Pancreatic cancer is more common in high income countries including the USA.¹ Lifestyle factors, such as smoking, contribute to the condition. Diabetes is also a risk factor, however, not enough is known about how the disease can be prevented.

Professor Sean Grimmond is Director of the University of Melbourne Centre for Cancer Research at the Victorian Comprehensive Cancer Centre. He described pancreatic cancer as ‘arguably the cancer with the greatest unmet need, because the survival rate once diagnosed is one of the worst of all tumours.’

According to support organisation, Pancare Foundation, it is estimated that 3,364 new cases of pancreatic cancer will have been diagnosed in Australia by the end of 2018.²

Two thirds of people with pancreatic cancer die within the first year, and only 8.7% of patients survive five years after their diagnosis. Pancreatic cancer has the highest mortality rate for all major cancers.

Prof Grimmond says the nature of the disease makes it difficult to treat, as most pancreatic cancers are aggressive.

‘These fast-growing cancers have a genetic defect that acts like a jammed-on accelerator, but the most common mutation in cells that promotes growth is currently not druggable. With other mutations we have been able to use drugs that slow down the gene and they either go into suicide mode or the immune system cleans them up.’

Doctors cannot currently predict which pancreatic lesions will turn cancerous and which will cause no harm. The research of Prof Grimmond and his team is set to change that.

‘We are creating an atlas of premalignancy. So we can determine when mutations might occur that will lead to cancer. This will help us to develop diagnostic tools.’

The hope is to create a pathology test that could act as a screening tool for those who may be at risk.

Screening programs have been shown to be effective at improving outcomes for other types of cancer including cervical cancer, breast cancer and bowel cancer.

While there is a known association between pancreatic cancer and Type 2 diabetes, research is ongoing to pinpoint if this is an early indicator of cancer developing, or if diabetes occurs as a result of the cancer, and how this knowledge could be used to help patients.

Survival rates for pancreatic cancer have seen little improvement in the past 40 years, but researchers are hoping to change this by learning more about the cancer and how it could be better detected and treated.

Pancreatic cancer develops from lesions in the pancreas. These are relatively common, particularly in people over 60, however, they do not always lead to cancer.

One of the biggest challenges is diagnosing the disease early. Patients currently need medical imaging such as a CT scan to identify lesions, after which a biopsy is taken and analysed by a pathologist looking for signs of cancer.

Depending on the pathologist’s findings, surgeons may take action to treat or remove lesions or put the patient on a ‘watch and wait’ regime, where repeat biopsies are taken annually so pathologists can check for cancer developing.

Prof Grimmond says, ‘The big challenge is that pancreatic cancer is usually asymptomatic until the late stages when patients present with metastatic disease. This means the cancer has spread and the chance to do surgery as the first line of treatment is gone.

‘Prevention here is the holy grail. If we could find better ways to detect early and be proactive in identifying people who are more likely to develop pancreatic cancer, we could win the war before the first shot is fired.’

The difference this will make to patients could be phenomenal.

Barry Westhorpe is CEO of Pancare Foundation, an organisation providing patient support services and advocacy for people living with pancreatic cancer and their families. He said;

‘These cancers have such poor survival rates, despite the advances in other areas of cancer medicine. Research efforts are vital to give hope to patients and their families. We know early diagnosis and a better understanding of the disease will make an enormous difference to the outcomes for people with this devastating disease.’

References:

1. https://www.pancan.org/news/new-global-cancer-statistics-released/
2. https://www.pancare.org.au/about-pancreatic-cancer/

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Based on data from 2009-2013, the estimated 5 year survival rate for pancreatic cancer is shocking, just 7.7 per cent.

We all know that cancer kills but with other types of cancer, particularly more common cancers, we have a better understanding and more ways to treat the disease. For example the 5 year survival rate for breast cancer is 90 per cent and for prostate cancer is 95 per cent.

So, why is pancreatic cancer difficult to diagnose?

Firstly, as with many cancers, pancreatic cancer may not lead to symptoms in the early stages. Those that may appear are often non-specific such as nausea, a change in bowel habits and loss of appetite. These could be caused by other common conditions, for example indigestion or irritable bowel syndrome so it is difficult for doctors to make a fast cancer diagnosis, and they will need to rule out other, more likely, causes first.

The location of the cancer within the pancreas can also determine how quickly it may be diagnosed. Cancers at the top of the pancreas that cause interference with the bile duct for example, may lead to symptoms quicker than those located at the other end of the pancreas – meaning there is more chance they will be picked up at a more treatable stage.

Pancreatic cancer is diagnosed by first using medical imaging such as ultrasound, CT scans, MRIs to locate the tumour and then confirming the presence of cancer through analysis of a tissue sample in a pathology laboratory. The sample may come from a tumour removed during surgery or via a biopsy.

Because pancreatic cancer is not common and due to the nature of the disease, we don’t have widely available screening tests like those available for other cancers – think mammograms and pap smears.

Why is pancreatic cancer so hard to treat?

As most patients don’t experience symptoms until their cancer is in a late stage, the cancer may have grown large and can also have spread (metastasized) to other organs such as the liver or lymph nodes.

Surgery to remove a tumour is most effective in the early stages of the disease as once the tumour has grown to other areas it can interfere with major blood vessels and other organs making it harder to remove.

An exciting development in testing

A team in California have been working on a blood test that could help to increase early diagnosis and therefore improve outcomes for pancreatic cancer patients.

Researchers from UC San Diego developed a method where a drop of blood is a placed on a small electronic chip, the current is then turned on and after a wait of several minutes, fluorescent labels are added, and the sample is examined under a microscope. If the blood sample tests positive for the pancreatic cancer protein biomarkers glypican-1 and CD63, then bright fluorescent circles will appear.

The research is published in journal ACS Nano, and first author Jean Lewis, an assistant project scientist in the Department of Nanoengineering at UC San Diego said;

“An important step towards being able to cure diseases that come out of nowhere, like pancreatic cancer, is early detection. We envision that in the future, physicians might perform this type of test using a quick finger stick to diagnose patients who may not know they have the disease yet.”

It may be early days, but this is an encouraging first step towards the possibility of an accessible screening test for those at higher risk, which would help to catch pancreatic cancer early.

*Image credit: Pancreapedia https://www.pancreapedia.org/reviews/anatomy-and-histology-of-pancreas

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