Pancreatic cancer is one of the cancers with the poorest prognosis, with a 5-year survival rate of just 5%.¹ Diagnosis most often occurs at an advanced stage of the disease, when the tumour can no longer be operated on, as a result of the late clinical expression of the disease.

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.

The pancreas, an essential digestive organ

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.

REMEMBER

1. HEALTHY LIFESTYLE
   Although 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.
2. HEREDITARY FACTORS
   During 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.
3. EARLY BIOMARKERS
   Many 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.

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¹Source: Long-term illnesses (ALD) Guide, pancreatic cancer, November 2010, French National Authority for Health (HAS).
²Source: International Agency for Research on Cancer, Globocan 2018, WHO.