Major Breakthrough In Pancreatic Cancer Research

[Arthur Little]

Hitherto ... indeed for many decades, survival rates for this particularly aggressive - hard to treat - form of cancer have remained practically unchanged.

However, at last, there is [some] hope of "light at the end of
the tunnel", due to trials using a combination of the standard chemotherapy drug, gemacitabine with capecitabine on 732
hospital patients in Sweden France & Germany.

www.bbc.co.uk/news/health-36444413

certainly looks promising. Especially when there're claimed
to be no notable differences in side effects arising.

[Doc Alan]

Pancreatic cancer is fortunately uncommon, yet is among the top 10 cancers causing death worldwide, in the UK and the Philippines.


The pancreas produces insulin and digestive enzymes. Problems with cancer of this site are :- NO early symptoms, then symptoms which may also have other causes ( back pain, unexpected weight loss, jaundice ).


Risk factors include increasing age, smoking, and other illnesses such as diabetes and inflammation of the pancreas ( perhaps alcohol-related ) - but ONLY a small proportion develop this cancer.


NOT all pancreatic tumours have the same outlook. Some are benign ( not cancer ). There’s a spectrum of cancers from " low grade " to " aggressive ". Steve Jobs ( late Chief Executive of Apple ) survived 7 years after diagnosis of " islet cell / neuroendocrine " carcinoma of pancreas.


Surgery is usually the only cure for this cancer, but is suitable for less than 15% of patients.


The " major win in the pancreatic cancer fight " was a trial involving patients who first had surgery. They were then given either the standard chemotherapy drug alone, or combined with another drug.

Problems with chemotherapy drugs are that they not only have anti-cancer activity but also attack other rapidly dividing cells.


Long term ( 5 years ) survival was found to improve - in this trial - from 16% to 29%. Good news, but average 5 years survival is nearer 5% for all pancreatic cancers.


The way forward with this and other cancers is personalised treatment for EACH patient . Whatever the risk factors ( smoking, poor diet, obesity, alcohol excess, environmental pollution, radiation, infections, occupation ) ALL cancers result from mutation of genes. There’s an element of luck in who develops cancer.


In future, drugs will TARGET each patient’s cancer AFTER genetic testing - either from a tissue sample / biopsy, as now, or a blood sample. This already happens for certain cancers such as arise in breast or skin. Resources need to be found for more / all patients to benefit.

[Michael Parnham]

Not a Cancer that I've heard of before, but a brilliant and interesting write up Alan, as usual thank you

[Doc Alan]

Not a Cancer that I've heard of before, but a brilliant and interesting write up Alan, as usual thank you

Thank you so much, Michael .

[Doc Alan]

Of 10 million people diagnosed worldwide with some form of cancer each year, less than 340,000 have pancreatic cancer. However, it causes 330,000 deaths each year and only 5% survive 5 years.


The problem is that most cases are diagnosed at an advanced disease stage.


There are grounds for optimism, thought to be worth an editorial in this month’s " Lancet Oncology ".


Apart from the trial already mentioned, a Japanese trial comparing two drugs in advanced pancreatic cancer also showed improved survival ( 44% against 24% ).


Immunotherapy - boosting the body’s natural defences to fight the cancer - is at last producing promising results ! We’ve known for many years that our immune system can recognize cancer cells as different to those of the rest of the body. Of course if it was that good, cancer would never arise at all. Immunotherapy drugs which target the immune system are one way survival could be increased in pancreatic cancer.

Various types of immunotherapy - including cancer vaccines, " monoclonal " ( specific ) antibodies, and even using modified viruses to kill cancer cells - are already in use. There’s no reason, in time, why pancreatic cancer may not also be treated in this way.


The challenges are to make the diagnosis sooner ... and to meet the increasing cost of treatment as cancers generally become commoner.

[Steve.r]

Still an uphill challenge Alan. Only the future will relieve humanity of this awful disease.

[grahamw48]

The guy who was 'best man' at my first wedding (in Manila) died from this in 2010.

His condition towards the end was shocking and pitiful.

A cure for this illness cannot come soon enough.

[Arthur Little]

Thank you so much, as always, Alan ... for taking the time to update us on the latest advances in the fight against cancer in MANY of its most common manifestations.

