Slow progress in deadliest of cancers

Despite advances in survival rates in most cancers, pancreatic cancer remains among the deadliest of all, with the lowest survival rates. It is rarely diagnosed early.

The odds of dying from cancer have been slowly but steadily declining over the past several years. The latest statistics from the Canadian Cancer Registry show that the long-term prognosis for most types of cancer has generally improved since the 1990s.

Patrick Swayze, seen in May 2008, died Sept. 14, 2009, after a nearly two-year battle with pancreatic cancer. ((Mark J. Terrill/Associated Press) )
The overall five-year survival rate for Canadians diagnosed with cancer from 2004-06 is estimated to be 62 per cent of that of an identical group without cancer. Between 1994 and 1996, the estimated ratio was 57 per cent.

Cancer is not necessarily the death sentence it might once have been.

But not all cancers are equal and in the case of pancreatic cancer, there has been little progress in extending survival. Only 21 per cent of people diagnosed with pancreatic cancer can expect to be alive a year later. After five years, only six per cent of people with pancreatic cancer can expect to be alive. If there is a bright side, if you make it through five years, chances are good that you'll see another five years.

What is the pancreas?

It's a crucial part of your digestive system that secretes hormones — including insulin — to help your body deal with sugar. The pancreas also produces digestive juices, which help your body digest food.

Why is pancreatic cancer so deadly?

One of the key factors in surviving cancer is early detection. With breast cancer or testicular cancer, a small lump or an abnormality might send you for a checkup. Pancreatic cancer doesn't usually offer those hints that have you looking for answers.

Claude Bechard resigned as Quebec's abriculture and intergovernmental affairs minister only hours before he died on Sept. 7, 2010, of pancreatic cancer. ((Jacques Boissinot/Canadian Press))
By the time you're showing symptoms, the cancer is already in its advanced stages.

Actor Patrick Swayze was diagnosed with Stage 4 pancreatic cancer in January 2008. Despite the advanced stage of the disease, at first he responded well to treatment. He survived for 20 months. Before he died, the cancer had spread to his liver.

Apple CEO Steve Jobs was diagnosed with the disease in 2004 and is one of the six per cent of pancreatic cancer patients to survive five years or more. Jobs had a far less common form of the disease that responds better to treatment.  Nevertheless, on Jan. 17, 2011, Jobs announced he is taking a medical leave of absence from Apple Inc. so he can focus on his health.

In the United States, more than 40,000 people a year are diagnosed with pancreatic cancer. Around 2,500 of them develop islet cell tumours, or pancreatic neuroendocrine tumours, which is the type of pancreatic cancer Jobs has.

Jobs underwent a pancreaticoduodenectomy, which is also known as the Whipple procedure, to treat tumours on the head of the pancreas. In 2009, he also received a liver transplant.

What are the signs and symptoms of pancreatic cancer?

  • Pain in the upper abdomen that may radiate into your back.
  • Jaundice.
  • Loss of appetite.
  • Unexplained weight loss.
  • Depression.
  • Blood clots.

What are the causes/risk factors for pancreatic cancer?

It's not clear what causes pancreatic cancer. However, the risk seems to be higher for people older than 60, those who are overweight or obese, diabetics, and smokers. A family history of pancreatic cancer is also considered as a risk factor, as is chronic inflammation of the pancreas (also known as pancreatitis).

A study released in June 2009 suggested that being overweight or obese in early adulthood was associated with a greater risk of pancreatic cancer — especially in men. It also found that being obese at an older age is associated with a lower overall survival rate.

Other risk factors include inherited conditions, such as:

  • Familial breast cancer (BRCA2).
  • Familial atypical multiple mole melanoma syndrome (FAMMM, also called atypical mole syndrome).

But some people develop pancreatic cancer without any of those risk factors. 

How is pancreatic cancer treated?

It depends on how advanced the illness is. If it's in its early stages — still confined to the pancreas — surgery may be an option. But if pancreatic cancer is more advanced, treatment options may be more limited. Radiation, chemotherapy and targeted therapy — drugs that attack specific abnormalities within cancer cells — may be options.

If the cancer is fairly advanced, the only option may be drugs to help relieve the patient's symptoms and control pain.

Currently, there are hundreds of clinical trials underway to find better ways to treat or detect pancreatic cancer. Among them are investigations of drugs that stop cancer from growing new blood vessels. Without new blood vessels, cancer cells may be prevented from getting the nutrients they need to grow — and make the patient sicker. Researchers are also studying whether vaccines can help treat pancreatic cancer by enhancing the immune system.

A study that started in July 2010 is trying to determine whether a new drug that was designed to penetrate and attack pancreatic cancer cells is effective. The trial involves people with advanced cancer who do not have a good prognosis using available therapies.

What else are researchers looking at when it comes to pancreatic cancer?

In the U.K., researchers are trying to determine whether a new test for a protein can help in early diagnosis of pancreatic cancer. The protein — Mcm or minichromosome maintenance protein — has been found to be a relevant marker for certain types of tumours. Research has suggested the test is accurate. But more study is needed to determine if it's reliable.

Another protein under the microscope is MUC4, a newly discovered tumour marker that is not found in a healthy pancreas. Again, it shows promise in determining treatment and cancer therapy.

Another study is looking at the use of thalidomide in helping people suffering from severe weight loss. People with pancreatic cancer are often unable to eat and lose weight rapidly. Due to the drug's strong link to birth defects, women who may become pregnant are excluded from this study.