Why Is Pancreatic Cancer So Deadly?

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Why Is Pancreatic Cancer So Deadly?

Why Is Pancreatic Cancer So Deadly?

The reason for its deadliness lies in the pancreas’s location. The pancreas is nestled deep within the abdomen, between the stomach and the spine. It’s a hidden organ with atypical early symptoms, making it difficult to detect the disease in its early stages.

As a result, most patients are diagnosed when the disease is already in its advanced stages, leaving them with no surgical options, leading to a poor prognosis for pancreatic cancer.

The difficulty in early diagnosis and poor treatment outcomes are the main reasons why pancreatic cancer is often referred to as the “king of cancers.”

Although the five-year survival rate for pancreatic cancer patients is less than 5%, early detection can lead to long-term cures.

Why Is Pancreatic Cancer So Deadly?

Recently, a study published by the International Pancreatic Cancer Screening Alliance revealed that high-risk individuals for pancreatic cancer, if they consistently undergo regular screening using two specialized methods, can achieve a five-year survival rate as high as 73.3%, with an average survival period of nearly 10 years!

The research indicates that high-risk individuals for pancreatic cancer, when they follow regular screening, can achieve a five-year survival rate of 73.3%, with an average survival period of 9.8 years, even if they develop pancreatic cancer!

Among the individuals diagnosed with pancreatic ductal adenocarcinoma (PDAC), the most common type of pancreatic cancer (accounting for over 90% of cases), those who maintain regular follow-up screening include 58% in stage 1 and 16% in stage 2. In contrast, among high-risk individuals who do not adhere to regular screening, 86% are diagnosed in the later stages, illustrating a significant difference in prognosis between the two groups.

Pancreatic ductal adenocarcinoma (PDAC) often lacks noticeable early symptoms, and very few people undergo specific screening for it. Therefore, most PDAC cases are diagnosed when they are no longer operable, and some may have already progressed to advanced stages.

Just like most cancers, even the “king of cancers,” PDAC, can be cured if it’s discovered in the early, surgically treatable stage. Especially in recent years, with significant improvements in neoadjuvant and adjuvant therapies for PDAC, the prognosis for operable patients has been steadily improving, and the hope for a cure is no longer distant.

Recent research data shows that the five-year survival rates for stage IA and IB PDAC patients are as high as 83.7% and 74.3%, respectively.

Some individuals with a significant family history of PDAC, certain specific genetic mutations, or syndromes that increase cancer risk belong to a “high-risk group.” They are more prone to developing PDAC.

Why Is Pancreatic Cancer So Deadly?

In recent years, there has been a growing body of research on regular screening and follow-up using endoscopic ultrasound (EUS) or magnetic resonance cholangiopancreatography (MRCP) for high-risk individuals for PDAC. The data shows that these two techniques help high-risk individuals detect PDAC at an earlier stage, increasing the chances of a curative surgical intervention.

However, there is a challenge among high-risk individuals due to the presence of benign and malignant lesions that are difficult to differentiate, such as cystic pancreatic lesions. This can sometimes lead to the overtreatment of low-risk lesions, as high-risk individuals tend to be cautious and anxious, potentially opting for surgery out of fear.

Recently, the International Pancreatic Cancer Screening Alliance (CAPS) analyzed a large dataset of 1731 high-risk individuals who underwent regular screening with the mentioned techniques to observe if such screenings benefitted their survival. The results revealed that screening an average of 194 high-risk individuals per year detected one PDAC patient.

Among the individuals diagnosed with PDAC through regular screening, 58% were in stage 1 and 16% in stage 2. In contrast, among those who did not adhere to regular screening, 86% were diagnosed in advanced stages.

Most crucially, high-risk individuals who were detected through regular screening exhibited a very favorable long-term prognosis, with a 73.3% five-year survival rate and an overall average survival period of 9.8 years. In comparison, high-risk individuals who did not adhere to regular screening had a five-year survival rate of 0% and an overall average survival period of 1.5 years.

The National Comprehensive Cancer Network (NCCN) guidelines recommend that high-risk individuals with a family history of pancreatic cancer or specific genetic mutations undergo annual EUS or MRCP screening.

Why Is Pancreatic Cancer So Deadly?
NCCN Imaging-Based Screening and Surveillance Criteria

However, in practice, EUS and MRCP screening require specialized interpretation, making it necessary for these screenings to be conducted under the guidance of experienced multidisciplinary professionals.

Another challenge is that the current guidelines for selecting the screening population are somewhat stringent. The current NCCN guidelines suggest that screening should start at the age of 50 (or 10 years earlier than the age at which a first-degree or second-degree relative developed PDAC) for individuals with mutations in specific genes, such as ATM, BRCA1, BRCA2, PALB2, TP53, or those with Lynch syndrome and a first-degree or second-degree relative with PDAC.

Recently, the clinical practice guidelines of the American Society for Gastrointestinal Endoscopy have begun to support regular imaging screening for individuals with pathogenic mutations in BRCA1, BRCA2, and PALB2, regardless of their family history, starting at the age of 50, although the level of evidence for this recommendation is very low.

While there is growing interest in blood-based early cancer screening research, its effectiveness in PDAC screening has not been confirmed. Therefore, guidelines and professional associations do not recommend using such blood tests for screening.

In summary, research has demonstrated that regular screening for high-risk individuals for PDAC is beneficial in reducing the mortality rate of PDAC patients.

About pancreatic cancer.

