The incidence of pancreatic cancer (pancreatic ductal adenocarcinoma) has risen over recent decades and is now one of the commonest causes of cancer death in Europe, USA and other industrialized countries. Worldwide pancreas cancer is responsible for at least 220,000 deaths each year - from Europe there are 60,139 new cases per year, representing 10.4% of all digestive tract diseases and 64,801 deaths per year in the USA.
The UK has an especially high incidence of 10-12 per 100,000 population per year with. There are around 7,000 deaths per year in the UK alone and unfortunately the prognosis is extremely poor. Survival rate for patients is between 4 and 12 months and at five years only 5 in 1,000 patients have a chance of survival.
More than half the patients diagnosed with pancreatic cancer are below the age of 70.
The present treatment for pancreatic cancer is surgery but these results are shown to be poor compared to other cancers. If surgery is not an option other treatment modalities include chemotherapy with cytotoxics (cancer drugs) and radiotherapy (X-ray treatment)but pancreatic cancer is fairly resistant to these forms of treatment.
Why is pancreatic cancer such a terrible disease? There are three main reasons for this.
Sadly, the pessimistic outcome from pancreatic cancer has led to the perception that pancreas cancer is too serious a condition to do much about either clinically or scientifically. In recent years however, Cancer Research UK has done a great deal in supporting research that is changing the perception of this cancer by clinicians and research scientists. At last this is beginning to give a glimmer of hope to patients.
Like many cancers the risk increases with increasing age but this can only be considered as a background factor to the real causes. So far only three strong causative associations have been established. These are tobacco smoking, chronic pancreatitis and genetic factors.
Surgeons have made a major contribution to changing the nihilistic approach to this cancer. At one time resection for pancreatic cancer was associated with post-operative mortality rates of around 20-50%. Even relatively recent studies from two large UK Regions (the West Midlands and Yorkshire) have revealed post-operative mortality rates of 20-30% if the surgery was performed in District General Hospital by non-specialist consultant surgeons. In contrast contemporary studies reveal a mortality average of <6% if pancreatic cancer resections are performed by specialist pancreatic surgeons. What has also been worrying is the small number of actual resections done by non-specialists amounting to only 2.6-4.0% of cases. In specialist units the resection rates are much higher and cannot be just attributed to biased referral. Resection is worthwhile with five-year survival rates of 10-20% or more. These contrasting data have now led to Government Guidelines that all pancreatic cancer surgery is centralized into specialist units with multidisciplinary teams serving populations of 2-4 million. Thus there has been a remarkable turn around in the perception of this disease within the past few years to the extent that it has become a focus of Government policy.
The majority of patients present with obstructive jaundice and this can now be treated without dangerous surgery. The jaundice can be relieved by stenting the strictured bile duct endoscopically or radiologically. At one time surgery was the only way of dealing with this problem but at great cost in terms of operative mortality (20% or more) and hospital stay. Now with improved methods of diagnosis and pre-operative staging using combinations of computed tomography, endoscopic retrograde cholangio- pancreatography, endoluminal ultrasound, laparoscopy and fine needle aspiration for cytology, patients need only have surgery for curative resection. Although advanced pancreatic cancer is relatively resistant to chemotherapy drugs we now know that SURVIVAL IS INCREASED with drug treatment. Moreover there is evidence that aspects of the quality of life will be better preserved with the use of certain types of chemotherapy. The search is now on to identify the best combination of drugs to use in pancreatic cancer, particularly focusing on the new generation of anti-cancer drugs.
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