What makes pancreatic cancer so deadly in comparison to other cancers?
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Symptomatic pancreatic cancer is nearly always diagnosed at stage 4 (meaning it already spread to other organ systems). Early diagnosis at stages 1 or 2 yields much higher survivability. However early pancreatic cancer diagnosis usually only occurs coincidentally during diagnosis or treatment of other conditions.
just to throw in some rare good news. My father was diagnosed with pancreatic cancer in 2002, and had a whipple procedure where they took out the head of his pancreas, his gall bladder and a bit of his stomach. He is alive and well 21 years later. In fact he lost so much weight from the surgery, his type 2 diabetes went away for almost 2 decades. he’s currently in great shape and very active for an 83 year old man.
I just had a colleague die from pancreatic cancer. Saw him just a few weeks ago and we were joking about losing our hair. He was a good dude. Me, not as much.
My Mom was diagnosed with it last summer. She was gone 6 weeks later. A week after diagnosis, she suffered a stroke, which is apparently common with pancreatic cancer.
It’s very deadly indeed. But there some good news too! Over the past 20 year the chance to survive it ( = being alive 5 years after diagnosis) has increased no less than four times!
Ah. Yes.
From 2% to 8%.
I haven’t seen this otherwise in the comments: beyond being caught late, it is really hard to treat with chemotherapy (a trait it shares with liver cancer).
The pancreas makes a bunch of things to dump into your blood and your small intestine. The cells of the pancreas are specialized for pumping chemicals out. Thus if chemo comes along….they mostly pump it out too. (The liver is similar, plus it also breaks down foreign substances)
Your pancrease is so good at its job it can lose 90% of its function before you would notice any change. So usually when symptoms show the cancer is already progressed
I deeply apologize if it’s been asked in this thread, but are there certain things we can do in life to mitigate the chance of getting pancreatic cancer?
Not just pancreatic, but endocrine tumors in general. Ovarian, kidney, pancreatic, etc all tend to be caught late because they, typically, don’t produce symptoms until that point – and even then the symptoms may be vague and nondescript. By the time they’re diagnosed, the cancer has usually already metastisized making it much, much, harder to successfully treat.
Here’s my quick summary as an oncologist; happy to elaborate on any of this. It is not truly ELI5, but it’s a very complex topic!
The difference between different types of cancer is not simply that they are the same disease starting in different locations. Instead, cancer is a result of an accumulation of genetic abnormalities – numerous errors need to be made in the blueprints that tell cells how to behave for them to become a cancer, and these errors need to happen in very particular genes, specifically either oncogenes (genes that when mutated promote growth) or tumor supressor genes (genes that protect the cells from growing out of control). Either the oncogenes get activated, or the tumor suppressor genes get turned off. Even within the same cancer type, different people will have different blueprint errors, and this can significantly change how the cancer behaves, specifically how aggressive it is (how fast it grows and spreads), and what treatments it responds to. In addition, each cancer type tends to utilize or depend on their environment in very particular ways (aka all the cells around them including connective tissue and blood vessels). For instance, some cancers, based on their environment, the cells they form from, and the mutations that commonly lead to them becoming a cancer, are very dependent on sending signals to form blood vessels to get more oxygen and nutrients, and so blocking that leads to cancer cell death. Some cancers evade the immune system exquisitely well and their growth very much depends on this mechanism, so if you can help the immune system find them, that leads to cancer cell death.
In pancreatic cancer, the following are struggles:
1) Pancreatic cancer commonly occurs in the setting of 2 particular genetic mutations – TP53 and KRAS. These are seen in other cancer types as well (and often are associated with more aggressive disease) but they seem to be the most common driver mutations in this type of cancer. Not only do these mutations tend to be associated with aggressiveness, but other than one particular KRAS mutation (KRAS G12C), we do not have targetable treatment options for these mutations, unlike some other types of cancer like lung, where we have identified more than a dozen driver mutations and have created drugs to target these, which can significantly change outcomes and life expectancy in these patients.
2) Pancreatic cancer cells have a unique tumor cell environment that does not seem to utilize the mechanisms from the environment that I discussed above. They are very good at surviving despite a lower number of blood vessels, and the environment in a pancreatic tumor is often full of dense connective tissue. So blocking blood vessel growth doesn’t seem to significantly improve outcomes, and boosting the immune system doesn’t seem to either, limiting our effective treatment options. In addition, the low amount of blood vessels and dense connective tissue likely impacts penetration of our chemotherapy, and responses to chemo in general are low.
3) Like others mentioned, it is often diagnosed late, in more advanced stages. But, oh boy, once it starts causing symptoms, things are not good. This is because of the location of the pancreas, and partially the tumor environment I discussed above. One thing that grows very well in pancreatic tumors are nerves. This makes pancreatic cancer particularly painful when the masses grow large enough, which often impacts people’s quality of life, eating and nutrition, and functional status. The location in the pancreas puts these tumors near very sensitive structures – particularly the pancreatic duct and common bile duct, as well as multiple large blood vessels. This makes surgery very difficult, and blockage of the common bile duct in particular can be life threatening unless it is unblocked – bile is an essentially garbage product made by the body, and the liver’s job is to get rid of it through the bile ducts which empty into the intestines. The pancreas has a duct that also empties there. Blockage of this can lead to liver failure and infection, and if severe, this blockage needs to be relieved (such as with a stent) or patients cannot usually survive treatment with chemotherapy.
TLDR: Pancreatic cancer tends to develop from particular genetic mutations that make it very aggressive, treatments are limited due to lack of targetable genetic mutations and a tumor environment that makes other treatments either less effective or not effective at all, the environment of the tumor and location means that, while it is often advanced at time of diagnosis, when symptoms develop, they are very morbid and make patients less likely to be able to tolerate any chemotherapy.
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