Why is pancreatic cancer a silent killer?

20th May, 2013 2:42
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Charles ImberCharles Imber

New research carried out at the Mayo Clinic in the USA highlight a potential marker that could be used to find out whether someone has pancreatic cancer or chronic pancreatitis. The two conditions are difficult to tell apart.

The researchers have found a single marker that can be identified in digestive juices extracted during a routine endoscopy. The test needs a lot of development work but it could have an accuracy of over 90%.

Mr Charles Imber comments: “It is good that pancreatic cancer research is coming up with new ideas about detecting and treating this disease. We desperately need to improve survival rates and early diagnosis and treatment is the best way of doing that.”

So why is pancreatic cancer often diagnosed late?

“Pancreatic cancer is often referred to as a ‘silent killer’ because it produces so few symptoms until it is fairly well advanced,” explains Mr Imber.

The pancreas, an organ that produces the hormone insulin and the digestive enzyme pancreatic amylase, is located next to the liver and it shares part of the bile duct with the gallbladder. The organ itself has few nerves, so a tumour within the pancreas can grow large before it causes any pain or other symptoms.

By the time that happens, the tumour has often spread, either to the liver, the lungs or elsewhere in the abdomen and so cannot be removed by surgery. Treatment options are then limited to palliative chemotherapy as a cure is not possible. Sadly, this is the situation in four out of five cases, which is why survival rates are still quite low.

Just four in every 100 people diagnosed with pancreatic cancer are alive five years later.

What symptoms does pancreatic cancer cause?

It is only when a pancreatic tumour starts to block the bile duct that the following symptoms develop:

-   Unexplained loss of weight
-   Jaundice – a yellow colouration of the skin all over the body, with the first signs appearing in the whites of the eyes.
-   Pale stools and dark urine.
-   Intense itching in the skin.

If you have any of these symptoms it is best to see your GP sooner rather than waiting to see if they go away.

What leads to an early diagnosis?

Some patients who are diagnosed early have a small, localised tumour very close to the opening of the bile duct into the duodenum. This type of tumour is called a peri-ampullary tumour and has the best long term prognosis because it can be picked up at an earlier stage.

Tumours that are detected before they have spread or progressed locally can be removed completely by surgery. The operation is called a pancreaticoduodenectomy but is also known as a Whipple operation. After successful surgery, most patients are then treated with chemotherapy to help reduce the risk of that the tumour will come back, or at least to increase the time to recurrence.

“Our surgical techniques have also become more aggressive recently and involvement of local major blood vessels such as the portal vein, which are very close to the pancreas, no longer represent a contraindication to surgery. Recent data that our unit has produced suggest this can be done safely for the patient with good long term results,” adds Mr Imber.

Growing evidence also suggests that treating locally advanced pancreatic cancer with chemotherapy before surgery – known as neo-adjuvant chemotherapy – can shrink the tumour significantly. This makes it more likely that an operation can go ahead and that the tumour will be removed entirely with a good margin of healthy tissue.

If you want to know more, Pancreatic Cancer UK has lots of good information on pancreatic cancer and is raising money for research.

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