is one of the risk factors for pancreatic cancer.
  • There could be a hereditary predisposition to pancreatic cancer in certain individuals. 
  • The presence of type 2 diabetes is also a known risk factor for pancreatic cancer. 
  • Smoking is the most important cause of pancreatic cancer. 25% of pancreatic cancers are connected to smoking.
  • Obesity is also linked to pancreatic cancer. Obese people are 20% more likely to develop pancreatic cancer.

Out of all the factors, both obesity and smoking are modifiable factors since an individual has complete control over these. 

In cases of chronic pancreatitis, there is a recurrent inflammation of the pancreas. There are many reasons for this condition. However, smoking and drinking are the most common causes of chronic pancreatitis.

What decides the treatment of pancreatic cancer?

The possibility of a cure for any cancer depends on five factors:

(1) Biology of the tumor OR the type of tumor. E.g., Stage for Neuroendocrine tumors has much better results than adenocarcinoma.

(2) Spread of the tumor: This determines the stage of the tumor. The higher the stage, the lower are the cure rates. 

(3) Organ affected: Breast cancer has significantly better outcomes than several other digestive system cancers. 

(4) If standard recommended treatment has been given and if a patient could undergo the treatment without significant side effects. 

Complications associated with surgery and chemotherapy reduce the treatment results. Similarly, delay in treatment and dose reductions in chemotherapy is also not desirable.   

(5) How the patient’s cancer is responding to the treatment. Cancer that responds well to treatment has better outcomes than the one that is not.

When not specifically mentioned, pancreatic cancer means adenocarcinoma of the pancreas. It is the most common variety of pancreatic cancer. Neuroendocrine tumors and cystic neoplasms of the pancreas are the other major types of pancreatic cancers.

Adenocarcinoma of the pancreas is one of those cancers with a very low chance of cure compared to cancers of other digestive organs. Overall, the 5-year survival rate in pancreatic cancer is 10%, i.e., even after good quality treatment, only 10 out of 100 patients will survive beyond 5 years.

Let’s consider the 5-year survival rates by stage. It is 39% in the early stage (localized), 13% if cancer has spread in the surrounding regions, 3% for cancer that has spread to the other distant organs. Unfortunately, only less than 15% of patients are diagnosed in the early stages.

Is pancreatic cancer always fatal?

Pancreatic cancer is uncommon compared to other cancers.

Detection of pancreatic cancer in its earliest stages increases a patient’s survival chances. However, most pancreatic cancer patients don’t show any symptoms in the early stages. As a result, only 10-15 percent of individuals get diagnosed with pancreatic cancer that doctors can surgically remove.

Only 10% of those diagnosed with pancreatic cancer survive five years after their disease has been detected. Overall, cancer survival in this population is among the lowest globally.

Considering the above facts, we can assume that pancreatic cancer is fatal in most patients.

How can pancreatic cancer be diagnosed early?

It’s natural to desire a diagnosis of pancreatic cancer when it is in an early stage, considering the deadly nature of this disease. However, there are no specific signs or symptoms to diagnose pancreatic cancers. 

Early cancers don’t show any signs or symptoms. Hence additional tests are needed to identify pancreatic cancer in early stages. However, the cost of the tests, lack of solid scientific evidence, and relatively low incidence make implementing such tests at a large scale difficult even for developed countries.

However, some individuals have hereditary conditions that predispose them to an increased risk of pancreatic cancer. 10% of pancreatic cancers are attributed to such hereditary conditions. Hence, it is worthwhile carrying out such tests to diagnose early-stage pancreatic cancers in these high-risk individuals.

We see a high risk of pancreatic cancer in the following genetic conditions:

  • BRCA2
  • Lynch syndrome
  • Familial pancreatitis
  • Peutz Jegher’s syndrome

Individuals undergo genetic counseling and testing to diagnose these conditions before screening for pancreatic cancer. Individuals without an increased risk of pancreatic cancer should not pursue any tests without seeking medical advice.

While diagnosing, endoscopic USG is not readily available and is highly operator-dependent. In addition, MRI is less accurate in diagnosing small lesions than endoscopic USG.

Ca19-9 is a biomarker in blood that is elevated in pancreatic cancer. However, it is not sensitive enough to identify early cancer. Therefore, several blood markers are being studied to help diagnose early pancreatic cancers.

Where does pancreatic cancer spread first?

Pancreatic cancer spreads in 3 modes:

  1. Local spread to the surrounding organs, e.g., Superior mesenteric vein and portal vein, duodenum, etc. It happens as the tumour grows dimensionally and involves the adjacent organs. 
  2. Lymphatic cancer spread happens when the loose cancer cells enter the lymphatic channels present in and around the tumour. Such spread gives rise to enlarged lymph nodes in the region affected. 
  3. Hematogenous spread (spread via the bloodstream): the loose cancer cells can also spread via the bloodstream and lodge in organs like the liver (most common), lungs, bones, and brain.

In conclusion, local and lymphatic spread generally occurs first. Hematogenous spread appears much later as the tumour advances.

How fast does pancreatic cancer go from Stage 1 to Stage 4?

Pancreatic cancer spreads more slowly than thought. A mathematical model showed it takes roughly 12 years before a cancer cell develops in the pancreas’ high-grade lesion. From the onset of cancer to at least one cell acquiring the potential to spread, there are about 7 years. There are about 3 years to a patient’s death from that point on.  

This information means there are many opportunities to catch this cancer at an early stage if proper interventions are used. Unfortunately, however, we don’t have sensitive tools to diagnose pancreatic cancer at an early stage.

What is the longest someone has survived pancreatic cancer?

There are no survivors beyond 10 years in pancreatic cancer, even those treated with curative intent. However, there are some anecdotal reports of long-term survivors in the literature.

These are exceptional cases. There is a report of one patient who has beaten pancreatic cancer and is still alive after 30 years, doing well. Though these rare cases do not guide treatment decisions, they give us hope to keep fighting this deadly disease because you may be the one with a different destiny.

Conclusion

Pancreatic cancer is a severe cancer that shows no symptoms in the initial stages. The cure of pancreatic cancer depends upon its diagnosis and how much it has spread. 

You can consult our experts to know more about this cancer in detail.

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