Physician's Weekly
January 20, 2023
Recent developments in cancer research – Pancreatic Cancer

This is the fourth in a series of instalments devoted to breakthroughs for the more common solid and blood cancers; this week is dedicated to pancreatic cancer (PC).

The pancreas is a horizontally oriented organ located in your upper abdomen lying behind your stomach. It is approximately 15 cm long and fish-shaped. The right side is the widest and is known as the head while the body and tail make up its middle and left side, respectively. It makes about 8 ounces of digestive secretions daily, these secretions are made up of enzymes that empty into the first part of the small intestine (duodenum) and play an integral role in food digestion. The pancreas also contains clusters of cells, known as the Islets of Langerhans.

These are responsible for the secretion of two blood sugar-regulating hormones, insulin, and glucagon, directly into the bloodstream.

PC has the lowest survival rate of all the major cancers. The primary reason why PC is so deadly is that in the majority of instances, it is not discovered until it has metastasized (spread) to other areas. In 90% of cases, PC arises from the ducts, and the sufferer’s overall 5-year survival rate is 3-6%. Daily almost 1,000 persons around the world die from PC. It is estimated that by 2030 PC will surpass breast, prostate, and colorectal cancers to become the leading cause of cancer deaths worldwide.

Over the last 40 years, we have seen a significant improvement in the prognosis for most cancers; with PC this improvement has only been marginal. Early detection markedly improves the chances of surviving. Unfortunately, 80+% of persons are diagnosed late and their life expectancy is 4-6 months. Risk factors include increasing age, cigarette smoking, consuming unhealthy fats, obesity, chronic heavy alcohol consumption, diabetes, family history of PC, pesticide exposure, untreated H. Pylori, Hepatitis B infection, and liver cirrhosis.

Some recent discoveries and advancements regarding PC:

  • Studies have found that new adjuvant chemotherapy combinations show some promise in improving life expectancy, even if just marginally at this time.
  • The Pancreatic Cancer Detection Consortium (PCDC) is hard at work on a DNA-based blood test to detect PC early.
  • Scientists in the UK and Finland are working on a urine test for detecting PCs.
  • The PCDC is also working on imaging techniques that can detect new tumour cells in the pancreas.
  • The use of an immunotherapy.
  • Pembrolizumab in a small subgroup of PC patients is showing promise.
  • There is extensive work being done using targeted therapy to attack the unique molecular structure of up to 25% of PCs. Initial data released in The Lancet has shown that such therapy can improve the longevity of those with PC by up to a year.

It is important for everyone to familiarize themselves with some of the primary and often subtle symptoms of PC which are listed below:

  • Mid to upper abdominal and mid-back discomfort/ pain. Often starts as an intermittent discomfort that subsequently increases in intensity.
  • Recent onset of difficult-to-control type 2 diabetes
  • Dark urine, pale stool, and yellowing of the eyes
  • Itchy skin
  • Nausea and vomiting
  • Extreme tiredness
  • Unexplained loss of appetite and weight loss
  • Changes in bowel habit
  • Abdominal bloating and/or indigestion
  • Depression

Recently diagnosed pancreatic cancer (PC) patients should attend their doctor with a close family member or friend, and below are some questions that need to be asked:

  • Where in the pancreas is the PC located?
  • Has the PC spread? What is the stage? What is the prognosis?
  • What are all the treatment options? Are all available locally? If not, what’s not?
  • Should molecular profiling be done before specific treatment is carried out?
  • What is the goal and likely success of my treatment?
  • Can copies of all the reports be provided?
  • Is there any additional treatment that can be beneficial even if it means having to travel or pay to bring it into the country?
  • Are other doctors going to be involved in my treatment?
  • What are the possible side effects of the proposed treatments?
  • Is a second opinion locally or overseas recommended or worth pursuing?
  • (In advanced cases) What are the plans for palliative care?

Lung cancer will be covered next Friday.

 

Author: Dr. C. Malcolm Grant – Family Physician, c/o Family Care Clinic, Arnos Vale, www.familycaresvg.com, [email protected], 1(784)570-9300 (Office), 1(784)455-0376 (WhatsApp)

Disclaimer: The information provided in the above article is for educational purposes only and does not substitute for professional medical advice. Please consult a medical professional or healthcare provider if you are seeking medical advice, diagnoses, or treatment. Dr. C. Malcolm Grant, Family Care Clinic or The Searchlight Newspaper or their associates, respectively, are not liable for risks or issues associated with using or acting upon the information provided above.