Although it only comes in 12th place for cancers diagnosed worldwide in 2018, pancreatic cancer is nevertheless the 7th most deadly.² Revised to population size, the number of new cases is increasing considerably in industrialized countries and especially in Europe (particularly France, Belgium, Germany, as well as Central and Eastern Europe), North America, Australia, and New Zealand.
Although the causes are still largely unknown, smoking and excessive alcohol consumption influence onset. Diets that are high in fat and protein, obesity, and diabetes may also be involved. However, many cases occur in the absence of these factors, including in people over the age of 50. In 5% to 10% of cases1, a family predisposition is observed. Certain gene mutations, including BRCA2 already known to be involved in breast and ovarian cancer, are also at play.
AN ESSENTIAL DIGESTIVE ORGAN
The pancreas is a digestive system organ, located deep in the abdomen, behind the stomach. It has two main roles:
- An “exocrine” role. It produces the pancreatic juice, discharged into the duodenum (first segment of the intestine, after the stomach) which plays a part in digestion
- An “endocrine” role. The pancreas secretes two enzymes that are crucial for regulating the level of blood glucose (glycemia), with antagonistic roles: insulin and glucagon
In 90% of cases, pancreatic cancer affects the tissues involved in exocrine function, particularly the ducts which transport pancreatic juice – this cancer is also known as “pancreatic ductal adenocarcinoma.” In most cases (75% to 80%), it is the head of the pancreas which is affected, less frequently the central section or the tail. There are other cancers that affect the endocrine function of the pancreas, which require alternative management.
DIAGNOSIS THAT COMES TOO LATE
The poor prognosis of pancreatic cancer is largely explained by its late diagnosis: the patient starts getting the first signs when the cancer is already at an advanced stage. Only 20% of patients are diagnosed with a stage that is still operable: among them, the survival rate reaches 20% five years after diagnosis – versus 5%1 for all stages combined, whether operable or not.
Among others, symptoms include loss of appetite, weight loss, and stomach pain, which can extend to the sides and the back. If the tumour affects the head of the pancreas, it causes compression of the common bile duct, which carries the bile from the liver to the intestine. The bile then flows back into the circulation, resulting in yellowing of the eyes and the skin (jaundice), dark-coloured urine, and sometimes itching of the skin.
Diagnosis relies on imaging, firstly an abdominal ultrasound, followed by a CT scan. The first helps to clarify the size of the tumour and its possible extension in the form of metastases, towards the ganglia, liver or bones. The diagnosis is confirmed by tumour analysis, for operable tumours, or biopsy, for inoperable tumours.
SURGERY, THE ONLY POTENTIAL CURE
The decision to operate on the patient depends on the size and location of the tumour, as well as the general condition of the patient (age, presence of other diseases). When the head of the pancreas is affected, a surgical procedure known as the “Whipple procedure” includes the removal of not only this section, but also those located nearby: common bile duct, adjacent sections of the stomach and intestine. It is major surgery which cannot be offered to all patients.
CHEMOTHERAPY, A THERAPEUTIC ALTERNATIVE
Chemotherapy is systematic in patients with pancreatic cancer, whether they have been operated on or not. The medicines used block the proliferation of cells. They target rapidly dividing cells, whether cancerous or not – which explains the side effects of these treatments.
After surgery, chemotherapy is described as “adjuvant”: it seeks to eliminate residual cancer cells, and thus prevent relapse. In some cases, it can be performed before the operation, in order to reduce the size of the tumour to make it operable: it is called “neo-adjuvant”. In the absence of surgery, chemotherapy helps control the tumour and alleviate symptoms. When the disease is at an advanced stage, it is most often based on the combination of several drugs to combine their actions.
Radiotherapy can also be used, in combination with chemotherapy, when the tumour is locally advanced but not operable, and even to treat often painful bone metastases.
Becoming a key player in oncology fits the long term strategy of Servier. This is why the Group is dedicating 40% of its investments into R&D in the fight against cancer and the unsatisfied needs of patients, with the aim of reaching 50% in the next few years. One aim: to provide innovative therapeutic solutions to people affected by cancer. In combination with the World Pancreatic Cancer Coalition (WPCC), Servier is committed to the fight against one of the deadliest cancers in the world by sponsoring the awareness campaign Demand Better.
HEALTHY LIFESTYLEAlthough it is difficult to prevent this type of cancer, the risk can be reduced by adopting a healthy lifestyle, giving up smoking, eating a balanced diet, and regularly exercising.
HEREDITARY FACTORSDuring the last world cancer congress, clinical advice was issued concerning the analysis of hereditary factors of the disease. For diagnosed patients, analysis of their presence is recommended in first and second-degree relatives. The genetic risk assessment should also be offered to other family members.
EARLY BIOMARKERSMany studies are underway to identify early biomarkers which could confirm the presence of pancreatic cancer at an earlier stage and thus, improve the future of patients with this cancer.
1Source: Long-term illnesses (ALD) Guide, pancreatic cancer, November 2010, French National Authority for Health (HAS).