Ongoing Research for Pancreatic Cancer
What causes Pancreatic Cancer?
As mentioned before, pancreatic cancer is caused by DNA mutations, and there are three primary ways in which the DNA may be mutated: DNA mutation inherited from mom or dad, we can do something, like smoke, that damages our DNA, or our DNA can be damaged by chance.
Some of the risk factors include:
- Cigarette smoking: Smoking doubles the risk of pancreatic cancer. Smoking is also associated with early age at diagnosis, and, very importantly, the risk of pancreatic cancer drops close to normal in people who quit smoking. Simply put, cigarette smoking is the leading preventable cause of pancreatic cancer. In fact, some scientists have estimated that 20-25% of pancreatic cancers are caused by smoking cigarettes.
- Age: The risk of developing pancreatic cancer increases with age. Over 80% of the cases develop between the ages of 60 and 80.
- Race: Studies in the United States have shown that pancreatic cancer is more common in the African American population than it is in the white population. Some of this increased risk may be due to socioeconomic factors and to cigarette smoking.
- Gender: Cancer of the pancreas is more common in men than in women. Men are more likely to smoke than women.
- Religious background: Pancreatic cancer is proportionally more common in Ashkenazi Jews than the rest of the population. This may be because of a particular inherited mutation in the breast cancer gene (BRCA2) which runs in some Ashkenazi Jewish families.
- Chronic pancreatitis: Long-term inflammation of the pancreas (pancreatitis) has been linked to cancer of the pancreas.
- Diabetes: Diabetes is both a symptom of pancreatic cancer, and long-standing adult-onset diabetes also increases the risk of pancreatic cancer.
- Obesity: Obesity significantly increases the risk of pancreatic cancer.
- Diet: Diets high in meats, cholesterol fried foods and nitrosamines may increase risk, while diets high in fruits and vegetables reduce risk. Folate may be protective.
- Genetics: As mentioned earlier, a number of inherited cancer syndromes increase the risk of pancreatic cancer. These include inherited mutations in the BRCA2, FAMMM, PalB2 or Peutz-Jeghers genes.
While pancreatic cancer survival rates have been improving from decade to decade, the disease is still considered largely incurable.
Pancreatic Cancer Prognosis
According to the American Cancer Society, for all stages of pancreatic cancer combined, the one-year relative survival rate is 20%, and the five-year rate is 4%. These low survival rates are attributable to the fact that fewer than 20% of patients' tumours are confined to the pancreas at the time of diagnosis; in most cases, the malignancy has already progressed to the point where surgical removal is impossible.
In those cases where resection can be performed, the average survival rate is 18 to 20 months. The overall five-year survival rate is about 10%, although this can rise as high as 20% to 25% if the tumour is removed completely and when cancer has not spread to lymph nodes.
Tumour size does appear to impact survival rates. The larger the tumour, the less likely it is to be cured by resection. However, even large tumours may be removed and a number of patients with tumours greater than 4-5 cm appear to have been cured by surgery.
There is increasing evidence that the best pancreatic cancer outcomes are achieved at major medical centres with extensive experience -- those that perform more than 20 Whipple procedures annually.
In patients where a cure is not possible, progression of the disease may be accompanied by progressive weakness, weight loss, and pain. Effective techniques for pain management are widely available today and used by physicians experienced in the care of pancreatic cancer patients. The techniques include nerve blockers and various drugs that can be taken by mouth or injection. There are also a variety of effective techniques available to treat bile duct obstruction which may produce jaundice and stomach obstruction caused by growth of the tumour. Both surgical and non-surgical techniques may be effective.