Pancreatic cancer is a type of cancer that originates in the pancreas, a vital organ located deep within the abdomen, behind the stomach.

The pancreas has two main functions: it produces digestive enzymes to help break down food, and it also plays a crucial role in regulating blood sugar levels by producing hormones like insulin.

Here are some key points about pancreatic cancer:

Types of Pancreatic Cancer:
- Pancreatic Ductal Adenocarcinoma (PDAC): This is the most common type, accounting for about 90% of all pancreatic cancer cases. It begins in the cells lining the pancreatic ducts.
- Pancreatic Neuroendocrine Tumors (PNETs): These are rare and usually grow more slowly than PDAC. They can produce hormones and lead to various symptoms.
Symptoms: Pancreatic cancer often presents with vague and non-specific symptoms in its early stages. These symptoms may include abdominal pain, jaundice (yellowing of the skin and eyes), unexplained weight loss, changes in stool, and digestive issues.
Risk Factors: Several factors can increase the risk of developing pancreatic cancer, including age (it’s more common in older individuals), smoking, obesity, family history of pancreatic cancer, certain inherited genetic mutations, chronic pancreatitis, and diabetes.
Diagnosis: Diagnosing pancreatic cancer typically involves a combination of imaging tests (CT scans, MRI, ultrasound), blood tests (CA 19-9), and potentially a biopsy. Early diagnosis can be challenging because symptoms often don’t appear until the cancer has reached an advanced stage.
Staging: Pancreatic cancer is staged to determine the extent of its spread. The stages range from 0 (localized cancer) to IV (advanced cancer that has spread to other organs).
Treatment: The treatment for pancreatic cancer depends on the stage and extent of the disease. It often involves a combination of surgery, chemotherapy, radiation therapy, targeted therapy, and immunotherapy. Surgery to remove the tumor is the primary treatment for localized cancer, but it’s not always possible if the cancer is too advanced.
Prognosis: The prognosis for pancreatic cancer is generally poor because it’s often diagnosed at an advanced stage. The five-year survival rate is low, with only about 10-20% of patients surviving that long. However, early-stage tumors that can be surgically removed have a better prognosis.
Prevention: While it’s not always possible to prevent pancreatic cancer, certain lifestyle changes can help reduce the risk. These include quitting smoking, maintaining a healthy weight, and limiting alcohol consumption. For individuals with a family history of the disease, genetic counseling and screening may be recommended.
Research and Advances: Ongoing research is focused on improving early detection methods and developing more effective treatments for pancreatic cancer. Clinical trials are exploring new therapies, including immunotherapy and targeted treatments.

Pancreatic cancer is a challenging disease due to its late diagnosis and aggressive nature.

It underscores the importance of early detection and raising awareness about risk factors and symptoms to improve outcomes for patients.

What are the latest advancements in pancreatic cancer treatment?

As of my last knowledge update in January 2022, there were ongoing research and developments in pancreatic cancer treatment.

Some promising advancements and trends in pancreatic cancer treatment up to that point:

Immunotherapy: Immune checkpoint inhibitors, such as pembrolizumab and nivolumab, were being explored in clinical trials for pancreatic cancer. Immunotherapy aims to enhance the body’s immune system to target and destroy cancer cells. The results of these trials were eagerly awaited to determine their efficacy.
Targeted Therapies: Several targeted therapies were under investigation. These therapies are designed to target specific molecules or pathways involved in the growth and spread of cancer cells. For example, therapies targeting the HER2 protein were showing promise in subsets of pancreatic cancer patients.
PARP Inhibitors: Poly(ADP-ribose) polymerase (PARP) inhibitors, such as olaparib, were being studied for patients with BRCA mutations. These inhibitors can help prevent cancer cells from repairing DNA damage, making them a potential treatment option for certain pancreatic cancer cases.
Neoadjuvant Therapy: Neoadjuvant chemotherapy, which is given before surgery, was increasingly used to shrink tumors and improve the chances of successful surgical removal. This approach was becoming more common for borderline resectable or locally advanced pancreatic cancer.
Minimally Invasive Surgery: Advances in surgical techniques, including robotic-assisted surgery and laparoscopic procedures, were allowing for more precise and less invasive removal of tumors. These approaches could lead to quicker recovery times for patients.
Personalized Medicine: Pancreatic cancer treatment was moving toward more personalized approaches based on a patient’s specific tumor characteristics and genetic profile. This allows for more targeted therapies and potentially better treatment outcomes.
Radiation Therapy Advances: Techniques like stereotactic body radiation therapy (SBRT) were being explored to deliver highly focused radiation to the tumor while sparing surrounding healthy tissues. This could increase the effectiveness of radiation therapy and reduce side effects.
Liquid Biopsies: Liquid biopsies, which involve analyzing blood samples for circulating tumor DNA, RNA, or other biomarkers, were being studied for their potential to monitor treatment response and detect disease recurrence earlier.
Supportive Care: There was a growing emphasis on improving the quality of life for pancreatic cancer patients. Palliative care and supportive services were increasingly integrated into treatment plans to manage symptoms and side effects.

It’s important to note that advancements in cancer research and treatment are ongoing, and new developments may have emerged since my last update.

If you or someone you know is dealing with pancreatic cancer, we recommend consulting with an oncologist or a medical professional for the most up-to-date information on treatment options and clinical trials that may be available.

Additionally, organizations like the American Cancer Society and the Pancreatic Cancer Action Network provide resources and updates on the latest developments in pancreatic cancer research and treatment.