Kathryn E. Vinson, MS, CCRC
Pancreatic cancer is one that strikes fear in the most stoic among us. Cancer.net tells us that although pancreatic cancer accounts for only 3% of cancer diagnoses in a given year, it is responsible for 7% of cancer deaths annually. So, why this disparity in incidence and mortality rates? Let’s take some time today to visit about pancreatic cancer, and what makes it such a challenging foe.
Diagnosis and Symptoms
One of the major problems with pancreatic cancer is that it is most often not diagnosed until it has reached an advanced stage. A terrifying 52% of people are not diagnosed until the disease has spread beyond the pancreas and invaded distant parts of the body. Only 10% of patients are diagnosed when the cancer is still confined to the pancreas, and even then, the five-year survival rate is only 32%.
But why is this? There are really two reasons – 1) a lack of affordable and reliable screening methods and 2) most pancreatic cancers don’t become symptomatic until it is far advanced. Due to the location of the pancreas, tumors are difficult to be felt upon physical examination, again unless they are very large. While some patients present with jaundice, others don’t until the disease has progressed. Same with ascites, or a build up of fluid in the abdomen. There is a tumor marker that is sometimes elevated, but not always. Past that, we get into expensive imaging tests such as CT scans that are hard to justify for a screening. As you can see – pancreatic cancer is a sneaky and smart disease.
As with other cancers, pancreatic cancer is staged by stage number and sub-stage, and also the TNM system. While we are used to hearing “Stage 1B” or “Stage 3A”, pancreatic cancer may also be staged by describing its treatment pathway. This method is much more descriptive, more common, and helps to define treatment strategies.
Resectable pancreatic cancer is that which can be surgically removed. While the tumor may or may not have extended beyond the pancreas, it hasn’t invaded nearby blood vessels, and there isn’t any evidence of spready beyond that. It is estimated that 10-15% of pancreatic cancers are diagnosed at this stage, with a five-year survival rate of about 32%.
Borderline resectable tumors are those that might be able to surgically removed, but may need chemotherapy or radiation prior to surgery in order to shrink it to a more manageable size.
Locally advanced tumors may still be confined to the area around the pancreas, but has invaded blood vessels or close organs. This type of cancer cannot be surgically resected and represents 35-40% of diagnoses. At this stage, survival rates fall drastically to about 12%
Metastatic pancreatic cancer is sadly the stage where the majority of patients are diagnosed – representing 45-55% of diagnoses, with a devastating five-year survival rate of only 3%.
Options for treating pancreatic cancer vary by the spread of the disease. For resectable or borderline resectable cancers, the tumor is surgically removed either immediately upon diagnosis, or after the tumor has been reduced in size by chemotherapy or radiation. Both chemo and radiation may also be used after surgery in an effort to prevent recurrence. For more advanced cancers, chemo and radiation are still within the realm of possibilities, but more targeted therapies and immunotherapies are also options. It is important to understand that even though cancer may be termed unresectable, advanced, or even terminal, chemotherapeutic drugs may be suggested as a method of palliative care in order to shrink the tumor and provide pain relief. Clinical trials may also be an option for you, please consult with your physician about any possible trials that you find.
As always, much love, many prayers, and abundant blessings to all of the warriors out there!