Slightly , but can I ask whether there are ANY known risk(s)
to patients undergoing a 'colonscopy' in screening for bowel cancer - and the effectiveness of such an invasive procedure - as against,
say, the use of either MRI or CT scans as diagnostic "tools"?

[Doc Alan]

Unlike pancreatic cancer, bowel cancer CAN be detected by screening of people with no symptoms. The NHS screening programme started 10 years ago and has detected over 25,000 cancers.


As bowel cancers increase with age, screening starts at 60 ( 50 in Scotland, or younger for people at higher risk ). It identifies traces of blood in faeces. Such " hidden " / slight bleeding may or may not be from a cancer. It may be from a non-cancerous growth called a polyp ( which could lead to cancer if untreated ).


Less than 2/3 of those eligible for free NHS bowel cancer screening have taken part since it started in 2006.


Communication about screening could be better. Benefits are overstated and harms downplayed. While most people screened for bowel cancer DON’T have it, there may be unclear or abnormal results. NO screening test is perfect - there may be " false negative " results ( cancer missed ) or “ false positive “ results ( not due to cancer ).

In the small proportion of people with abnormal results ( and some apparently healthy people ), they may be invited for " bowel scope screening “ . This either uses a flexible tube with a camera on the end to look at the lower bowel ( sigmoidoscope ) or a longer tube ( colonoscope ) to examine the entire bowel. These allow " biopsies " / samples to be taken or complete removal of small polyps, which must then be examined microscopically by a medical pathologist.


There ARE risks with these " invasive " procedures, but very low ( such as bleeding or perforation of the bowel ). Private scanning clinics may use " non-invasive " methods such as MRI and ultrasound scans, which may not allow biopsies to be taken.


The best hope for cure of bowel cancer - common both in UK and the Philippines - is early diagnosis and surgical removal. Clearly if they have worrying signs / symptoms then it’s sensible to attend a doctor.

Whether people choose to be screened is a personal decision. They should weigh up the benefits, and less often publicised disadvantages, and discuss with their doctor, before reaching that decision.



( Please note : underlined words in my posts give links to more detailed information. )

[Trefor]

Not a Cancer that I've heard of before, but a brilliant and interesting write up Alan, as usual thank you

This is not a dig at you Michael, but this does exhibit what is wrong with the system. Correct me if I am wrong, but I think you are a more mature gentleman? If people have never heard of the cancer, and that they should be screened then how are we ever going to get this under control? When I turned 40 my company paid for a medical and I learned all about it then (together with other middle-aged man onset things...).

Awareness and willingness to be tested are a pre-cursor to early diagnosis improvements

[grahamw48]

I took part in the free bowel cancer screening (last year), and fortunately I was found to be clear of it.

I also went for my free AAA (Abdominal Aortic Aneurysm) scan a couple of weeks ago, which did reveal that I had one of 'these'... but fairly small at present.

It means I'll have to go for annual scans now, but at least I'm (and my GP is) aware of it now.

Thankyou NHS.

[Doc Alan]

Of course the more people know and understand about the many types of cancer, and how they may be treated, the better. Signs and symptoms of the commoner cancers should be recognised, as early diagnosis usually means a good chance of curative treatment.


Unfortunately pancreatic cancer may have symptoms ( such as back pain, weight loss, or jaundice ) which can be caused by many commoner conditions. A family doctor is likely to see a patient with this form of cancer no more often than every few years. It’s understandable that people may not be aware of this relatively uncommon cancer. Even if they were, there is NO screening test available.


SCREENING tests DON’T involve people who are ill or have symptoms. With any screening programme the gamble is taken that ultimately it will cause more good than harm. People who feel well may decide against such tests. False positives, false negatives, and " overdiagnosis " are possible problems. Conditions may be picked up which might never have harmed the person during their lifetime. The risks of treatment, including surgery, may also be significant ( " over-treatment " ).


Several Forum threads deal with the topic, hopefully helping members make informed decisions about their health.

( Please note : underlined words in my posts give links to more detailed information. )

[Arthur Little]

Thank you again, Alan ... for your constant reassurance on each of these extremely IMPORTANT health issues and medical matters.